Morotti Andrea, Busto Giorgio, Bernardoni Andrea, Marini Sandro, Casetta Ilaria, Fainardi Enrico
Department of Neurology and Neurorehabilitation, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
Neurocrit Care. 2020 Oct;33(2):525-532. doi: 10.1007/s12028-020-00929-z.
The prognostic impact of perihematomal hypoperfusion in patients with acute intracerebral hemorrhage (ICH) remains unclear. We tested the hypothesis that perihematomal hypoperfusion predicts poor ICH outcome and explored whether hematoma growth (HG) is the pathophysiological mechanism behind this association.
A prospectively collected single-center cohort of consecutive ICH patients undergoing computed tomography perfusion on admission was analyzed. Cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area. pCBF was categorized into normal (40-55 mL/100 g/min), low (< 40 mL/100 g/min), and high (> 55 mL/100 g/min). HG was calculated as total volume increase from baseline to follow-up CT. A modified Rankin scale > 2 at three months was the outcome of interest. The association between cerebral perfusion and outcome was investigated with logistic regression, and potential mediators of this relationship were explored with mediation analysis.
A total of 155 subjects were included, of whom 55 (35.5%) had poor outcome. The rates of normal pCBF, low pCBF, and high pCBF were 17.4%, 68.4%, and 14.2%, respectively. After adjustment for confounders and keeping subjects with normal pCBF as reference, the risk of poor outcome was increased in patients with pCBF < 40 mL/100 g/min (odds ratio 6.11, 95% confidence interval 1.09-34.35, p = 0.040). HG was inversely correlated with pCBF (R = -0.292, p < 0.001) and mediated part of the association between pCBF and outcome (proportion mediated: 82%, p = 0.014).
Reduced pCBF is associated with poor ICH outcome in patients with mild-moderate severity. HG appears a plausible biological mediator but does not fully account for this association, and other mechanisms might be involved.
急性脑出血（ICH）患者血肿周围低灌注的预后影响仍不明确。我们检验了血肿周围低灌注可预测ICH不良预后这一假设，并探讨了血肿扩大（HG）是否为这种关联背后的病理生理机制。
对前瞻性收集的单中心队列中连续入院时接受计算机断层扫描灌注的ICH患者进行分析。在手动勾勒的血肿周围低密度区域测量脑血流量（pCBF）。pCBF分为正常（40 - 55 mL/100 g/min）、低（<40 mL/100 g/min）和高（>55 mL/100 g/min）。HG计算为从基线到随访CT的总体积增加量。三个月时改良Rankin量表>2为感兴趣的结局。采用逻辑回归研究脑灌注与结局之间的关联，并通过中介分析探索这种关系的潜在中介因素。
共纳入155名受试者，其中55名（35.5%）预后不良。pCBF正常、低和高的比例分别为17.4%、68.4%和14.2%。在调整混杂因素并将pCBF正常的受试者作为对照后，pCBF<40 mL/100 g/min的患者预后不良风险增加（比值比6.11，95%置信区间1.09 - 34.35，p = 0.040）。HG与pCBF呈负相关（R = -0.292，p < 0.），并介导了pCBF与结局之间关联的一部分（中介比例：82%，p = 0.014）。
轻度至中度严重程度的ICH患者中，pCBF降低与不良预后相关。HG似乎是一个合理的生物学中介因素，但不能完全解释这种关联，可能还涉及其他机制。
