Xu Mangmang, Li Baojin, Zhong Di, Cheng Yajun, Wu Qian, Zhang Shuting, Zhang Shihong, Wu Bo, Liu Ming
Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China.
Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Aging Neurosci. 2021 Feb 19;13:628271. doi: 10.3389/fnagi.2021.628271. eCollection 2021.
Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH). We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0-4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1-6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome. A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181-8.956, = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220-3.456, = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230-6.878, = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039-3.157, = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017-2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080-4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB < 10 (adjusted HR 2.669, 95% CI 1.248-5.707, = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066-9.250, = 0.038). Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.
脑小血管病（CSVD）在原发性脑出血（ICH）中的长期预后意义尚不确定。我们对连续的原发性ICH且接受了MRI检查的患者进行了CSVD与临床结局的纵向分析。评估了基线CSVD负荷（包括白质高信号[WMH]、脑微出血[CMB]、腔隙和血管周围间隙扩大[EPVS]）。通过合并每个CSVD标志物的存在情况计算累积CSVD评分（范围0 - 4）。在中位随访4.9年[四分位间距[IQR] 3.1 - 6.0]期间，我们对参与者进行了功能结局不良[改良Rankin量表[mRS]≥4]、卒中复发和随时间变化的生存情况的随访。进行了简约和完整的多变量逻辑回归分析以及Cox回归分析，以估计CSVD标志物单独和共同与每个结局的关联。共有153例患者纳入分析。10个及以上CMB（校正比值比[adOR] 3.252，95%可信区间1.181 - 8.956，P = 0.023）和脑室周围WMH（PWMH）（adOR 2.053，95%可信区间1.220 - 3.456，P = 0.007）与功能结局不良显著相关。PWMH（adOR 2.908，95%可信区间1.230 - 6.878，P = 0.015）和脑叶CMB严重程度（adOR 1.811，95%可信区间1.039 - 3.157，P = 0.036）与卒中复发相关。累积CSVD评分与功能结局不良（adOR 1.460，95%可信区间1.017 - 2.096）和卒中复发（adOR 2.258，95%可信区间1.080 - 4.723）相关。10个及以上CMB的患者中有36.1%（13/36）死亡，而CMB < 10的患者中这一比例为18.8%（22/117）（校正风险比2.669，95%可信区间1.248 - 5.707，P = 0.011）。此外，累积CSVD评分≥2与生存率降低相关（校正风险比3.140，95%可信区间1.066 - 9.250，P = 0.038）。严重的PWMH、CMB或累积CSVD负担对ICH的长期结局有重要影响。
