From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France.
Neurology. 2021 Feb 16;96(7):e995-e1004. doi: 10.1212/WNL.0000000000011378. Epub 2020 Dec 22.
To determine whether mixed location intracerebral hemorrhages/microbleeds (mixed ICH) is a risk factor for vascular unfavorable outcome compared to cerebral amyloid angiopathy-related ICH (CAA-ICH) or strictly deep hypertensive ICH/microbleeds (HTN-ICH).
A total of 300 patients with spontaneous ICH were included. Clinical data, neuroimaging markers, and follow-up outcomes (recurrent ICH, ischemic stroke, and vascular death) were compared among mixed ICH (n = 148), CAA-ICH (n = 32), and HTN-ICH (n = 120). The association between follow-up events and neuroimaging markers was explored using multivariable Cox regression models.
Patients with mixed ICH were older (65.6 ± 12.1 years vs 58.1 ± 13.3 years, < 0.001) than patients with HTN-ICH, but younger than patients with CAA-ICH (73.3 ± 13.8 years, = 0.001). Compared to CAA-ICH, mixed ICH had similar incidence of vascular events (all > 0.05). Compared to HTN-ICH, mixed ICH is associated with higher ICH recurrence (hazard ratio [HR] 3.0, 95% confidence interval [CI] 1.2-7.7), more ischemic stroke (HR 8.2, 95% CI 1.0-65.8), and vascular composite outcome (HR 3.5, 95% CI 1.5-8.2) after adjustment for age and sex. In patients with mixed ICH, the presence of cortical superficial siderosis (cSS) is associated the development of ICH recurrence (HR 4.8, 95% CI 1.0-23.2), ischemic stroke (HR 8.8, 95% CI 1.7-45.5), and vascular composite outcome (HR 6.2, 95% CI 1.9-20.2). The association between cSS and ischemic stroke ( = 0.01) or vascular composite outcome ( = 0.003) remained significant after further adjustment for other radiologic markers.
Mixed ICH harbors higher risk of unfavorable vascular outcome than HTN-ICH. Presence of cSS in mixed ICH independently predicts vascular event, suggesting the contribution of detrimental effect due to coexisting CAA.
确定混合部位脑实质出血/微出血（混合 ICH）与脑淀粉样血管病相关 ICH（CAA-ICH）或单纯深部高血压性 ICH/微出血（HTN-ICH）相比，是否是血管不良结局的危险因素。
共纳入 300 例自发性 ICH 患者。比较混合 ICH（n=148）、CAA-ICH（n=32）和 HTN-ICH（n=120）患者的临床资料、神经影像学标志物和随访结局（ICH 复发、缺血性卒中和血管性死亡）。采用多变量 Cox 回归模型探讨随访事件与神经影像学标志物之间的关系。
混合 ICH 患者较 HTN-ICH 患者年龄更大（65.6±12.1 岁 vs 58.1±13.3 岁， ＜0.001），但较 CAA-ICH 患者年轻（73.3±13.8 岁， = 0.001）。与 CAA-ICH 相比，混合 ICH 血管事件发生率相似（均 ＞0.05）。与 HTN-ICH 相比，混合 ICH 与更高的 ICH 复发（风险比[HR]3.0，95%置信区间[CI]1.2-7.7）、更多的缺血性卒中和血管复合结局（HR 3.5，95%CI 1.5-8.2）相关，校正年龄和性别后差异有统计学意义。在混合 ICH 患者中，皮质表面铁沉积（cSS）的存在与 ICH 复发（HR 4.8，95%CI 1.0-23.2）、缺血性卒中和血管复合结局（HR 8.8，95%CI 1.7-45.5）的发生相关，校正其他影像学标志物后差异仍有统计学意义（HR 6.2，95%CI 1.9-20.2）。cSS 与缺血性卒中和血管复合结局的相关性（ = 0.01）或血管复合结局的相关性（ = 0.003）在进一步校正其他影像学标志物后仍有统计学意义。
与 HTN-ICH 相比，混合 ICH 血管不良结局风险更高。混合 ICH 中 cSS 的存在独立预测血管事件，提示共存 CAA 导致的不良影响。
