Won Yu-Deok, Kim Jae-Min, Cheong Jin-Hwan, Ryu Je-Il, Koh Seong-Ho, Han Myung-Hoon
Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Korea.
Department of Neurology, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Gyonggi-do, Korea.
J Clin Med. 2021 Jun 7;10(11):2526. doi: 10.3390/jcm10112526.
hemorrhagic transformation (HT) is a frequent complication of ischemic stroke, and parenchymal hematoma (PH)-type HT has been shown to correlate with symptomatic deterioration. Because both bone and vascular smooth muscle cells are composed of type 1 collagen, we hypothesized that the integrity of blood vessels around the infarction area might be more damaged in osteoporotic conditions after a cardioembolic stroke.
we measured frontal skull Hounsfield unit (HU) values on brain CT images from cardioembolic stroke patients. We conducted a receiver operating characteristic curve analysis in a large sample registry to identify the optimal HU threshold for predicting osteopenia and osteoporosis. Hazard ratios were estimated using a Cox regression analysis to identify whether osteoporotic conditions were an independent predictor of PH-type HT in patients with cardioembolic stroke.
altogether, 600 consecutive patients (>18 years old) with cardioembolic stroke were enrolled over a 12-year period at our hospital. The infarction volume and hypothetical osteoporosis were independent predictive factors for PH-type HT development in patients with cardioembolic stroke. In the male group, hypothetical osteoporosis was an independent predictor for PH-type HT development after cardioembolic stroke (hazard ratio, 4.12; 95% confidence interval, 1.40-12.10; = 0.010).
our study suggests an association between possible osteoporosis and the development of PH-type HT in patients with cardioembolic stroke. Our findings could help to predict PH-type HT by providing a convenient method for measuring the HU value using brain CT images.
出血性转化（HT）是缺血性卒中常见的并发症，脑实质血肿（PH）型HT与症状恶化相关。由于骨骼和血管平滑肌细胞均由I型胶原组成，我们推测心源性栓塞性卒中后，骨质疏松情况下梗死灶周围血管的完整性可能受损更严重。
我们测量了心源性栓塞性卒中患者脑部CT图像上的额骨Hounsfield单位（HU）值。我们在一个大型样本登记库中进行了受试者工作特征曲线分析，以确定预测骨质减少和骨质疏松的最佳HU阈值。使用Cox回归分析估计风险比，以确定骨质疏松情况是否是心源性栓塞性卒中患者PH型HT的独立预测因素。
在12年期间，我院共纳入600例连续的心源性栓塞性卒中患者（年龄>18岁）。梗死体积和假设的骨质疏松是心源性栓塞性卒中患者发生PH型HT的独立预测因素。在男性组中，假设的骨质疏松是心源性栓塞性卒中后发生PH型HT的独立预测因素（风险比，4.12；95%置信区间，1.40 - 12.10；P = 0.010）。
我们的研究表明，心源性栓塞性卒中患者可能存在的骨质疏松与PH型HT的发生之间存在关联。我们的研究结果通过提供一种使用脑部CT图像测量HU值的便捷方法，有助于预测PH型HT。
