Department of Neurology, Oulu University Hospital, Oulu, Finland.
Stroke. 2013 Mar;44(3):585-90. doi: 10.1161/STROKEAHA.112.671230. Epub 2013 Jan 17.
Underlying comorbidities, previous strokes, and medication may increase the risk for primary intracerebral hemorrhage (PICH) and its recurrence. The aim of this study was to determine the independent predictors for recurrent PICH.
We identified 961 subjects with first-ever PICH from 1993 to 2008 among the population of Northern Ostrobothnia, Finland. Hospital and death records were reviewed and data on drug use were obtained from the national register of prescribed medicines. Kaplan-Meier survival curves and Cox proportional hazards models were used to demonstrate predictors for recurrence of PICH.
Total follow-up time of the 961 patients was 3481 person-years. During the follow-up time, 58 subjects had altogether 68 recurrent PICHs. The annual average incidence of first recurrence was 1.67%. Cumulative 5- and 10-year incidence rates were 9.6% and 14.2%, respectively. In univariable analysis, history of ischemic stroke, diabetes mellitus, and aspirin use were associated with a higher recurrence rate. In multivariable analysis, only previous ischemic stroke (adjusted hazard ratio, 2.22; 95% confidence interval, 1.22-4.05; P=0.009) independently predicted PICH recurrence. Diabetes mellitus tended to increase (adjusted hazard ratio, 2.38; 95% confidence interval, 0.98-5.80; P=0.056), whereas treated hypertension tended to decrease (0.45, 0.20-1.01; P=0.054) the risk for fatal recurrent PICH.
Previous ischemic stroke independent of confounding factors may increase the risk for PICH recurrence.
基础合并症、既往脑卒中及用药可能增加原发性脑出血（PICH）及其复发的风险。本研究旨在确定 PICH 复发的独立预测因素。
我们在芬兰北奥斯特罗波的尼亚地区的人群中，于 1993 年至 2008 年期间，识别出了 961 例首次发生的 PICH 患者。我们查阅了医院和死亡记录，并从国家处方药物登记处获得了用药数据。我们使用 Kaplan-Meier 生存曲线和 Cox 比例风险模型来展示 PICH 复发的预测因素。
961 例患者的总随访时间为 3481 人年。在随访期间，58 例患者共发生了 68 次 PICH 复发。首次复发的年平均发生率为 1.67%。累积 5 年和 10 年的发生率分别为 9.6%和 14.2%。在单变量分析中，缺血性脑卒中史、糖尿病和阿司匹林的使用与更高的复发率相关。在多变量分析中，仅有既往缺血性脑卒中（调整后的危险比，2.22；95%置信区间，1.22-4.05；P=0.009）独立预测了 PICH 复发。糖尿病倾向于增加（调整后的危险比，2.38；95%置信区间，0.98-5.80；P=0.056），而治疗性高血压则倾向于降低（0.45，0.20-1.01；P=0.054）致命性 PICH 复发的风险。
既往缺血性脑卒中独立于混杂因素可能会增加 PICH 复发的风险。
