Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, City Hospital, Nottingham, NG5 1PB, UK.
Department of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
Transl Stroke Res. 2021 Apr;12(2):275-283. doi: 10.1007/s12975-020-00845-6. Epub 2020 Sep 9.
Neurological deterioration is common after intracerebral hemorrhage (ICH). We aimed to identify the predictors and effects of neurological deterioration and whether tranexamic acid reduced the risk of neurological deterioration. Data from the Tranexamic acid in IntraCerebral Hemorrhage-2 (TICH-2) randomized controlled trial were analyzed. Neurological deterioration was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) of ≥ 4 or a decline in Glasgow Coma Scale of ≥ 2. Neurological deterioration was considered to be early if it started ≤ 48 h and late if commenced between 48 h and 7 days after onset. Logistic regression was used to identify predictors and effects of neurological deterioration and the effect of tranexamic acid on neurological deterioration. Of 2325 patients, 735 (31.7%) had neurological deterioration: 590 (80.3%) occurred early and 145 (19.7%) late. Predictors of early neurological deterioration included recruitment from the UK, previous ICH, higher admission systolic blood pressure, higher NIHSS, shorter onset-to-CT time, larger baseline hematoma, intraventricular hemorrhage, subarachnoid extension and antiplatelet therapy. Older age, male sex, higher NIHSS, previous ICH and larger baseline hematoma predicted late neurological deterioration. Neurological deterioration was independently associated with a modified Rankin Scale of > 3 (aOR 4.98, 3.70-6.70; p < 0.001). Tranexamic acid reduced the risk of early (aOR 0.79, 0.63-0.99; p = 0.041) but not late neurological deterioration (aOR 0.76, 0.52-1.11; p = 0.15). Larger hematoma size, intraventricular and subarachnoid extension increased the risk of neurological deterioration. Neurological deterioration increased the risk of death and dependency at day 90. Tranexamic acid reduced the risk of early neurological deterioration and warrants further investigation in ICH. URL: https://www.isrctn.com Unique identifier: ISRCTN93732214.
脑出血后常出现神经功能恶化。我们旨在确定神经功能恶化的预测因素和影响，以及氨甲环酸是否降低神经功能恶化的风险。对氨甲环酸脑出血 2 期（TICH-2）随机对照试验的数据进行了分析。神经功能恶化定义为 NIHSS 增加≥4 分或格拉斯哥昏迷量表（GCS）下降≥2 分。如果在发病后≤48 h 开始，则认为是早期神经功能恶化，如果在发病后 48 h 至 7 d 开始，则认为是晚期神经功能恶化。采用 logistic 回归分析确定神经功能恶化的预测因素和影响，以及氨甲环酸对神经功能恶化的影响。在 2325 例患者中，735 例（31.7%）出现神经功能恶化：590 例（80.3%）为早期，145 例（19.7%）为晚期。早期神经功能恶化的预测因素包括来自英国、既往脑出血、入院时收缩压较高、NIHSS 较高、发病至 CT 时间较短、基线血肿较大、脑室内出血、蛛网膜下腔出血和抗血小板治疗。年龄较大、男性、NIHSS 较高、既往脑出血和基线血肿较大预测晚期神经功能恶化。神经功能恶化与改良 Rankin 量表评分>3 独立相关（比值比 4.98，3.70-6.70；p<0.001）。氨甲环酸降低了早期神经功能恶化的风险（比值比 0.79，0.63-0.99；p=0.041），但不降低晚期神经功能恶化的风险（比值比 0.76，0.52-1.11；p=0.15）。较大的血肿大小、脑室内和蛛网膜下腔出血增加了神经功能恶化的风险。神经功能恶化增加了 90 天死亡和依赖的风险。氨甲环酸降低了早期神经功能恶化的风险，值得进一步研究脑出血。网址：https://www.isrctn.com 独特标识符：ISRCTN93732214。
