Taylor Blake, Appelboom Geoffrey, Yang Annie, Bruce Eliza, LoPresti Melissa, Bruce Samuel, Christophe Brandon, Claassen Jan, Sander Connolly E
Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA; College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
J Clin Neurosci. 2015 Mar;22(3):526-9. doi: 10.1016/j.jocn.2014.09.009. Epub 2014 Dec 12.
Brain arteriovenous malformations (AVM) are the most common cause of intracerebral hemorrhage (ICH) in young adults. Although previous studies have found that the mortality and morbidity of ICH due to AVM (AVM-ICH) is lower than in spontaneous ICH, it is unclear whether the more favorable prognosis is directly related to the presence of the vascular malformation. We included 34 patients with AVM-ICH and 187 with spontaneous intracerebral hemorrhage (sICH) due to either hypertension or cerebral amyloid angiopathy. Patient data were obtained from the prospective Intracerebral Hemorrhage Outcomes Project, which enrolls ICH patients admitted to Columbia University Medical Center. Using ICH etiology (AVM-ICH or sICH) and previously verified predictors of ICH outcome, two multivariate analyses were performed with and without age to compare the odds of death at 3 months and the functional outcome. Although mortality in AVM-ICH group was lower than the sICH group (20.6% versus 43.3%, respectively), this value was only significant when age was excluded (p=0.017) and lost its significance when we controlled for age (p=0.157). There was an analogous loss of significance with functional outcome using the modified Rankin Scale. In conclusion, our data suggests that the previously observed lower case fatality rate and more favorable functional outcomes in the AVM-ICH group compared to the sICH group may largely be the result of age.
脑动静脉畸形（AVM）是年轻成年人脑出血（ICH）最常见的病因。尽管先前的研究发现，由AVM导致的ICH（AVM-ICH）的死亡率和发病率低于自发性ICH，但尚不清楚更有利的预后是否与血管畸形的存在直接相关。我们纳入了34例AVM-ICH患者和187例因高血压或脑淀粉样血管病导致的自发性脑出血（sICH）患者。患者数据来自前瞻性脑出血结局项目，该项目纳入了入住哥伦比亚大学医学中心的ICH患者。利用ICH病因（AVM-ICH或sICH）以及先前验证的ICH结局预测因素，进行了两项多变量分析，分别纳入和排除年龄因素，以比较3个月时的死亡几率和功能结局。尽管AVM-ICH组的死亡率低于sICH组（分别为20.6%和43.3%），但该值仅在排除年龄因素时具有显著性（p=0.017），而在控制年龄因素后失去显著性（p=0.157）。使用改良Rankin量表评估功能结局时也出现了类似的显著性丧失。总之，我们的数据表明，与sICH组相比，先前观察到的AVM-ICH组较低的病死率和更有利的功能结局可能在很大程度上是年龄因素的结果。
