阻塞性睡眠呼吸紊乱对脑梗死患者脑微出血的影响.pdf

·1362 · 南方医科大学学报（J South Med Univ ） 2012;32(9) 临床研究 阻塞性睡眠呼吸紊乱对脑梗死患者脑微出血的影响 徐杰文，邓丽影，邹学良，刘 昊，俞 晔，丁勇民 南昌大学第二附属医院神经内科，江西 南昌 330006 摘要：目的研究阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对脑梗死患者脑微出血的影响。方法 连续选取经磁敏感加权成 像（SWI）检查显示为脑微出血的急性脑梗死患者行睡眠多导图（PSG）检查，比较非OSAHS 患者和OSAHS 患者脑微出血的临 床及影像学特征。结果 入选49 名患者，其中脑梗死合并OSAHS 者27 人（55.1%），脑梗死未合并OSAHS 组22 人（44.9%）。危 险因素比较显示OSAHS 组高血压、吸烟史和既往卒中史明显高于非OSAHS 组，而且临床下卒中OSAHS 组为37.0%（10/27）， 非OSAHS 组为9.0%（2/22）。影像学研究显示OSAHS 组微出血病灶77.8%分布在皮质-皮质下区，55.6%在基底节区，幕下区为 25.9% ；非OSAHS 组皮质-皮质下区为50.0%、基底节区为40.9%、幕下区为50.0% ，(P0.05) ；脑梗死病因分型分析显示OSAHS 组40.7%患者合并脑白质疏松，48.1%的患者为≥2 个病因，而非OSAHS 组合并脑白质疏松为13.6% ，≥2 个病因的为18.2%（P 0.05）。结论 OSAHS 可能是脑微出血的危险因素。脑梗死合并OSAHS 者的脑微出血病灶更多、更广，病因更复杂，卒中再发 几率高。 关键词：脑梗死；阻塞性睡眠呼吸暂停低通气综合征；脑微出血 中图分类号：R743.3 文献标志码：A 文章编号：1673-4254（2012）09-1362-04 doi: 10.3969/j.issn. 1673-4254.2012.09.034 /kcms/detail/44.1627.R1206.027.html Impact of obstructive sleep apnea-hypopnea syndrome on cerebral microbleeds in patients with cerebral infarction XU Jiewen, DENG Liying, ZOU Xueliang, LIU Hao, YU Ye, DING Yongmin Department of Neurology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China Abstract: Objective To investigate the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on cerebral microbleeds (CMBs) in patients with cerebral infarction. Methods Consecutive patients with acute cerebral infarction who had cerebral microbleeds shown by susceptibility-weighted imaging (SWI) were enrolled to undergo polysomnography (PSG). The patients were divided into two groups, namely non-OSAHS group with apnea-hypopnea index (AHI) less than 5 and OSAHS group with greater AHI, and the clinical and radiological features of cerebral microbleeds were compared between them. Results Forty-nine patient