Clinical Study On The Relationship Between Minor Stroke With Clopidogrel-aspirin Antiplatelet Therapy And Cerebral Microbleeds

Objectives:To investigate the imaging features,risk factors of cerebral microbleeds（CMBs）in patients with minor stroke and detect the occurrence of short-term cerebral hemorrhage events and CMBs progression after clopidogrel-aspirin antiplatelet therapy.Methods:Consecutive 97 patients with minor stroke who were in department of neurology of 967th hospital of PLA from August 2017 to August 2018 were prospectively recruited.All patients met the following inclusion criteria:（1）the diagnostic criteria should meet the guidelines for the diagnosis and treatment of acute ischemic stroke in China 2014;（2）within 72 hours after onset;（3）brain MRI examination indicated new cerebral infarction;（4）National Institutes of Health Stroke Scale（NIHSS）score≤5;（5）patient aged over 40 years old.Exclusion criteria:（1）brain CT/MRI examination indicated hemorrhagic cerebrovascular disease;（2）NIHSS score>5;（3）potential factors of cerebral hemorrhage such as cerebral vascular malformations,tumors,aneurysms;（4）suspected to be a patient with cerebral amyloid vascular disease;（5）accompanied by severe visceral diseases or diseases of the blood system;（6）received thrombolytic therapy within the time window,had accepted anticoagulation therapy,and received vascular interventional therapy during the follow-up period;（7）those who have psychological diseases such as claustrophobia and cannot complete MRI examination.All patients needed to complete brain CT and MRI examination within 72 hours after onset,including conventional T₁WI,T₂WI,FLAIR,DWI,SWI,and some patients accepted MRA examination.Depending on the presence of CMBs,the patients were divided into CMBs and non-CMBs groups.And all of them accepted related blood biochemical tests including creatinine,uric acid,estimated glomerular filtration rate（eGFR）,homocysteine,total cholesterol,low density lipoprotein（LDL）and triglyceride.The basic clinical data,including age,gender,hypertension,diabetes,ischemic heart disease,hyperlipidemia,atrial fibrillation,history of smoking,white matter hyperintensities,cognitive decline,previous history of cerebral hemorrhage,previous history of cerebral infarction,oral antiplatelet drugs,were collected.The clinical data including general conditions and biochemical indicators were compared between the two groups.The risk factors of CMBs were firstly analyzed by single factor analysis.Then the independent risk factors of CMBs were analyzed in multivariable logistic regression analysis.All patients received clopidogrel-aspirin antiplatelet treatment for 21 days and then treated with oral clopidogrel or aspirin alone.These patients were followed up for 3-12 months.The cases of cerebral hemorrhage events and the number and location of CMBs before and after the follow-up were recorded.Statistical analysis was performed using SPSS 19.0.The normal distribution of the measurement data was expressed by means±standard deviation（SD）.The t-test was used for continuous variables.Relationship between the two group were assessed with the Chi-square test or Fisher exact probability test for norminal variables.If the P value was less than 0.05,it was accepted as statistically significant.Results:CMBs were found in 54/97 patients（55.67%）.A total of 313 CMBs were detected,of which 115（36.74%）were located in basal ganglia region at the most,followed by temporal lobe or temporal lobe white matter（21.73%）,brain stem（10.22%）and occipital lobe（9.27%）.There were 22 cases with 1 CMBs（40.74%）,15 cases with CMBs 2⁴（27.78%）,6 cases with CMBs 5¹0（11.11%）,and 11 cases with CMBs>10（20.37%）.Univariate analysis showed that age,history of diabetes,white matter hyperintensities,cognitive decline,previous history of cerebral hemorrhage,previous history of cerebral infarction,and history of oral antiplatelet drugs were risk factors for CMBs.Multivariable logistic regression analysis indicated that history of diabetes was an independent risk factor for CMBs（OR=0.337,95%CI,0.131⁰.869;P=0.024）.No cerebral hemorrhage events occurred during follow-up period.SWI was reviewed in a total of 16 cases in the follow-up period,with 7 cases in the CMBs（+）group and 9 cases in the CMBs（-）group.The number of CMBs increased in 5 out of 7 patients who had primary CMBs,whereas in only 3 out of 9 patients who did not.There was no statistically significant difference between the two groups（P>0.05）.Conclusion:1 CMBs occurrence in patients with minor stroke is significantly associated with history of diabetes.2 Patients can be treated with dual antiplatelet therapy in the short term according to the current guidelines,but multi-center clinical studies with larger samples and longer follow-up time are still needed.3 In patients with minor stroke in the process of secondary prevention,the increase in CMBs is not correlated with the existence of primary CMBs.