脑淀粉样血管病出血复发的危险因素：整体小血管疾病严重程度评分与个别神经影像学标志物的比较分析。
Hemorrhage recurrence risk factors in cerebral amyloid angiopathy: Comparative analysis of the overall small vessel disease severity score versus individual neuroimaging markers.
机构信息
Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
出版信息
J Neurol Sci. 2017 Sep 15;380:64-67. doi: 10.1016/j.jns.2017.07.015. Epub 2017 Jul 9.
INTRODUCTION
An MRI-based score of total small vessel disease burden (CAA-SVD-Score) in cerebral amyloid angiopathy (CAA) has been demonstrated to correlate with severity of pathologic changes. Evidence suggests that CAA-related intracerebral hemorrhage (ICH) recurrence risk is associated with specific disease imaging manifestations rather than overall severity. We compared the correlation between the CAA-SVD-Score with the risk of recurrent CAA-related lobar ICH versus the predictive role of each of its components.
METHODS
Consecutive patients with CAA-related ICH from a single-center prospective cohort were analyzed. Radiological markers of CAA related SVD damage were quantified and categorized according to the CAA-SVD-Score (0-6 points). Subjects were followed prospectively for recurrent symptomatic ICH. Adjusted Cox proportional hazards models were used to investigate associations between the CAA-SVD-Score as well as each of the individual MRI signatures of CAA and the risk of recurrent ICH.
RESULTS
In 229 CAA patients with ICH, a total of 56 recurrent ICH events occurred during a median follow-up of 2.8years [IQR 0.9-5.4years, 781 person-years). Higher CAA-SVD-Score (HR=1.26 per additional point, 95%CI [1.04-1.52], p=0.015) and older age were independently associated with higher ICH recurrence risk. Analysis of individual markers of CAA showed that CAA-SVD-Score findings were due to the independent effect of disseminated superficial siderosis (HR for disseminated cSS vs none: 2.89, 95%CI [1.47-5.5], p=0.002) and high degree of perivascular spaces enlargement (RR=3.50-95%CI [1.04-21], p=0.042).
CONCLUSION
In lobar CAA-ICH patients, higher CAA-SVD-Score does predict recurrent ICH. Amongst individual elements of the score, superficial siderosis and dilated perivascular spaces are the only markers independently associated with ICH recurrence, contributing to the evidence for distinct CAA phenotypes singled out by neuro-imaging manifestations.
简介
基于 MRI 的脑淀粉样血管病（CAA）总小血管疾病负担评分（CAA-SVD-Score）已被证明与病理改变的严重程度相关。有证据表明，CAA 相关性颅内出血（ICH）复发风险与特定的疾病影像学表现相关，而不是与整体严重程度相关。我们比较了 CAA-SVD-Score 与复发性 CAA 相关皮质 ICH 风险之间的相关性，以及其各个组成部分的预测作用。
方法
对来自单中心前瞻性队列的 CAA 相关 ICH 连续患者进行分析。根据 CAA-SVD-Score（0-6 分）对与 CAA 相关 SVD 损伤的放射学标志物进行量化和分类。对受试者进行前瞻性随访，以了解症状性 ICH 复发情况。使用校正的 Cox 比例风险模型来研究 CAA-SVD-Score 以及 CAA 的每个 MRI 特征与复发性 ICH 的风险之间的关联。
结果
在 229 例 CAA 合并 ICH 患者中，中位随访 2.8 年[IQR 0.9-5.4 年，781 人年]期间共发生 56 例复发性 ICH 事件。更高的 CAA-SVD-Score（每增加 1 分，HR=1.26，95%CI [1.04-1.52]，p=0.015）和年龄较大与更高的 ICH 复发风险相关。对 CAA 的个别标志物的分析表明，CAA-SVD-Score 的发现是由于弥漫性浅表铁质沉着症（弥漫性 cSS 与无 cSS 的 HR：2.89，95%CI [1.47-5.5]，p=0.002）和血管周围间隙扩大程度较高（RR=3.50-95%CI [1.04-21]，p=0.042）的独立影响所致。
结论
在皮质 CAA-ICH 患者中，更高的 CAA-SVD-Score 确实可以预测 ICH 的复发。在评分的个别元素中，浅表铁质沉着症和扩张的血管周围间隙是唯一与 ICH 复发独立相关的标志物，为神经影像学表现所确定的不同 CAA 表型提供了证据。
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