Sansing Lauren H, Kaznatcheeva Elena A, Perkins Candice J, Komaroff Eugene, Gutman Frederick B, Newman George C
Department of Neurology, General Clinical Research Center, State University of New York at Stony Brook, New York, USA.
J Neurosurg. 2003 May;98(5):985-92. doi: 10.3171/jns.2003.98.5.0985.
Development of edema is known to contribute to poor outcome after spontaneous intracerebral hemorrhage (ICH). Recent research has identified thrombin as a key mediator in the development of edema in animal models; however, little has been published correlating the coagulation cascade and edema in humans.
In this retrospective clinical study of 80 patients with spontaneous supratentorial ICH, the authors sought to identify factors associated with edema development and outcome, including lesion imaging parameters, anticoagulant use, international normalized ratio and platelet count on hospital admission, and treatment with mannitol and steroid medications. A multivariate model was used to identify edema volume, use of mannitol, elevated blood glucose, and the presence of intraventricular hemorrhage as predictors of poor outcome at the time patients were discharged from the hospital. The authors developed a quadratic model for predicting edema volume against time by using a random coefficients model, and found that edema peaks between Days 5 and 6 after onset of ICH. The volume of the hemorrhage and the platelet count correlated significantly with edema volume within the first 24 hours post-ICH in the multiple regression analysis (p < 0.0001, r2 = 0.75). Edema growth during the first 5 days post-ICH also correlated with the platelet count, with an increasing platelet count associated with an increasing growth of edema (p = 0.0013).
The authors propose that factors released from activated platelets at the site of hemorrhage, for example vascular endothelial growth factor, may interact with thrombin to increase vascular permeability and contribute to the development of edema.
已知水肿的形成会导致自发性脑出血（ICH）后预后不良。最近的研究已确定凝血酶是动物模型中水肿形成的关键介质；然而，关于人体凝血级联反应与水肿之间关系的报道很少。
在这项对80例自发性幕上脑出血患者的回顾性临床研究中，作者试图确定与水肿形成及预后相关的因素，包括病变影像学参数、抗凝剂使用情况、入院时的国际标准化比值和血小板计数，以及甘露醇和类固醇药物治疗情况。采用多变量模型确定水肿体积、甘露醇的使用、血糖升高及脑室内出血的存在作为患者出院时预后不良的预测因素。作者通过使用随机系数模型建立了一个预测水肿体积随时间变化的二次模型，发现水肿在脑出血发病后第5天至第6天达到峰值。在多元回归分析中，出血体积和血小板计数与脑出血后最初24小时内的水肿体积显著相关（p<0.0001，r2=0.75）。脑出血后前5天的水肿增长也与血小板计数相关，血小板计数增加与水肿增长增加相关（p=0.0013）。
作者提出，出血部位活化血小板释放的因子，例如血管内皮生长因子，可能与凝血酶相互作用，增加血管通透性并促进水肿的形成。
