脑淀粉样病变致脑出血机制探讨.docVIP

脑淀粉样病变致脑出血机制探讨 　　[摘要] 目的 探讨淀粉样脑血管病（CAA）引发脑出血的临床特点、发病机制及预后相关因素分析。 方法 对我院近3年收治的CAA引发的23例脑出血患者，均行头颅CT、MRI及SWI检查，计算颅内出血的体积、进行入院及出院时GCS评分及出院时mRS评分，进行预后分析，并结合文献对其发病机制进行深入探讨。 结果 CAA引发的脑出血有自发性、多灶性及短期复发的特点，头颅CT对新鲜出血敏感，MRI对新鲜出血和陈旧性出血均可显示，SWI显示皮质及皮质下有多个微出血灶，而基底节区、脑干、小脑无微出血灶。 结论 CAA是非高血压脑出血的重要原因；SWI示脑出血特征性表现可作为诊断依据，GCS评分出院比入院增加，出院时mRS评分与入院时GCS评分及脑出血体积有相关性。 　　[关键词] 脑淀粉样病变；脑出血；发病机制 　　[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-9701（2015）21-0004-04 　　[Abstract] Objective To investigate the clinical features， pathogenesis and prognosis related factors of cerebral amyloid angiopathy（CAA） induced cerebral hemorrhage. Methods Twenty-three patients with CAA induced cerebral hemorrhage who had been treated in our hospital in the recent 3 years were given head CT， MRI and SWI examination. The intracranial hemorrhage volume， GCS scores at hospital admission and discharge and mRS scores at hospital discharge were calculated， and the prognosis analysis was conducted. The pathogenesis was investigated in-depth combining literature. Results CAA induced cerebral hemorrhage had the features of spontaneity， mulifocality and short-term recurrence. Head CT was sensitive to fresh hemorrhage， MRI could display both fresh hemorrhage and old hemorrhage， and SWI displayed cortical and subcortical multiple microbleeds but no basal ganglia region， brainstem or cerebellum microbleeds. Conclusion CAA is an important cause of non-hypertensive cerebral hemorrhage. Cerebral hemorrhage features displayed by SWI can serve as the diagnostic reference； The GCS scores at hospital discharge increase compared to those at hospital admission； The mRS scores at hospital discharge are correlated to the GCS scores and cerebral hemorrhagic volume at hospital admission. 　　[Key words] Cerebral amyloid angiopathy； Cerebral hemorrhage； Pathogenesis 　　脑淀粉样血管病（cerebral amyloid angiopathy，CAA）是淀粉样物质沉积在脑内血管导致症状性脑血管功能障碍的一种疾病，是老年人的一种卒中类型[1]。脑淀粉样血管病目前已经被列入脑出血的原因之一，既往临床上很难与脑动脉粥样硬化所致的脑出血鉴别，仅在病理检查时才能确诊。但是近年来，由于对痴呆认识的提高和CT、MRI、SWI的普及，该病