解析西非人群自发性脑出血的危险因素。
Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans.
机构信息
From Kwame Nkrumah University of Science and Technology (F.S.S., L.A., A. Singh, D.O.), Kumasi, Ghana; University of California (B.O.), San Francisco; Medical University of South Carolina (M.G., D.L., C.J., F.M.), Charleston; College of Medicine (O. Akpa, G. Ogbole, M.O., J.A., A.O., A. Adeoye, L. Ogunjimi, O. Arulogun, F.A., O. Ogah, A. Makanjuola, O. Adebayo, A. Agunloye, S.L., S.D., M.F., C.E.), University of Ibadan, Nigeria; University of Ghana Medical School (A. Akpalu, R.L., B.C.-T.), Accra; University of Ilorin Teaching Hospital (K.W., L. Oyinloye, P.K., E.S.); Federal Medical Centre (R.A., O. Adeleye), Abeokuta; Ahmadu Bello University (R.O., O.B., V.S., H.I.), Zaria; Obafemi Awolowo University Teaching Hospital (M.K., B.F., O. Ajose, S.O.), Ile-Ife; Aminu Kano Teaching Hospital (L. Owolabi, A. Mande), Kano, Nigeria; University of Kentucky (D.A.), Lexington; University of Alabama at Birmingham (H.T.); University of Cambridge (H.S.M.), UK; Delta State University Teaching Hospital (O. Olugbo); Jos Teaching Hospital (G. Osaigbovo, A. Salaam, G.A., C.I.), Plateau State; Federal Medical Centre (I.C.), Umuahia, Abia State; Federal Medical Centre (T.S.), Owo, Ondo State; and Ladoke Akintola University of Technology Teaching Hospital (A. Akintunde), Ogbomosho, Oyo State, Nigeria.
出版信息
Neurology. 2020 Mar 10;94(10):e998-e1012. doi: 10.1212/WNL.0000000000009056. Epub 2020 Feb 19.
OBJECTIVE
To characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.
METHODS
The Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.
RESULTS
Of 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78-213.72); dyslipidemia, 2.95 (1.84-4.74); meat consumption, 1.55 (1.01-2.38); family history of CVD, 2.22 (1.41-3.50); nonconsumption of green vegetables, 3.61 (2.07-6.31); diabetes mellitus, 2.11 (1.29-3.46); stress, 1.68 (1.03-2.77); and current tobacco use, 14.27 (2.09-97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43-2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00-1.01); presence of midline shift, 1.54 (1.11-2.13); lobar ICH, 1.72 (1.16-2.55); and supratentorial bleeds, 2.17 (1.06-4.46).
CONCLUSIONS
Population-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.
目的
描述西非自发性脑出血（sICH）发生和严重程度的危险因素。
方法
Stroke Investigative Research and Educational Network（SIREN）研究是一项多中心病例对照研究，涉及加纳和尼日利亚的 15 个地点。患者为 CT 证实的 sICH 成年患者，年龄、性别和种族匹配的无卒中社区对照。使用标准仪器评估血管、生活方式和社会心理因素。使用条件逻辑回归评估与 sICH 及其严重程度相关的因素，以估计优势比（OR）和人群归因风险（PAR）及其 95%置信区间（CI）。
结果
在 2944 例经裁决的中风病例中，854 例为脑出血（ICH）。ICH 患者的平均年龄为 54.7±13.9 岁，男性居多（63.1%），77.3%为非叶性。sICH 的病因亚型包括高血压（80.9%）、结构性血管异常（4.0%）、脑淀粉样血管病（0.7%）、全身疾病（0.5%）、药物相关（0.4%）和未确定（13.7%）。按 PAR 递减顺序排列的 8 个与 sICH 发生独立相关的因素及其调整后的 OR（95%CI）分别为：高血压，66.63（20.78-213.72）；血脂异常，2.95（1.84-4.74）；肉食消费，1.55（1.01-2.38）；心血管疾病家族史，2.22（1.41-3.50）；不食用绿叶蔬菜，3.61（2.07-6.31）；糖尿病，2.11（1.29-3.46）；压力，1.68（1.03-2.77）；目前吸烟，14.27（2.09-97.47）。使用 NIH 卒中量表评分＞15 分与调整后的 OR（95%CI）相关的严重 sICH 相关因素包括不食用绿叶蔬菜，2.03（1.43-2.88）；收缩压每升高 1mmHg，1.01（1.00-1.01）；中线移位，1.54（1.11-2.13）；叶性 ICH，1.72（1.16-2.55）；和幕上出血，2.17（1.06-4.46）。
结论
在西非，对主要因素进行人群水平控制将大大减轻 sICH 的负担。
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