吴毅杰　沈佳慧　周亦

[摘要] 目的 分析非瓣膜性心房颤动脑栓塞患者脑微出血（CMB）发生的危险因素，为此类患者治疗方案提供指导。 方法 选取2014年1月～2016年12月在苏州大学附属太仓医院神经内科住院合并非瓣膜性心房颤动脑栓塞患者117例，根据有无CMB分为CMB组（48例）和非CMB组（69例），比较两组患者的人口学特征、常见卒中危险因素、实验室检查指标。 结果 入选的117例患者中，48例（41%）被检测出合并CMB，CMB组患者平均年龄大于非CMB组（P = 0.002），同型半胱氨酸（Hcy）水平高于非CMB组（P = 0.033），CMB组患者低密度脂蛋白（LDL-C）水平低于非CMB组（P = 0.037），差异均有统计学意义。对可能的危险因素进行多因素Logistic回归分析显示高龄是CMB发生重要危险因素（P = 0.07，OR = 1.079，95%CI：1.021～1.140）。 结论 合并非瓣膜性心房颤动脑栓塞患者CMB发生率较高，患者CMB的发生主要与患者高龄相关。

[关键词] 心房颤动；脑栓塞；脑微出血

[中图分类号] R743 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0054-04

[Abstract] Objective To analyze the cerebral microbleeds （CMB） risk factors of patients with non-valvular atrial fibrillation and cerebral infarction， and provide guidance for therapeutic schedule for these patients. Methods One hundred and seventeen patients with non-valvular atrial fibrillation and cerebral infarction were enrolled that treated in the Department of Neurology， the Taicang Affiliated Hospital of Soochow University from January 2014 to December 2016， that were divided into CMB group （48 cases） and non-CMB group （69 cases）. The demographic characteristics， the common risk factors of stroke and laboratory examination indices were compared between the two groups. Results Among the 117 patients， 48 cases （41%） were detected with CMB； the average age of the CMB group was higher than the non-CMB group （P = 0.002） ； the homocyatein （Hcy） level of the CMB group was higher than the non-CMB group （P = 0.033） ； the low density lipoprotein （LDL-C） of the CMB group was lower than the non-CMB group （P = 0.037）； all the differences were statistically significant. Through a Logistic regression analysis， elderly was independently associated with the presence of CMB （P = 0.07， OR = 1.079， 95%CI： 1.021-1.140）. Conclusion There is a high prevalence of CMB in patients with non-valvular atrial fibrillation and cerebral infarction and the occurrence of CMB is mainly associated with elderly.

[Key words] Atrial fibrillation； Cerebral microbleeds； Cerebral microbleeds

非瓣膜性房顫是临床上导致脑栓塞事件发生的重要原因，房颤往往导致脑栓塞患者神经功能缺损程度更加严重，预后更差[1]。规范化抗凝治疗可显著改善房颤脑栓塞患者预后，使脑栓塞的相对危险度显著降低，但抗凝治疗在减少脑栓塞事件的同时往往伴随着出血风险尤其是脑出血风险的增加，导致临床医生和患者对口服抗凝药物致出血风险的过度担忧，从而造成在我国抗凝治疗率偏低的现状[2-3]。有研究显示房颤脑栓塞患者伴脑微出血（cerebral microbleed，CMB）时抗凝治疗会增加有症状脑出血发生风险[4]，CMB是华法林治疗心源性脑栓塞后继发脑出血的独立危险因素[5]。……