血肿形态和密度在脑出血中的意义：急性脑出血强化降压试验研究。
Significance of Hematoma Shape and Density in Intracerebral Hemorrhage: The Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial Study.
机构信息
From the Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia (C.D., L.D., C.S.A.); Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia (H.A., S.S., X.W., J.C., E.H., R.I.L.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z., M.L.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Division of Clinical Neurosciences, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, QC, Canada (C.S.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, United Kingdom (T.R.); Unidad de Neurología vascular, Servicio de Neurología, Departamento de Medicina, Clínica Alemana, Santiago, Chile (P.M.L.); Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.).
出版信息
Stroke. 2016 May;47(5):1227-32. doi: 10.1161/STROKEAHA.116.012921. Epub 2016 Apr 12.
BACKGROUND AND PURPOSE
In patients with acute intracerebral hemorrhage (ICH), the shape and density of the hematoma are associated with its subsequent growth, but the impact of these parameters on clinical outcome is uncertain.
METHODS
Baseline computed tomographic scans and clinical data were obtained in the Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial (INTERACT2). Three independent neurologists blind to clinical data assessed ICH for shape and density using a previously described scale. Shape was defined as irregular when the ICH had ≥2 extra lesions added to the ellipsoid-shaped ICH. Density was heterogeneous when there were ≥3 low-density lesions within the ICH. Outcome measures were death and major disability (modified Rankin scale score of 3-5), combined and separate at 90-day postrandomization. Multivariable logistic regression models were used to determine the significance of hematoma characteristics on outcome.
RESULTS
There were 2066 patient computed tomographic scans included in the analysis, with 46% and 38% having irregular and heterogeneous ICH, respectively. Irregular shape was independently associated with death/major disability (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.29-1.98) and major disability alone (adjusted odds ratio, 1.60; 95% CI, 1.31-1.95), but not with death alone (adjusted odds ratio, 0.97; 95% CI, 0.68-1.39). Heterogeneous density was not associated with clinical outcomes (adjusted odds ratio, 1.06; 95% CI, 0.85-1.33), 1.04 (95% CI, 0.73-1.48), and 1.14 (95% CI, 0.93-1.39), respectively, for death/major disability, death alone, and disability alone).
CONCLUSIONS
Irregular shape, but not heterogeneous density, is independently associated with poor outcome after ICH.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
背景与目的
在急性脑出血（ICH）患者中，血肿的形状和密度与后续的血肿增长相关，但这些参数对临床结果的影响尚不确定。
方法
在强化降压急性脑出血试验 2（INTERACT2）中，我们获取了基线计算机断层扫描（CT）扫描和临床数据。3 位独立的神经科医生在不了解临床数据的情况下，使用先前描述的量表评估 ICH 的形状和密度。当 ICH 除了椭圆形 ICH 外还有≥2 个额外病灶时，形状被定义为不规则。当 ICH 内有≥3 个低密度病灶时，密度被定义为不均匀。结局指标为 90 天随机分组后的死亡和主要残疾（改良 Rankin 量表评分 3-5），合并和分别评估。多变量逻辑回归模型用于确定血肿特征对结局的意义。
结果
分析纳入了 2066 例患者的 CT 扫描，其中 46%和 38%的患者血肿形状不规则和不均匀。不规则形状与死亡/主要残疾（调整后的优势比，1.60；95%置信区间 [CI]，1.29-1.98）和主要残疾（调整后的优势比，1.60；95%CI，1.31-1.95）独立相关，但与单独死亡（调整后的优势比，0.97；95%CI，0.68-1.39）无关。不均匀密度与临床结局无关（调整后的优势比，1.06；95%CI，0.85-1.33）、1.04（95%CI，0.73-1.48）和 1.14（95%CI，0.93-1.39），分别用于死亡/主要残疾、死亡和残疾。
结论
不规则形状，而不是不均匀密度，与 ICH 后的不良结局独立相关。
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