Svensson Edith H, Abul-Kasim Kasim, Engström Gunnar, Söderholm Martin
Cardiovascular Research - Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Radiology Diagnostics, Department of Translational Medicine, Lund University, Malmö, Sweden.
Eur Stroke J. 2020 Sep;5(3):278-285. doi: 10.1177/2396987320932069. Epub 2020 Jun 12.
While the relationship between hypertension and incident intracerebral haemorrhage is well established, other risk factors are less clear. This study examined risk factors for primary intracerebral haemorrhage, separately for lobar and non-lobar intracerebral haemorrhage.
Incidence of intracerebral haemorrhage was studied among 28,416 individuals from the population-based Malmö Diet and Cancer cohort. Intracerebral haemorrhage cases were ascertained using the Swedish Hospital Discharge Register and the Stroke Register of Malmö, validated by review of hospital records and images, and classified by location by a neuroradiologist. Multivariable Cox regression was used.
Three hundred and thirty-three intracerebral haemorrhages occurred, mean follow-up time was 18.4 years. Systolic blood pressure (hazard ratio per 10 mmHg 1.19 [95% confidence interval 1.13-1.26], diastolic blood pressure (hazard ratio 1.42 [1.27-1.59]), oral anticoagulants (hazard ratio 4.26 [2.17-8.38]), smoking (hazard ratio 1.45 [1.14-1.87]), living alone (hazard ratio 1.32 [1.04-1.69]) and low apolipoprotein B (hazard ratio per 10 mg/dL: 0.94 [0.90-0.99]) were significantly associated with incident intracerebral haemorrhage after multivariable adjustment. Systolic blood pressure, smoking and oral anticoagulants were associated with lobar intracerebral haemorrhage. Systolic blood pressure, diastolic blood pressure, living alone and diabetes were associated with non-lobar intracerebral haemorrhage. Diabetes and diastolic blood pressure showed significantly different relationships with lobar and non-lobar intracerebral haemorrhage. Alcohol, apolipoprotein A1, body mass index, waist circumference, physical activity and education were not independently associated with intracerebral haemorrhage. Blood pressure, smoking, low apolipoprotein B, oral anticoagulants and living alone were associated with intracerebral haemorrhage. Diabetes was associated with non-lobar intracerebral haemorrhage only. Further research is required on differences between lobar and non-lobar intracerebral haemorrhage.
虽然高血压与脑出血事件之间的关系已得到充分证实，但其他风险因素尚不清楚。本研究分别针对脑叶性和非脑叶性脑出血，研究原发性脑出血的风险因素。
在基于人群的马尔默饮食与癌症队列中的28416名个体中研究脑出血的发病率。脑出血病例通过瑞典医院出院登记册和马尔默卒中登记册确定，经医院记录和影像复查验证，并由神经放射科医生按部位分类。采用多变量Cox回归分析。
发生了333例脑出血，平均随访时间为18.4年。多变量调整后，收缩压（每10 mmHg的风险比为1.19 [95%置信区间1.13 - 1.26]）、舒张压（风险比为1.42 [1.27 - 1.59]）、口服抗凝剂（风险比为4.26 [2.17 - 8.38]）、吸烟（风险比为1.45 [1.14 - 1.87]）、独居（风险比为1.32 [1.04 - 1.69]）和低载脂蛋白B（每10 mg/dL的风险比为0.94 [0.90 - 0.99]）与脑出血事件显著相关。收缩压、吸烟和口服抗凝剂与脑叶性脑出血有关。收缩压、舒张压、独居和糖尿病与非脑叶性脑出血有关。糖尿病和舒张压与脑叶性和非脑叶性脑出血的关系显著不同。饮酒、载脂蛋白A1、体重指数、腰围、体力活动和教育程度与脑出血无独立关联。血压、吸烟、低载脂蛋白B、口服抗凝剂和独居与脑出血有关。糖尿病仅与非脑叶性脑出血有关。需要对脑叶性和非脑叶性脑出血之间的差异进行进一步研究。
