脑淀粉样血管病合并缺血性脑卒中患者的抗栓治疗策略*

doi:10.3870/j.issn.1672-0741.25.10.040

摘要/Abstract

摘要： 脑淀粉样血管病（cerebral amyloid angiopathy,CAA）是一种年龄相关的脑小血管病,其病理特点为β-淀粉样蛋白在大脑皮层和软脑膜小血管壁的沉积,导致血管功能障碍并引起周围脑组织损伤。其发病率与年龄密切相关,且是老年脑叶出血和认知下降的重要原因。目前临床对于CAA尚无特效治疗方法,患者的长期管理集中在降低脑叶出血风险和再发风险。然而随年龄增长,人群中缺血性脑卒中的患病率升高,因此当CAA合并缺血性脑卒中时,应综合考虑CAA患者抗凝、抗血小板治疗的出血/缺血风险比。目前对于此类患者的治疗策略研究有限,该文将从流行病学、影像特征、出血风险分层、抗栓策略以及出血风险监测等角度进行综述。

关键词: 脑淀粉样血管病, 缺血性脑卒中, 脑微出血, 皮质浅表铁沉积, 抗栓治疗

Abstract: Cerebral amyloid angiopathy （CAA） is an age-related cerebral small vessel disease characterized by β-amyloid deposition in the walls of small vessels in the cerebral cortex and the leptomeninges, leading to vascular dysfunction and perivascular brain injury. Its incidence increases significantly with age, and CAA is a major cause of lobar hemorrhage and dementia in the elderly. Currently, there are no disease-modifying treatments for CAA, and clinical management focuses primarily on reducing the occurrence and recurrence of intracerebral hemorrhage. However, the increasing prevalence of ischemic stroke with advancing age necessitates a comprehensive risk-benefit assessment of anticoagulant or antiplatelet therapies in CAA patients with concurrent ischemic stroke. Current research lacks adequate exploration of therapeutic strategies for this population. This review systematically addresses epidemiology, imaging biomarkers, hemorrhage risk stratification, antithrombotic approaches, and strategies to monitor bleeding risks.

Key words: cerebral amyloid angiopathy, ischemic stroke, cerebral microbleeds, cortical superficial siderosis, antithrombotic therapy

中图分类号:

R743.9

兰凌宁, 黄珊珊, 邓刚, 黄浩, 徐沙贝, 骆翔. 脑淀粉样血管病合并缺血性脑卒中患者的抗栓治疗策略^*[J]. 华中科技大学学报（医学版）, 2026, 55(5): 727-734.

Lan Lingning, Huang Shanshan, Deng Gang et al. Antithrombotic Therapy Strategies for Patients with Cerebral Amyloid Angiopathy and Ischemic Stroke[J]. Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2026, 55(5): 727-734.

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脑淀粉样血管病合并缺血性脑卒中患者的抗栓治疗策略^*

Antithrombotic Therapy Strategies for Patients with Cerebral Amyloid Angiopathy and Ischemic Stroke

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