Department of Neurology, Ruijin Hospital/Luwan Branch, School of Medicine, Shanghai Jiao Tong University.
Department of Neurology, Minhang Hospital, Fudan University.
J Atheroscler Thromb. 2021 Sep 1;28(9):997-1008. doi: 10.5551/jat.61267. Epub 2021 Feb 6.
To explore the predictive values of different small vessel disease (SVD) scores on functional recoveries and the clinical cerebrovascular events in mild intracerebral hemorrhage (ICH).
In this study, we enrolled conscious and mild ICH patients without surgery and further divided them into the cerebral amyloid angiopathy (CAA)-ICH group and hypertension (HTN)-ICH group. The severity of individual SVD markers, including lacunes, cerebral microbleeds (CMBs), enlarged perivascular spaces (EPVS), white matter hyperintensity (WMH), and cortical superficial siderosis (cSS), was evaluated. The original SVD score, modified SVD score, refined SVD score, and CAA-SVD score and the total number of SVD markers were further calculated. Functional recoveries were evaluated using the modified Rankin scale. Recurrences of stroke were defined as readmission to the hospital with a definite diagnosis of stroke.
A total of 163 ICH patients (60 CAA-ICH and 103 HTN-ICH) were included in the study. The CAA-SVD score (OR=3.429; 95% confidence interval (CI)=1.518-7.748) had the best predictive effect on functional dependence in the CAA-ICH group, among which cSS severities probably played a vital role (OR=4.665; 95% CI=1.388-15.679). The total number of SVD markers [hazard ratio (HR)=3.765; 95% CI=1.467-9.663] can better identify stroke recurrences in CAA-ICH. In HTN-ICH, while the total number of SVD markers (HR=2.136; 95% CI=1.218-3.745) also demonstrated association with recurrent stroke, this effect seems to be related with the influence of lacunes (HR=5.064; 95% CI=1.697-15.116).
The CAA-SVD score and the total number of SVD markers might identify mild CAA-ICH patients with poor prognosis. However, it would be better to focus on lacunes rather than on the overall burden of SVD to predict recurrent strokes in HTN-ICH.
探讨不同小血管疾病（SVD）评分对轻度脑出血（ICH）患者功能恢复和临床脑血管事件的预测价值。
本研究纳入了意识清楚且未接受手术的轻度 ICH 患者，并进一步将其分为脑淀粉样血管病（CAA）-ICH 组和高血压（HTN）-ICH 组。评估了个体 SVD 标志物的严重程度，包括腔隙、脑微出血（CMB）、扩大的血管周围间隙（EPVS）、脑白质高信号（WMH）和皮质表面铁沉积（cSS）。进一步计算了原始 SVD 评分、改良 SVD 评分、细化 SVD 评分、CAA-SVD 评分和 SVD 标志物总数。使用改良 Rankin 量表评估功能恢复情况。卒中复发定义为因明确诊断为卒中而再次住院。
共纳入 163 例 ICH 患者（60 例 CAA-ICH 和 103 例 HTN-ICH）。在 CAA-ICH 组中，CAA-SVD 评分（OR=3.429；95%置信区间（CI）=1.518-7.748）对功能依赖的预测效果最佳，其中 cSS 严重程度可能起着重要作用（OR=4.665；95% CI=1.388-15.679）。SVD 标志物总数（HR=3.765；95% CI=1.467-9.663）可更好地识别 CAA-ICH 患者的卒中复发。在 HTN-ICH 中，尽管 SVD 标志物总数（HR=2.136；95% CI=1.218-3.745）与卒中复发也有关，但这种效应似乎与腔隙的影响有关（HR=5.064；95% CI=1.697-15.116）。
CAA-SVD 评分和 SVD 标志物总数可能有助于识别预后不良的轻度 CAA-ICH 患者。然而，预测 HTN-ICH 患者的卒中复发时，最好将重点放在腔隙上，而不是整体 SVD 负担上。
