脑微出血与静脉溶栓后脑出血风险
Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis.
作者信息
Zand Ramin, Tsivgoulis Georgios, Singh Mantinderpreet, McCormack Michael, Goyal Nitin, Ishfaq Muhammad Fawad, Shahripour Reza Bavarsad, Nearing Katherine, Elijovich Lucas, Alexandrov Anne W, Liebeskind David S, Alexandrov Andrei V
机构信息
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia.
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.
出版信息
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):538-544. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.127. Epub 2017 Jan 3.
BACKGROUND
Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH.
METHODS
In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death.
RESULTS
Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9).
CONCLUSIONS
Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present.
背景
与没有脑微出血（CMB）的中风患者相比，有CMB的中风患者发生症状性脑出血（sICH）的风险可能更高。我们研究的目的是调查CMB的存在和负担是否与静脉溶栓（IVT）后sICH相关。
方法
在这项多中心研究中，对连续接受静脉注射组织纤溶酶原激活剂治疗的患者进行前瞻性识别和分析。排除治疗后24小时内未进行磁共振成像（MRI）的患者。CMB被定义为在T2*加权MRI上呈圆形或椭圆形、低信号病变，伴有直径达10毫米的磁敏感伪影。结局指标包括sICH的发生或死亡。
结果
在672例接受IVT的患者中（平均年龄62±14岁，52%为男性，入院时美国国立卫生研究院卒中量表[NIHSS]中位数：7分），103例患者在T2MRI上有CMB。10例患者有超过10个CMB，其余93例患者在T2MRI上有1 - 10个CMB。有1 - 10个CMB的患者和没有CMB的患者之间sICH发生率无差异（5.8%对3.5%；P = 0.27）。然而，CMB超过10个的患者中sICH更频繁发生（P = 0.0009）（30%，经校正的Wald方法计算的95%置信区间[CI]：10% - 61%）。在调整潜在混杂因素后，T2*MRI上CMB超过10个独立（P = 0.0004）与sICH发生可能性更高相关（优势比[OR]：13.4, 95%CI：3.2 - 55.9）。
结论
我们的研究结果表明，当存在超过10个CMB时，IVT后sICH风险增加。
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