From The George Institute for Global Health (S.S., H.A., Y.H., E.H., C.D., R.I.L., J.C., C.S.A.), the University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; Department of Neurology (R.B.), Innsbruck Medical University, Austria; Department of Neurology (Y.L., J.Z.), Baotou Central Hospital, China; Center for Stroke Research Berlin (E.J.), Charité-University Medicine Berlin, Germany; The Shanghai Institute of Hypertension (J.W.), Ruijin Hospital, Shanghai Jiaotong University, China; Servicio de Neurología (P.M.L.), Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; and Department of Cardiovascular Sciences (T.R.), Leicester Royal Infirmary, University of Leicester, UK.
Neurology. 2014 Dec 9;83(24):2232-8. doi: 10.1212/WNL.0000000000001076. Epub 2014 Nov 5.
The prognostic importance of the speed of early hematoma growth in acute intracerebral hemorrhage (ICH) has not been well established. We aimed to determine the association between the rate of increase in hematoma volume and major clinical outcomes in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) studies. The effects of early intensive blood pressure (BP) lowering according to the speed of hematoma growth were also investigated.
Pooled analyses of the INTERACT1 (n = 404) and INTERACT2 (n = 2,839) studies-randomized controlled trials of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. The speed of ultraearly hematoma growth (UHG) was defined as hematoma volume (mL)/onset-to-CT time (hours). Primary outcome was death or major disability (modified Rankin Scale score of 3-6) at 90 days.
Among a total of 2,909 patients (90%) with information on UHG and outcome, median speed of UHG was 6.2 mL/h. There was a linear association between UHG and outcome: multivariable-adjusted odd ratios 1.90 (95% confidence interval 1.50-2.39) for 5-10 mL/h and 2.96 (2.36-3.71) for >10 mL/h vs the <5 mL/h group. There were no clear differences in the effects of intensive BP lowering according to 3 speeds of UHG on outcome (p = 0.75 for homogeneity).
The speed of UHG in patients with ICH was continuously associated with increased risks of death or major disability, and from lower levels than previously reported (≥5 mL/h). The benefits of intensive BP lowering appear to be independent of the speed of bleeding.
急性脑出血（ICH）患者血肿早期增长速度的预后意义尚未得到充分证实。本研究旨在确定血肿体积增加率与强化降压降低急性脑出血试验（INTERACT）研究中主要临床结局的相关性。还研究了根据血肿增长速度进行早期强化降压的效果。
对 INTERACT1（n=404）和 INTERACT2（n=2839）研究的汇总分析-这是两项针对伴有升高的收缩压的自发性 ICH 患者的随机对照试验，将患者随机分配到强化（目标收缩压<140mmHg）或基于指南的（<180mmHg）降压管理组。超早期血肿增长速度（UHG）定义为血肿体积（mL）/发病至 CT 时间（小时）。主要结局为 90 天时的死亡或主要残疾（改良 Rankin 量表评分 3-6）。
在总共 2909 例（90%）有 UHG 和结局信息的患者中，UHG 的中位数速度为 6.2mL/h。UHG 与结局呈线性相关：多变量校正后的比值比为 1.90（95%置信区间 1.50-2.39），5-10mL/h 和 2.96（2.36-3.71）>10mL/h 组与<5mL/h 组相比。根据 UHG 的 3 种速度，强化降压对结局的影响没有明显差异（同质性检验 p=0.75）。
ICH 患者 UHG 的速度与死亡或主要残疾风险的增加持续相关，且风险水平低于先前报道（≥5mL/h）。强化降压的益处似乎独立于出血速度。
