摘要： 目的 探讨脑微出血对老年高血压性脑出血血肿扩大的预测作用。方法 采用磁敏感加权成像对98 例老年高血压性脑出血患者进行脑微出血灶观察，据发病后24 h 头部CT 血肿扩大和实验室指标变化，采用多因素Logistic回归分析评价脑微出血对脑出血后血肿扩大的预测价值。结果 98 例患者中25 例于发病后24 h 复查CT 显示血肿扩大，发生率约为25.51%，脑微出血组为43.75%（14/32），高于非脑微出血组的16.67%（11/66；χ² = 8.319，P = 0.004）。多因素Logistic回归分析显示，脑微出血为老年高血压性脑出血血肿扩大的独立影响因素（OR = 0.241，95％CI：0.065 ~ 0.861；P = 0.017）。结论 老年高血压性脑出血急性期（24 h）合并脑微出血患者血肿扩大风险明显增加，应及时采取相关预防措施以改善预后。

关键词: 颅内出血, 高血压性, 磁共振成像, 回归分析, 老年人

Abstract: Objective  To investigate whether cerebral microbleeds (CMBs) can predict hematoma growth in elderly patients with acute hypertensive intracerebral hemorrhage.  Methods  The clinical records of 98 elderly patients with acute hypertensive intracerebral hemorrhage who underwent initial CT within 6 h and repeated CT and susceptibility-weighted imaging (SWI) within 24 h of onset were analyzed. Based on the performance of SWI, patients were divided into microbleeds group and non-microbleeds group. Forward multivariate Logistic regression analysis was used to evaluate the predicting value of CMBs on the growth of intracerebral hematoma.  Results  Among 98 patients, hematoma growth was found in 25 cases in the second CT scan. The ratio in microbleeds group was significantly higher than that in non-microbleeds group (43.75% vs 16.67%; χ² = 8.319, P = 0.004). Multivariate Logistic regression showed that CMBs was independent risk factor for intracerebral hematoma (OR = 0.241, 95%CI: 0.065-0.861; P = 0.017).  Conclusions  CMBs in patients with acute intracerebral hematoma can predict high risk of hemotoma growth, and effective treatment should be taken to improve the prognosis of patients.

Key words: Intracranial hemorrhage, hypertensive, Magnetic resonance imaging, Regression analysis, Aged