Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Stroke. 2010 Aug;41(8):1641-5. doi: 10.1161/STROKEAHA.110.585265. Epub 2010 Jul 8.
Anemia is 1 potential mechanism by which the brain receives inadequate oxygenation. The purpose of this study was to determine in acute stroke patients whether lower hemoglobin values were associated with worse hemispatial neglect.
In 203 subjects, neglect testing batteries were administered within 24 hours of admission for acute right hemispheric stroke. We analyzed the error rate on each test as well as "any neglect" (z score >or=2 on any of 3 selected tests compared with normal controls), as predicted by hemoglobin level, with adjustment for infarct size, National Institutes of Health Stroke Scale score, age, and sex.
The association between hemoglobin and neglect varied on the basis of hemoglobin level. At lower hemoglobin levels (<12 g/dL), each 1-point higher hemoglobin value was protective (adjusted odds ratio=0.56; 95% CI, 0.35 to 0.89) from having "any neglect." However, for a hemoglobin value >14 g/dL, each 1-point higher hemoglobin value was associated with higher odds of having neglect (adjusted odds ratio=1.67; 95% CI, 1.09 to 2.57). Similar relations were found for predicted error rate on the horizontal line bisection, line cancellation, and copy Ogden scene neglect tests. These relations seemed to be more pronounced in individuals who had a diffusion/perfusion mismatch.
Lower and higher hemoglobin levels were each associated with increased odds of neglect and with worse severity of neglect, independent of stroke size and severity. Higher hemoglobin values may represent dehydration or hyperviscosity. The importance of the extremes of hemoglobin in identifying individuals at risk for worse functional consequences of stroke warrants further study.
贫血是大脑供氧不足的一个潜在机制。本研究旨在确定急性脑卒中患者中，血红蛋白值较低是否与更严重的偏侧忽略有关。
在 203 名研究对象中，于急性右侧半球卒中发病后 24 小时内进行了忽略测试。我们分析了每个测试的错误率，以及与正常对照组相比，3 项选定测试中任何一项的 z 评分>或=2 的“任何忽略”，并对血红蛋白水平、梗死灶大小、美国国立卫生研究院卒中量表评分、年龄和性别进行了调整。
血红蛋白与忽略之间的关联因血红蛋白水平而异。在较低的血红蛋白水平(<12 g/dL)下，血红蛋白每升高 1 点，就具有保护作用（校正比值比=0.56；95%可信区间，0.35 至 0.89），降低发生“任何忽略”的风险。然而，对于血红蛋白值>14 g/dL，血红蛋白每升高 1 点，与忽略的可能性增加相关（校正比值比=1.67；95%可信区间，1.09 至 2.57）。在水平直线二等分、直线删除和复制 Ogden 场景忽略测试的预测错误率上也发现了类似的关系。这些关系在存在弥散/灌注不匹配的个体中似乎更为明显。
较低和较高的血红蛋白水平均与忽略的可能性增加以及忽略的严重程度增加独立相关，与卒中的大小和严重程度无关。较高的血红蛋白值可能代表脱水或高粘度。在识别处于卒中后功能预后较差风险的个体方面，血红蛋白水平的极端值的重要性需要进一步研究。
