The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India.
J Neurol Neurosurg Psychiatry. 2015 Dec;86(12):1319-23. doi: 10.1136/jnnp-2014-309870. Epub 2015 Jan 14.
Controversy exists over the prognostic significance of the affected hemisphere in stroke. We aimed to determine the relationship between laterality of acute intracerebral haemorrhage (ICH) and poor clinical outcomes.
A subsidiary analysis of the INTERACT Pilot and INTERACT2 studies--randomised controlled trials of patients with spontaneous acute ICH with elevated systolic blood pressure (BP), randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Outcomes were the combined and separate end points of death and major disability (modified Rankin scale (mRS) scores of 3-6, 6 and 3-5, respectively) at 90 days.
A total of 2708 patients had supratentorial/hemispheric ICH and information on mRS at 90 days. Patients with right hemispheric ICH (1327, 49%) had a higher risk of death at 90 days compared to those with left hemispheric ICH after adjustment for potential confounding variables (OR, 1.77 (95% CI 1.33 to 2.37)). There were no differences between patients with right and left hemispheric ICH regarding the combined end point of death or major disability or major disability in the multivariable-adjusted models (1.07 (0.89 to 1.29) and 0.85 (0.72 to 1.01), respectively).
Right hemispheric lesion was associated with increased risk of death in patients with acute ICH. The laterality of the ICH does not appear to affect the level of disability in survivors.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.
在中风中，受影响的大脑半球的预后意义存在争议。我们旨在确定急性颅内出血（ICH）的偏侧性与不良临床结局之间的关系。
INTERACT 试验和 INTERACT2 研究的子分析 - 针对伴有升高的收缩压（BP）的自发性急性 ICH 患者的随机对照试验，这些患者被随机分配到强化（目标收缩压 <140mmHg）或基于指南的（<180mmHg）BP 管理。结局是 90 天时死亡和主要残疾（改良 Rankin 量表（mRS）评分分别为 3-6、6 和 3-5）的联合和单独终点。
共有 2708 例幕上/半球性 ICH 患者和 90 天的 mRS 信息。在调整了潜在混杂变量后，与左侧半球性 ICH 患者相比，右侧半球性 ICH 患者（1327 例，49%）在 90 天时的死亡风险更高（OR，1.77（95%CI 1.33-2.37））。在多变量调整模型中，右侧和左侧半球性 ICH 患者在死亡或主要残疾或主要残疾的联合终点方面没有差异（1.07（0.89-1.29）和 0.85（0.72-1.01））。
急性 ICH 患者右侧大脑半球病变与死亡风险增加相关。ICH 的偏侧性似乎不会影响幸存者的残疾程度。
网址：http://www.clinicaltrials.gov。唯一标识符：NCT00226096 和 NCT00716079。
