协和医学杂志

2018, v.9(02) 112-117

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脑微出血与抗栓治疗
Cerebral Microbleeds and Anti-thrombotic Treatment

倪俊;崔丽英;
NI Jun;CUI Li-ying;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Neuroscience Center,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

脑微出血作为脑小血管病的出血性影像学标志物之一,是指慢性小灶性血液分解产物(主要物质为含铁血黄素)沉积在脑组织内形成的微小病灶,在磁共振梯度回波序列上呈现低信号。多种病因可导致脑微出血的发生,其中高血压小动脉病和脑淀粉样血管病是最常见的两种病因,局限脑叶微出血一般与脑淀粉样血管病相关,而高血压微出血多位于基底节、脑干或白质。脑微出血可同时增加缺血性和出血性卒中发生风险,尤其在接受抗栓、抗凝和溶栓治疗的患者中,脑微出血的存在显著增加了抗栓相关出血风险,但增加的出血风险是否可抵消或超过抗栓所带来的临床获益,目前尚无定论,值得思考和细化研究。此外,在抗栓和出血风险的权衡中,控制其他出血危险因素如高血压、酗酒、肾功能不全等,也是临床实践中的重要组成部分。
Cerebral microbleeds( CMBs),as hemorrhagic neuroimaging markers of cerebral small-vessel disease,are radiologically defined as small round or ovoid lesions of homogeneous signal intensity loss on T2*-gradient echo imaging and are believed to represent chronic hemosiderin deposition following microhemorrhage.Histopathological analysis of the vessels associated with CMBs have generally identified two main types of vascular pathological changes: hypertensive vasculopathy and cerebral amyloid angiopathy( CAA). CMBs with strictly lobar distribution are specific for CAA with deposition of β-amyloid in small arterial walls,while CMBs in the basal ganglia,white matter,and brainstem are related to hypertensive small arteries. Previous study showed that CMBs might increase the risk of bleeding. Especially,CMBs increase the risk of hemorrhagic complications in patients on antiplatelet,anticoagulation or thrombolytic therapy. However,whether the bleeding risk overweighs the clinical benefit of antithrombotic treatment remains unclear and warrants further investigations. Furthermore,controlling other risk factors,such as hypertension,alcoholism and renal function,is also an important part of clinical practice when considering the balance between the risks of bleeding and thrombus.

关键词(KeyWords): 脑微出血;抗血小板;抗凝;溶栓
cerebral microbleeds;antiplatelet;anticoagulation;thrombolysis

Abstract:

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基金项目(Foundation): 国家重点研发计划(2016YFC1300500-5);; 北京协和医院中青年科研基金项目(pumch-2016-2.16)

作者(Author): 倪俊;崔丽英;
NI Jun;CUI Li-ying;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Neuroscience Center,Chinese Academy of Medical Sciences & Peking Union Medical College;

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