脑室内出血在急性脑出血中的意义：急性脑出血强化降压治疗试验结果。
Significance of intraventricular hemorrhage in acute intracerebral hemorrhage: intensive blood pressure reduction in acute cerebral hemorrhage trial results.
机构信息
From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (P.M.L.); Department of Neurological Sciences, Universidad de Chile, Santiago, Chile (P.M.L.); Department of Neurology, APHP-Hôpital Lariboisière and DHU NeuroVasc Paris-Sorbonne, Université Paris Diderot-Sorbonne Paris Cité, Paris, France (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); and Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.).
出版信息
Stroke. 2015 Mar;46(3):653-8. doi: 10.1161/STROKEAHA.114.008470. Epub 2015 Feb 12.
BACKGROUND AND PURPOSE
Intraventricular hemorrhage (IVH) with spontaneous intracerebral hemorrhage indicates a poor prognosis but uncertainty exists over the pattern of association. We aimed to elucidate risk associations of IVH and outcome in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) data set.
METHODS
INTERACT2 was an international prospective, open-blinded end point, randomized controlled trial in 2839 patients with intracerebral hemorrhage (<6 hours) with elevated systolic blood pressure randomly assigned to intensive (target systolic blood pressure <140 mm Hg) or guideline-based (systolic blood pressure <180 mm Hg) blood pressure management. Associations of baseline IVH in 740 of 2613 (28%) patients and poor outcomes (death and major disability defined on the modified Rankin Scale) at 90 days were determined in linear and logistic regression models.
RESULTS
Patients with IVH were significantly older and with greater neurological impairment, history of ischemic stroke, and larger hematomas more often deep hemisphere located at presentation, after adjustment for other baseline variables. Death or major disability occurred in 66% with IVH versus 49% in intracerebral hemorrhage-alone patients (adjusted odds ratio, 1.68; 95% confidence interval, 1.38-2.06; P<0.01). Associations of IVH volume and clinical outcomes were strong and near continuous. Adjusted analyses by thirds of IVH volume indicate thresholds of ≈5 and 10 mL for significantly increased odds of death and death or major disability, respectively.
CONCLUSIONS
A strong association exists between the amount of IVH and poor outcome in intracerebral hemorrhage. An IVH volume of 5 to 10 mL emerges as a significant threshold for decision making on prognosis in these patients.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
背景与目的
伴有自发性脑出血的脑室内出血（IVH）提示预后不良，但两者之间的关联模式尚存在不确定性。我们旨在阐明脑出血强化降压治疗试验（INTERACT2）数据集中 IVH 与结局的风险关联。
方法
INTERACT2 是一项国际前瞻性、开放性盲终点、随机对照试验，纳入了 2839 例发病<6 小时的伴颅内压升高的脑出血患者，随机分为强化组（目标收缩压<140mmHg）和指南组（收缩压<180mmHg）。对 2613 例患者中的 740 例（28%）患者的基线 IVH 与 90 天的不良结局（死亡和改良Rankin 量表定义的主要残疾）进行了线性和逻辑回归模型分析。
结果
IVH 患者年龄较大，神经功能缺损更严重，有缺血性卒中病史，且血肿更大，更常位于深部脑叶，校正其他基线变量后仍如此。IVH 患者中死亡或主要残疾的发生率为 66%，而单纯脑出血患者为 49%（校正比值比，1.68；95%置信区间，1.38-2.06；P<0.01）。IVH 量与临床结局之间存在强烈的近似连续关联。按 IVH 体积的三分之一进行校正分析表明，死亡和死亡或主要残疾的风险显著增加的阈值分别约为 5 和 10mL。
结论
IVH 量与脑出血患者的不良预后之间存在很强的关联。IVH 体积在 5 至 10mL 之间可作为预测这些患者预后的重要阈值。
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