Reidler Paul, Brehm Alex, Sporns Peter B, Burbano Vanessa Granja, Stueckelschweiger Lena, Broocks Gabriel, Liebig Thomas, Psychogios Marios-Nikos, Ricke Jens, Dimitriadis Konstantinos, Dichgans Martin, Kunz Wolfgang G, Tiedt Steffen
Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
J Neurol Neurosurg Psychiatry. 2023 Jan;94(1):70-73. doi: 10.1136/jnnp-2021-326072. Epub 2021 May 26.
Experimental stroke studies suggest an influence of the time of day of stroke onset on infarct progression. Whether this holds true after human stroke is unknown, but would have implications for the design of randomised controlled trials, especially those on neuroprotection.
We pooled data from 583 patients with anterior large-vessel occlusion stroke from three prospectively recruited cohorts. Ischaemic core and penumbra volumes were determined with CT perfusion using automated thresholds. Core growth was calculated as the ratio of core volume and onset-to-imaging time. To determine circadian rhythmicity, we applied multivariable linear and sinusoidal regression analysis adjusting for potential baseline confounders.
Patients with symptom onset at night showed larger ischaemic core volumes on admission compared with patients with onset during the day (median, 40.2 mL vs 33.8 mL), also in adjusted analyses (p=0.008). Sinusoidal analysis indicated a peak of core volumes with onset at 11pm. Core growth was faster at night compared with day onset (adjusted p=0.01), especially for shorter onset-to-imaging times. In contrast, penumbra volumes did not change across the 24-hour cycle.
These results suggest that human infarct progression varies across the 24-hour cycle with potential implications for the design and interpretation of neuroprotection trials.
实验性中风研究表明，中风发作的时间对梗死进展有影响。在人类中风后这是否成立尚不清楚，但这将对随机对照试验的设计产生影响，尤其是对神经保护方面的试验。
我们汇总了来自三个前瞻性招募队列的583例前循环大血管闭塞性中风患者的数据。使用自动阈值通过CT灌注确定缺血核心区和半暗带体积。核心区生长以核心区体积与发病至成像时间的比值计算。为了确定昼夜节律性，我们应用多变量线性和正弦回归分析，并对潜在的基线混杂因素进行校正。
与白天发病的患者相比，夜间症状发作的患者入院时缺血核心区体积更大（中位数，40.2 mL对33.8 mL），校正分析中也是如此（p = 0.008）。正弦分析表明，核心区体积在晚上11点发作时达到峰值。与白天发病相比，夜间核心区生长更快（校正p = 0.01），尤其是发病至成像时间较短时。相比之下，半暗带体积在24小时周期内没有变化。
这些结果表明，人类梗死进展在24小时周期内有所不同，这可能对神经保护试验的设计和解释产生影响。
