心房颤动合并脑微出血患者抗凝治疗与症状性出血的相关性分析

摘要

目的 探讨非瓣膜性心房颤动合并脑微出血(CMB)抗凝治疗与症状性出血(ICH)的相关性.方法 心房颤动患者198例分为CMB组88例和无CMB组(对照组)110例,CHA2DS2-VASc评分>2分患者进行华法林抗凝治疗,CHA2DS2-VASc评分1分根据获益与风险衡量,行华法林抗凝或阿司匹林抗栓治疗,所有患者行1年随访,症状性出血(ICH)为终点事件,头颅CT以证实.结果 CMB组较无CMB组患者抗凝治疗后出血转化更高,但差异无统计学意义.但按数量进一步分层分析,当微出血的数量>4个,其出血转化明显高于对照组,按微出血部分进行分层分析,脑叶多发微出血>2个,其出血转化明显高于对照组.结论 CMB>4个,抗凝治疗更易出血;脑叶CMB>2个,抗凝治疗更易出血.%Objective? To?investigate?the?correlation?between?anticoagulant?therapy?and?symptomatic?hemorrhage(ICH)?in?patients?with?nonvalvular?atrial?fibrillation?and?cerebral?microbleeds(CMB).?Methods? A?total?of?198?patients?with?atrial?fibrillation?were?divided?into?CMB?group (n=88)?and?non-CMB?group(control?group),110?patients?with?CHA2DS2-VASc?score>2,and?warfarin?anticoagulant?therapy,CHA2DS2-VASc?score?1?point?according?to?the?benefit?and?risk,warfarin?anticoagulation?or?aspirin?antithrombotic?therapy?were?performed.?All?patients?underwent?1?year?follow-up.?Symptomatic?hemorrhage?(ICH)?was?the?end?point?event?and?confirmed?by?head?CT.?Results The?bleeding?in?the?CMB?group?was?higher?than?that?in?the?CMB-free?group?after?anticoagulant?therapy,but?the?difference?was?not?statistically?significant.?However,after?further?stratification?analysis?by?quantity,when?the?number?of?microbleeds?was?>4,the?hemorrhagic?transformation?was?significantly?higher?than?that?of?the?control?group.?After?stratified?analysis?according?to?the?microbleeds,the?cerebral?had?multiple?microbleeds?>2,the?Bleeding?transformation?was?significantly?higher?than?the?control?group.?Conclusion? When?CMB>4,anticoagulant?therapy?is?more?likely?to?bleed;when?brain?lobe?CMB>2,anticoagulant?therapy?is?more?likely?to?bleed.