Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK.
Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, Oxfordshire, UK
J Neurol Neurosurg Psychiatry. 2020 Jun;91(6):580-585. doi: 10.1136/jnnp-2019-322663. Epub 2020 Mar 12.
Patients with primary intracerebral haemorrhage (ICH) are at increased long-term risks of recurrent stroke and other comorbidities. However, available estimates come predominantly from hospital-based studies with relatively short follow-up. Moreover, there are also uncertainties about the influence of ICH location on risks of recurrent stroke, disability, dementia and quality of life.
In a population-based study (Oxford Vascular Study/2002-2018) of patients with a first ICH with follow-up to 10 years, we determined the long-term risks of recurrent stroke, disability, quality of life, dementia and hospital care costs stratified by haematoma location.
Of 255 cases with primary ICH (mean/SD age 75.5/13.1), 109 (42.7%) had lobar ICH, 144 (56.5%) non-lobar ICH and 2 (0.8%) had uncertain location. Annual rates of recurrent ICH were higher after lobar versus non-lobar ICH (lobar=4.0%, 2.7-7.2 vs 1.1%, 0.3-2.8; p=0.02). Moreover, cumulative rate of dementia was also higher for lobar versus non-lobar ICH (n/% lobar=20/36.4% vs 16/20.8%, p=0.047), and there was a higher proportion of disability at 5 years in survivors (15/60.0% vs 9/31.0%, p=0.03). The 10-year quality-adjusted life years (QALYs) were also lower after lobar versus non-lobar ICH (2.9 vs 3.8 for non-lobar, p=0.04). Overall, the mean 10-year censor-adjusted costs were £19 292, with over 80% of costs due to inpatient hospital admission costs, which did not vary by haematoma location (p=0.90).
Compared with non-lobar ICH, the substantially higher 10-year risks of recurrent stroke, dementia and lower QALYs after lobar ICH highlight the need for more effective prevention for this patient group.
原发性脑出血（ICH）患者长期存在复发性中风和其他合并症的风险增加。然而，现有评估主要来自于随访时间相对较短的基于医院的研究。此外，ICH 位置对复发性中风、残疾、痴呆和生活质量风险的影响也存在不确定性。
在一项基于人群的研究（牛津血管研究/2002-2018 年）中，我们对首次 ICH 患者进行了长达 10 年的随访，根据血肿位置对复发性中风、残疾、生活质量、痴呆和住院护理费用的长期风险进行了分层。
在 255 例原发性 ICH 患者中（平均/标准差年龄 75.5/13.1），109 例（42.7%）为皮质下ICH，144 例（56.5%）为非皮质下 ICH，2 例（0.8%）为位置不确定。皮质下 ICH 后复发性 ICH 的年发生率高于非皮质下 ICH（皮质下=4.0%，2.7-7.2% vs 1.1%，0.3-2.8%；p=0.02）。此外，皮质下 ICH 的痴呆累积发生率也高于非皮质下 ICH（皮质下 20/36.4%，非皮质下 16/20.8%，p=0.047），且幸存者在 5 年内残疾比例更高（皮质下 15/60.0%，非皮质下 9/31.0%，p=0.03）。皮质下 ICH 后的 10 年质量调整生命年（QALYs）也低于非皮质下 ICH（皮质下 2.9，非皮质下 3.8，p=0.04）。总体而言，10 年平均 censored-adjusted 成本为 19292 英镑，其中超过 80%的成本归因于住院治疗费用，这与血肿位置无关（p=0.90）。
与非皮质下 ICH 相比，皮质下 ICH 后 10 年复发性中风、痴呆风险显著增加，QALYs 降低，这突出表明需要为这一患者群体制定更有效的预防措施。
