同时性多发性脑内出血
Simultaneous Multiple Intracerebral Hemorrhages (SMICH).
作者信息
Wu Teddy Y, Yassi Nawaf, Shah Darshan G, Ma Minmin, Sharma Gagan, Putaala Jukka, Strbian Daniel, Campbell Bruce C V, Yan Bernard, Tatlisumak Turgut, Desmond Patricia M, Davis Stephen M, Meretoja Atte
机构信息
From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
Guest Editor for this article was Giuseppe Lanzino, MD.
出版信息
Stroke. 2017 Mar;48(3):581-586. doi: 10.1161/STROKEAHA.116.015186.
BACKGROUND AND PURPOSE
Simultaneous multiple intracerebral hemorrhages (SMICHs) are uncommon. Few single-center studies have analyzed characteristics and outcome of SMICH. We analyzed clinical characteristics and outcome of SMICH patients from 2 comprehensive stroke centers.
METHODS
Baseline imaging from consecutive intracerebral hemorrhage (ICH) patients (n=1552) from Helsinki ICH study and Royal Melbourne Hospital ICH study was screened for SMICH. ICH pathogenesis was classified according to the structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined classification system (SMASH-U). ICH caused by trauma, tumor, and aneurysmal rupture was excluded. Baseline clinical and radiological characteristics and 90-day mortality were compared between SMICH and single ICH patients. Association of SMICH with 90-day mortality was assessed in multivariable logistic regression models adjusted for predictors of ICH outcome.
RESULTS
Of 1452 patients, 85 (5.9%) were classified as SMICH. SMICH were more often female (58% versus 42%; =0.004), had lower baseline Glasgow Coma Scale (12 versus 14; =0.008), and more frequent lobar location (59% versus 34%; <0.001) compared with single ICH. The SMASH-U pathogenesis of SMICH patients was less often hypertensive (20% versus 37%; =0.001), more often systemic coagulopathy (12% versus 3%; <0.001), and trended toward more cerebral amyloid angiopathy (32% versus 23%; =0.071). SMICH was not associated with 90-day mortality on univariate (37% versus 35%; =0.610), multivariable (odds ratio, 0.783; 95% confidence interval, 0.401-1.529; =0.473), or propensity score-matched analyses (odds ratio, 0.760; 95% confidence interval, 0.352-1.638; =0.484).
CONCLUSIONS
SMICH occurs in ≈1 in 20 ICH, more commonly with lobar located hematomas and systemic coagulopathy with less hypertensive angiopathy. The associated mortality is similar to single ICH. Given varied etiologies, SMICH management should target the underlying pathology.
背景与目的
同时发生的多发性脑出血（SMICHs）并不常见。很少有单中心研究分析SMICH的特征和结局。我们分析了来自2个综合卒中中心的SMICH患者的临床特征和结局。
方法
对赫尔辛基脑出血研究和皇家墨尔本医院脑出血研究中连续的脑出血（ICH）患者（n = 1552）的基线影像进行筛选，以确定是否为SMICH。根据结构病变、药物、淀粉样血管病、全身/其他疾病、高血压、未确定分类系统（SMASH-U）对ICH的发病机制进行分类。排除由创伤、肿瘤和动脉瘤破裂引起的ICH。比较SMICH和单发ICH患者的基线临床和影像学特征以及90天死亡率。在针对ICH结局预测因素进行调整的多变量逻辑回归模型中评估SMICH与90天死亡率的关联。
结果
在1452例患者中，85例（5.9%）被分类为SMICH。与单发ICH相比，SMICH患者女性更多（58%对42%；P = 0.004），基线格拉斯哥昏迷量表评分更低（12对14；P = 0.008），且脑叶部位出血更常见（59%对34%；P < 0.001）。SMICH患者的SMASH-U发病机制中高血压性的较少见（20%对37%；P = 0.001），全身性凝血障碍更常见（12%对3%；P < 0.001），且脑淀粉样血管病有增多趋势（32%对23%；P = 0.071）。在单变量分析（37%对35%；P = 0.610）、多变量分析（比值比，0.783；95%置信区间，0.401 - 1.529；P = 0.473）或倾向评分匹配分析（比值比，0.760；95%置信区间，0.352 - 1.638；P = 0.484）中，SMICH与90天死亡率均无关联。
结论
SMICH在约每20例ICH中出现1例，更常见于脑叶血肿和全身性凝血障碍，高血压性血管病变较少。其相关死亡率与单发ICH相似。鉴于病因多样，SMICH的治疗应针对潜在病理情况。
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