717例急性缺血性卒中患者静脉溶栓后的微出血状态及3个月预后
Microbleed Status and 3-Month Outcome After Intravenous Thrombolysis in 717 Patients With Acute Ischemic Stroke.
作者信息
Turc Guillaume, Sallem Asmaa, Moulin Solène, Tisserand Marie, Machet Alexandre, Edjlali Myriam, Baron Jean-Claude, Leclerc Xavier, Leys Didier, Mas Jean-Louis, Cordonnier Charlotte, Oppenheim Catherine
机构信息
From the Departments of Neurology (G.T., J.-C.B., J.-L.M.) and Radiology (M.T., A.M., C.O.), Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR S894, DHU Neurovasc, Paris, France; and Departments of Neurology (S.M., D.L., C.C.) and Radiology (A.S., M.E., X.L.), Lille University Hospital and Université de Lille, UDSL, INSERM U1171, Lille, France.
出版信息
Stroke. 2015 Sep;46(9):2458-63. doi: 10.1161/STROKEAHA.115.009290. Epub 2015 Jul 30.
BACKGROUND AND PURPOSE
Whether cerebral microbleeds (CMBs) detected on pretreatment magnetic resonance imaging increase the risks of symptomatic intracranial hemorrhage (sICH) and, most importantly, poor outcome in patients treated by intravenous thrombolysis for acute ischemic stroke is still debated. We assessed the effect of CMB presence and burden on 3-month modified Rankin Scale and sICH in a multicentric cohort.
METHODS
We analyzed prospectively collected data of consecutive patients solely treated by intravenous thrombolysis for acute ischemic stroke, in 2 centers where magnetic resonance imaging is the first-line pretreatment imaging. Neuroradiologists blinded to clinical data rated CMBs on T2* sequence using a validated scale. Logistic regressions were used to assess relationships between CMBs and 3-month modified Rankin Scale or sICH.
RESULTS
Among 717 patients, 150 (20.9%) had ≥1 CMBs. CMB burden was associated with worse modified Rankin Scale in univariable shift analysis (odds ratio, 1.07; 95% confidence interval, 1.00-1.15 per 1-CMB increase; P=0.049), but significance was lost after adjustment for age, hypertension, and atrial fibrillation (odds ratio, 1.03; 95% confidence interval, 0.96-1.11 per 1-CMB increase; P=0.37). Results remained nonsignificant when taking into account CMB location or presumed underlying vasculopathy. The incidence of sICH ranged from 3.8% to 9.1%, depending on the definition. Neither CMB presence, burden, location, nor presumed underlying vasculopathy was independently associated with sICH.
CONCLUSIONS
Poor outcome or sICH was not associated with CMB presence or burden on pre-intravenous thrombolysis magnetic resonance imaging after adjustment for confounding factors. An individual patient data meta-analysis is needed to determine whether a subgroup of patients with CMBs carries an independent risk of poor outcome that might outweigh the expected benefit of intravenous thrombolysis.
背景与目的
在急性缺血性脑卒中患者接受静脉溶栓治疗时，治疗前磁共振成像检测到的脑微出血（CMB）是否会增加症状性颅内出血（sICH）的风险，以及最重要的是，是否会导致不良预后，目前仍存在争议。我们在一个多中心队列中评估了CMB的存在及负荷对3个月改良Rankin量表评分和sICH的影响。
方法
我们分析了在2个以磁共振成像作为一线治疗前成像手段的中心，对仅接受静脉溶栓治疗的急性缺血性脑卒中连续患者的前瞻性收集数据。对临床数据不知情的神经放射科医生使用经过验证的量表在T2*序列上对CMB进行评分。采用逻辑回归分析评估CMB与3个月改良Rankin量表评分或sICH之间的关系。
结果
在717例患者中，150例（20.9%）有≥1处CMB。在单变量移位分析中，CMB负荷与更差的改良Rankin量表评分相关（比值比，1.07；95%置信区间，每增加1处CMB为1.00 - 1.15；P = 0.049），但在对年龄、高血压和心房颤动进行校正后，这种相关性不再显著（比值比，每增加1处CMB为1.03；95%置信区间，0.96 - 1.11；P = 0.37）。考虑CMB的位置或推测的潜在血管病变时，结果仍无显著性差异。根据定义不同，sICH的发生率在3.8%至9.1%之间。CMB的存在、负荷、位置或推测的潜在血管病变均与sICH无独立相关性。
结论
在对混杂因素进行校正后，静脉溶栓前磁共振成像显示的CMB的存在或负荷与不良预后或sICH无关。需要进行个体患者数据的荟萃分析，以确定CMB患者亚组是否存在独立的不良预后风险，且该风险可能超过静脉溶栓的预期获益。
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