Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany,
Department of Neurology, Hospital de Braga, Braga, Portugal.
Cerebrovasc Dis Extra. 2021;11(1):15-21. doi: 10.1159/000513503. Epub 2021 Jan 27.
Intracerebral hemorrhage (ICH) recurrence risk is known to be higher in patients with cerebral amyloid angiopathy (CAA) as compared to other causes of ICH. Risk factors for ICH recurrence are not completely understood, and our goal was to study specific imaging microangiopathy markers.
Retrospective case-control study of patients with non-traumatic ICH admitted to a single center between 2014 and 2017 who underwent magnetic resonance imaging (MRI). Clinical characteristics of the index event and occurrence of death and ICH recurrence were collected from clinical records. MRI images were independently reviewed by 2 neuroradiologists. Groups of patients with CAA-related and CAA-unrelated ICH defined were compared. Presence of CAA was defined according to the Boston modified criteria. Survival analysis with Kaplan-Meier curves and Cox-regression analyses was performed to analyze ICH recurrence-free survival.
Among 448 consecutive patients with non-traumatic ICH admitted during the study period, 104 were included in the study, mean age 64 years (±13.5), median follow-up of 27 months (interquartile range, IQR 16-43), corresponding to 272 person-years of total follow-up. CAA-related ICH patients presented higher burden of lobar microbleeds (p < 0.001), higher burden of enlarged perivascular spaces (EPVS) in centrum semiovale (p < 0.001) and more frequently presented cortical superficial siderosis (cSS; p < 0.001). ICH recurrence in patients with CAA was 12.7 per 100 person-years, and no recurrence was observed in patients without CAA. Variables associated with ICH recurrence in the whole population were age (hazard ratio [HR] per 1-year increment = 1.05, 95% CI 1.00-1.11, p = 0.046), presence of disseminated cSS (HR 3.32, 95% CI 1.09-10.15, p = 0.035) and burden of EPVS in the centrum semiovale (HR per 1-point increment = 1.80, 95% CI 1.04-3.12, p = 0.035).
This study confirms a higher ICH recurrence risk in patients with CAA-related ICH and suggests that age, disseminated cSS, and burden of EPVS in the centrum semiovale are associated with ICH recurrence.
与其他原因引起的脑出血 (ICH) 相比，脑淀粉样血管病 (CAA) 患者的 ICH 复发风险更高。ICH 复发的危险因素尚未完全阐明，我们的目标是研究特定的影像学微血管病变标志物。
这是一项回顾性病例对照研究，纳入了 2014 年至 2017 年期间在单一中心因非外伤性 ICH 入院的患者，所有患者均接受了磁共振成像 (MRI) 检查。从临床记录中收集了指数事件的临床特征、死亡和 ICH 复发的发生情况。MRI 图像由 2 名神经放射科医生独立进行审查。将患者分为 CAA 相关和 CAA 不相关 ICH 组进行比较。根据波士顿改良标准定义 CAA 的存在。采用 Kaplan-Meier 曲线和 Cox 回归分析进行生存分析，以分析 ICH 无复发生存率。
在研究期间收治的 448 例连续非外伤性 ICH 患者中，有 104 例纳入了本研究，患者平均年龄 64 岁（±13.5），中位随访时间为 27 个月（四分位距，IQR 16-43），总随访时间为 272 人年。CAA 相关 ICH 患者的脑叶微出血负担更高（p < 0.001），脑白质半卵圆中心的扩大血管周围间隙（EPVS）负担更高（p < 0.001），皮质表面铁沉积（cSS）更常见（p < 0.001）。CAA 患者的 ICH 复发率为 12.7/100 人年，而无 CAA 患者未观察到 ICH 复发。全人群中与 ICH 复发相关的变量为年龄（每增加 1 岁 HR = 1.05，95%CI 1.00-1.11，p = 0.046）、弥散性 cSS（HR = 3.32，95%CI 1.09-10.15，p = 0.035）和脑白质半卵圆中心的 EPVS 负担（每增加 1 分 HR = 1.80，95%CI 1.04-3.12，p = 0.035）。
本研究证实了 CAA 相关 ICH 患者的 ICH 复发风险更高，并提示年龄、弥散性 cSS 和脑白质半卵圆中心的 EPVS 负担与 ICH 复发相关。
