From the Department of Neurology (D.R., A.B., W.R., J.G., M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (A.B., C.Y., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (M.F., D.W.), University of Cincinnati Academic Health Center, OH; Department of Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (F.T.), University of Illinois Hospital & Health Sciences System, Chicago.
Neurology. 2020 Dec 15;95(24):e3386-e3393. doi: 10.1212/WNL.0000000000010990. Epub 2020 Nov 20.
OBJECTIVE: To test the hypothesis that patients with deep intracerebral hemorrhage (ICH) would encounter hematoma expansion (HE) more frequently compared to patients with lobar ICH. METHODS: Patients with ICH with neuroimaging to calculate HE were analyzed from the multicenter Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) cohort. Patients with laboratory coagulopathy or preceding anticoagulant use were excluded to assess relationships of ICH location alone (deep vs lobar) with HE, defined as >33% relative growth. Odds ratios (ORs) and 95% confidence intervals (CIs) for these relationships were estimated with logistic regression. Sensitivity and specificity determined HE thresholds best associated with poor 3-month outcomes (modified Rankin score 4-6) stratified by location. RESULTS: There were 1,049 patients with deep and 408 patients with lobar ICH analyzed. Deep ICH locations were more likely to have HE (adjusted OR 1.57, 95% CI 1.08-2.29) after adjustment for age, sex, race, baseline hematoma size, and intraventricular hemorrhage. However, this difference was nonsignificant (adjusted OR 1.35, 95% CI 0.81-2.24) after controlling for time from symptom onset to admission CT in a subgroup analysis of 729 patients with these data. Yet, the threshold of HE best associated with poor outcomes was smaller in deep (30%) compared to lobar (50%) ICH. CONCLUSIONS: While HE was more frequent in deep than lobar ICH, this could be due to differences in symptom onset to admission CT times in our cohort. However, patients with deep ICH appear particularly vulnerable to the deleterious effects of small volumes of HE. Further studies should clarify whether ICH location needs to be considered in HE treatment paradigms.
目的:检验以下假设,即与脑叶 ICH 患者相比,深部脑内血肿(ICH)患者更常发生血肿扩大(HE)。
方法:从多中心种族/ICH (ERICH)队列的神经影像学计算 HE 的 ICH 患者中分析患者。排除有实验室凝血功能障碍或之前使用抗凝剂的患者,以评估 ICH 位置(深部与脑叶)与 HE (定义为> 33%相对增长)的关系,采用逻辑回归估计这些关系的比值比(OR)和 95%置信区间(CI)。根据位置分层,确定与不良 3 个月结局(改良 Rankin 评分 4-6)关联最佳的 HE 阈值。
结果:分析了 1049 例深部 ICH 和 408 例脑叶 ICH 患者。在调整年龄、性别、种族、基线血肿大小和脑室出血后,深部 ICH 部位更可能发生 HE(调整后的 OR 1.57,95%CI 1.08-2.29)。然而,在对具有这些数据的 729 例患者的亚组分析中,控制从症状发作到入院 CT 的时间后,这一差异无统计学意义(调整后的 OR 1.35,95%CI 0.81-2.24)。然而,与不良结局关联最佳的 HE 阈值在深部(30%)ICH 中小于脑叶(50%)ICH。
结论:尽管深部 ICH 比脑叶 ICH 更常发生 HE,但这可能是由于我们队列中从症状发作到入院 CT 的时间不同所致。然而,深部 ICH 患者似乎特别容易受到小体积 HE 的有害影响。进一步的研究应该阐明在 HE 治疗方案中是否需要考虑 ICH 位置。
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