Levine Joshua M, Snider Ryan, Finkelstein David, Gurol Mahmut E, Chanderraj Rishi, Smith Eric E, Greenberg Steven M, Rosand Jonathan
Department of Neurology, 3 W Gates Building, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
Neurocrit Care. 2007;7(1):58-63. doi: 10.1007/s12028-007-0039-3.
The pathophysiology and clinical significance of perihematomal edema (PHE), a cause of secondary neuronal injury after intracerebral hemorrhage (ICH), is poorly understood. A leading theory proposes that early PHE results from activation of the clotting cascade. We sought to test this theory by examining the relationship between early PHE and warfarin use in ICH patients.
ICH and PHE volumes were measured in consecutive patients with warfarin-related ICH and compared to those of controls with non-coagulopathic ICH. Subjects were identified from a prospective database of ICH patients. Clinical and radiological predictors of PHE volume and relative PHE (PHE volume/ICH volume) were identified. The relationship between PHE volume and 90-day mortality was determined.
For the 49 consecutive warfarin-related ICH patients and 49 matched controls: median INRs (interquartile ranges) were 3.2 (2.3, 4.1) and 1.1 (1.08, 1.2); median hematoma volumes were 37.8 cm(3) (6.7, 102.9) and 18.1 cm(3) (9, 51) (P = 0.18); median PHE volumes were 12 cm(3) (3.7, 36.7), and 11 cm(3) (4.1, 24) (P = 0.87); and median relative PHE was 0.38 (0.28, 0.52) and 2 (1.37, 3.06), respectively. In multivariable analysis, ICH volume and warfarin use independently predicted PHE volume. There was an association between higher PHE volume and decreased 90-day mortality.
Warfarin-related ICH is associated with less early relative edema than non-coagulopathic ICH. This is consistent with the theory that coagulation contributes to early edema. Early edema may be associated with improved functional outcome.
脑出血（ICH）后导致继发性神经元损伤的血肿周围水肿（PHE）的病理生理学及临床意义尚不清楚。一种主流理论认为早期PHE是由凝血级联反应激活所致。我们试图通过研究ICH患者早期PHE与华法林使用之间的关系来验证这一理论。
对连续的华法林相关ICH患者测量ICH及PHE体积，并与非凝血病性ICH的对照组进行比较。从ICH患者的前瞻性数据库中识别出研究对象。确定PHE体积及相对PHE（PHE体积/ICH体积）的临床及影像学预测因素。确定PHE体积与90天死亡率之间的关系。
对于49例连续的华法林相关ICH患者及49例匹配的对照组：国际标准化比值（INR）中位数（四分位间距）分别为3.2（2.3，4.1）和1.1（1.08，1.2）；血肿体积中位数分别为37.8 cm³（6.7，102.9）和18.1 cm³（9，51）（P = 0.18）；PHE体积中位数分别为12 cm³（3.7，36.7）和11 cm³（4.1，24）（P = 0.87）；相对PHE中位数分别为0.38（0.28，0.52）和2（1.37，3.06）。在多变量分析中，ICH体积及华法林使用独立预测PHE体积。PHE体积较高与90天死亡率降低之间存在关联。
与非凝血病性ICH相比，华法林相关ICH的早期相对水肿较少。这与凝血导致早期水肿的理论相符。早期水肿可能与功能转归改善有关。
