Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Department of Neurology, University of Bonn, Bonn, Germany.
J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104793. doi: 10.1016/j.jstrokecerebrovasdis.2020.104793. Epub 2020 Mar 27.
Although several studies have shown that interventions to lower blood lipid concentration may reduce the risk of coronary arterial disease and ischemic stroke, the correlation between serum lipid levels and hemorrhagic stroke remains controversial. To clarify any possible association between serum lipid and hematoma expansion, we examined various serum lipid indices in patients with and without early hematoma expansion.
Data of 572 intracerebral hemorrhage (ICH) patients from the cerebral small vessel disease cohort of Peking Union Medical College Hospital were retrospectively analyzed. Patients who finished the baseline brain computed tomography (CT) examination within 6 h post-ictus and the follow-up CT within 48 h after initial CT were included in the study. Hematoma expansion was delimited as an enlargement of hemorrhage volume over 33% or 12.5 mL between baseline and subsequent CT. Both uni- and multivariate logistic regression analyses were conducted to explore the association between early hematoma growth and various serum lipid indices, including triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, ratios of LDL-C/HDL-C and LDL-C/TC, as well as other demographic and clinical features.
Out of 157 patients included in the analysis, hematoma growth occurred in 45 (28.7%). Only higher baseline systolic blood pressure was found to be correlated with an increased risk of hematoma growth based on both univariate (odds ratio [OR] 1.014, 95% confidence interval [CI]: 1.002-1.026, P = .024) and multivariate logistic regression analyses (OR 1.022, 95%CI: 1.008-1.037, P = .003). No associations were detected between the various serum lipid indices examined and other clinical features with a likelihood of early hematoma growth between groups or within various subgroups defined by different characteristics including age, gender, baseline Glasgow Coma Scale score, systolic blood pressure, intraventricular extension, and hematoma location.
No association between various indices of serum lipid and hematoma growth was identified among patients and subgroups with spontaneous ICH in the Chinese population; these findings may help to guide lipid management after ICH. However, further multi-centered, larger scale studies are expected to verify our results.
尽管多项研究表明，降低血脂浓度的干预措施可能会降低冠状动脉疾病和缺血性卒中的风险，但血清脂质水平与出血性卒中之间的相关性仍存在争议。为了明确血清脂质与血肿扩大之间可能存在的关联，我们检测了伴有和不伴有早期血肿扩大的患者的各种血清脂质指标。
回顾性分析了北京协和医学院医院脑小血管病队列的 572 例脑出血（ICH）患者的数据。本研究纳入了发病后 6 小时内完成基线脑计算机断层扫描（CT）检查且在初始 CT 后 48 小时内完成随访 CT 的患者。血肿扩大定义为基线 CT 与后续 CT 相比出血量增加 33%或 12.5ml。采用单因素和多因素逻辑回归分析探讨了早期血肿增长与各种血清脂质指标（包括甘油三酯、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇、LDL-C/HDL-C 及 LDL-C/TC 比值）以及其他人口统计学和临床特征之间的关系。
在纳入分析的 157 例患者中，有 45 例（28.7%）发生血肿扩大。只有较高的基线收缩压在单因素（比值比[OR]1.014，95%置信区间[CI]：1.002-1.026，P=0.024）和多因素逻辑回归分析（OR 1.022，95%CI：1.008-1.037，P=0.003）中与血肿扩大的风险增加相关。未发现所检查的各种血清脂质指标与其他临床特征之间存在相关性，也未发现各组之间或根据年龄、性别、基线格拉斯哥昏迷量表评分、收缩压、脑室内扩展和血肿位置等不同特征定义的亚组之间存在早期血肿生长的可能性。
在中国人群自发性 ICH 患者和亚组中，未发现各种血清脂质指标与血肿生长之间存在关联；这些发现可能有助于指导 ICH 后的血脂管理。然而，需要进一步的多中心、更大规模的研究来验证我们的结果。
