From the Department of Medicine, Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., K.S.B.) and Department of Radiology and Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Canada; Division of Neurology, University of British Columbia, Vancouver, Canada (N.A.); and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (S.C., M.D.H., A.D.).
Stroke. 2015 Apr;46(4):954-60. doi: 10.1161/STROKEAHA.114.007544. Epub 2015 Feb 19.
There are limited data on the extent of blood-brain barrier (BBB) compromise in acute intracerebral hemorrhage patients. We tested the hypotheses that BBB compromise measured with permeability-surface area product (PS) is increased in the perihematoma region and predicts perihematoma edema growth in acute intracerebral hemorrhage patients.
Patients were randomized within 24 hours of symptom onset to a systolic blood pressure (SBP) treatment of <150 (n=26) or <180 mm Hg (n=27). Permeability maps were generated using computed tomographic perfusion source data acquired 2 hours after randomization, and mean PS was measured in the hematoma, perihematoma, and hemispheric regions. Hematoma and edema volumes were measured on noncontrast computed tomographic scans obtained at baseline, 2 hours and 24 hours after randomization.
Patients were randomized at a median (interquartile range) time of 9.3 hours (14.1) from symptom onset. Treatment groups were balanced with respect to baseline SBP and hematoma volume. Perihematoma PS (5.1±2.4 mL/100 mL per minute) was higher than PS in contralateral regions (3.6±1.7 mL/100 mL per minute; P<0.001). Relative edema growth (0-24 hours) was not predicted by perihematoma PS (β=-0.192 [-0.06 to 0.01]) or SBP change (β=-0.092 [-0.002 to 0.001]). SBP was lower in the <150 target group (139.2±22.1 mm Hg) than in the <180 group (159.7±12.3 mm Hg; P<0.0001). Perihematoma PS was not different between groups (4.9±2.4 mL/100 mL per minute for the <150 group, 5.3±2.4 mL/100 mL per minute for the <180 group; P=0.51).
BBB permeability is focally increased in the hematoma and perihematoma regions of acute intracerebral hemorrhage patients. BBB compromise does not predict acute perihematoma edema volume or edema growth. SBP reduction does not affect BBB permeability.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00963976.
目前有关急性脑出血患者血脑屏障（BBB）损伤程度的数据有限。我们检验了以下假设：采用渗透性-表面积乘积（PS）测量的 BBB 损伤在血肿周边区更明显，并能预测急性脑出血患者血肿周边水肿的增长。
患者在症状出现后 24 小时内随机分为收缩压（SBP）治疗组＜150mmHg（n=26）和＜180mmHg（n=27）。在随机分组后 2 小时使用计算机断层灌注源数据生成渗透性图谱，并测量血肿、血肿周边和半球区的平均 PS。在随机分组后基线、2 小时和 24 小时时行非增强 CT 扫描测量血肿和水肿体积。
患者在症状出现后中位（四分位数间距）9.3 小时（14.1）时被随机分组。两组间基线 SBP 和血肿体积相当。血肿周边 PS（5.1±2.4mL/100mL·min）高于对侧区域的 PS（3.6±1.7mL/100mL·min；P＜0.001）。相对水肿增长（0-24 小时）不能用血肿周边 PS（β=-0.192[-0.06 至 0.01]）或 SBP 变化（β=-0.092[-0.002 至 0.001]）来预测。＜150mmHg 目标治疗组的 SBP（139.2±22.1mmHg）低于＜180mmHg 组（159.7±12.3mmHg；P＜0.0001）。两组间的血肿周边 PS 无差异（＜150mmHg 组为 4.9±2.4mL/100mL·min，＜180mmHg 组为 5.3±2.4mL/100mL·min；P=0.51）。
急性脑出血患者的血肿及血肿周边区 BBB 通透性呈局灶性增加。BBB 损伤不能预测急性血肿周边水肿体积或水肿增长。SBP 降低不会影响 BBB 通透性。
