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目的:探讨急性高血压性脑出血患者的新发无症状性脑梗死(silent brain infarction,SBI)的发生率及相关危险因素,同时探讨伴发新发SBI的脑出血患者发生临床脑血管事件或血管相关性死亡的情况。方法:采用前瞻性研究,观察100例在发病3 d内经CT诊断为高血压性脑出血的患者,所有患者在发病第5天行MRI检查以明确新发SBI及脑微出血(cerebral microbleeds,CMBs)病灶,并在1年内定期随访后续的临床脑血管事件或血管相关性死亡。结果:100例患者中,观察到11例(11%)共有14个新发SBI病灶。经单因素分析发现,基线水平中伴有CMBs和脑白质疏松是新发SBI的危险因素。在随访的1年内,14例患者发生了临床脑血管事件或血管相关性死亡,其中9例发生脑梗死,1例再发脑出血,4例发生血管相关性死亡。Cox比例风险模型显示,高龄、房颤和伴有新发SBI为发生临床脑血管事件或血管相关性死亡的独立预测因素。结论:新发SBI在脑出血的急性期阶段常见,与CMBs及脑白质疏松相关。伴有新发SBI的高血压性脑出血患者未来1年内发生临床脑血管事件或血管相关性死亡的风险增加。
Objective: To investigate the incidence and related risk factors of silent brain infarction (SBI) in patients with acute hypertensive intracerebral hemorrhage (ICH), and to explore the relationship between clinical cerebrovascular events Vascular related deaths. Methods: A prospective study was conducted to observe 100 patients with hypertensive intracerebral hemorrhage diagnosed by CT within 3 days of onset. All patients underwent MRI examination on the 5th day to identify new SBI and cerebral microbleeds (CMBs ) Lesions were followed up regularly for subsequent clinical cerebrovascular events or vascular-related deaths within 1 year. RESULTS: Of the 100 patients, a total of 14 new SBI lesions were observed in 11 (11%) patients. Univariate analysis found that baseline levels of CMBs and leukoaraiosis were risk factors for new SBI. Within one year of follow-up, 14 patients experienced clinical cerebrovascular events or vascular-related deaths, including 9 with cerebral infarction, 1 with recurrent intracerebral hemorrhage and 4 with vascular-related death. The Cox proportional hazard model showed that advanced age, atrial fibrillation, and new SBI were independent predictors of clinical cerebrovascular events or vascular-related deaths. Conclusions: The newly diagnosed SBI is common in the acute phase of cerebral hemorrhage and is associated with CMBs and leukoaraiosis. Patients with hypertensive intracerebral hemorrhage with a new SBI have an increased risk of developing clinical cerebrovascular events or vascular-related death within the next year.