Unitat Neurovascular, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona., Ps. Vall d'Hebrón, 119-129. 08035, Barcelona, Spain.
Stroke. 2011 Sep;42(9):2447-52. doi: 10.1161/STROKEAHA.110.609461. Epub 2011 Jul 28.
Lower serum low-density lipoprotein cholesterol (LDL-C) levels have been associated with increased risk of death after intracerebral hemorrhage (ICH). Nevertheless, their link with hematoma growth (HG) is unknown. Therefore, we aimed to investigate the relationship between LDL-C levels, HG, and clinical outcome in patients with acute ICH.
We prospectively studied 108 consecutive patients with primary supratentorial ICH presenting within 6 hours from symptoms onset. National Institutes of Health Stroke Scale score and ICH volume on computed tomography scan were recorded at baseline and at 24 hours. Lipid profile was obtained during the first 24 hours. Significant HG was defined as hematoma enlargement >33% or >6 mL at 24 hours. Early neurological deterioration as well as mortality and poor long-term outcome (modified Rankin Scale score >2) at 3 months were recorded.
Although LDL-C levels were not correlated with ICH volume (r=-0.18; P=0.078) or National Institutes of Health Stroke Scale score (r=-0.17; P=0.091) at baseline, lower LDL-C levels were associated with HG (98.1±33.7 mg/dL versus 117.3±25.8 mg/dL; P=0.003), early neurological deterioration (89.2±31.8 mg/dL versus 112.4±29.8 mg/dL; P=0.012), and 3-month mortality (94.9±37.4 mg/dL versus 112.5±28.5 mg/dL; P=0.029), but not with poor long-term outcome (109.5±31.3 mg/dL versus 108.3±30.5 mg/dL; P=0.875). Moreover, LDL-C levels were inversely related to the amount of hematoma enlargement at 24 hours (r=-0.31; P=0.004). In multivariate logistic regression analysis, LDL-C level <95 mg/dL emerged as an independent predictor of HG (OR, 4.24; 95% CI, 1.26-14.24; P=0.020), early neurological deterioration (OR, 8.27; 95% CI, 1.66-41.16; P=0.010), and 3-month mortality (OR, 6.34; 95% CI, 1.29-31.3; P=0.023).
Lower serum LDL-C level independently predicts HG, early neurological deterioration, and 3-month mortality after acute ICH.
血清低密度脂蛋白胆固醇（LDL-C）水平降低与脑出血（ICH）后死亡风险增加有关。然而，其与血肿扩大（HG）的关系尚不清楚。因此，我们旨在研究急性 ICH 患者中 LDL-C 水平、HG 与临床预后之间的关系。
我们前瞻性研究了 108 例原发性幕上 ICH 患者，发病后 6 小时内就诊。基线和 24 小时时记录国立卫生研究院卒中量表评分和 CT 扫描的 ICH 体积。在 24 小时内获得血脂谱。24 小时时血肿扩大>33%或>6mL 定义为显著 HG。记录早期神经功能恶化以及 3 个月时的死亡率和不良预后（改良 Rankin 量表评分>2）。
尽管 LDL-C 水平与 ICH 体积（r=-0.18；P=0.078）或国立卫生研究院卒中量表评分（r=-0.17；P=0.091）在基线时无相关性，但较低的 LDL-C 水平与 HG（98.1±33.7mg/dL 与 117.3±25.8mg/dL；P=0.003）、早期神经功能恶化（89.2±31.8mg/dL 与 112.4±29.8mg/dL；P=0.012）和 3 个月时的死亡率（94.9±37.4mg/dL 与 112.5±28.5mg/dL；P=0.029）相关，但与不良预后无关（109.5±31.3mg/dL 与 108.3±30.5mg/dL；P=0.875）。此外，LDL-C 水平与 24 小时时的血肿扩大量呈负相关（r=-0.31；P=0.004）。多变量逻辑回归分析显示，LDL-C 水平<95mg/dL 是 HG（OR，4.24；95%CI，1.26-14.24；P=0.020）、早期神经功能恶化（OR，8.27；95%CI，1.66-41.16；P=0.010）和 3 个月死亡率（OR，6.34；95%CI，1.29-31.3；P=0.023）的独立预测因素。
血清 LDL-C 水平降低可独立预测急性 ICH 后 HG、早期神经功能恶化和 3 个月死亡率。
