Jingjing Zhang, Jingjing Zhao, Bo Hui, Le Wang, Jingya Wei, Dong Wei, Fang Yang, Wen Jiang
Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China.
Front Neurol. 2021 Oct 22;12:736383. doi: 10.3389/fneur.2021.736383. eCollection 2021.
The sulfonylurea receptor 1-transient receptor potential melastatin 4 (SUR1-TRPM4) channel is a target key mediator of brain edema. Sulfonylureas (SFUs) are blockers of the SUR1-TRPM4 channel. We made two assessments for the pretreatment of SFUs: (1) whether it associates with lower perihematomal edema (PHE) and (2) whether it associates with improved clinical outcomes in diabetic patients who have acute basal ganglia hemorrhage. This retrospective case-control study was conducted in diabetic adults receiving regular SFUs before the onset of intracerebral hemorrhage (ICH). All of the patients received the clinical diagnosis of spontaneous basal ganglia hemorrhage. The diagnosis was confirmed by a CT scan within 7 days after hemorrhage. For each case, we selected two matched controls with basal ganglia hemorrhage based on admission time (≤5 years) and age differences (≤5 years), with the same gender and similar hematoma volume. The primary outcome was PHE volume, and the secondary outcomes were relative PHE (rPHE), functional independence according to modified Rankin Scale score and Barthel Index at discharge, and death rate in the hospital. A total of 27 patients (nine cases and 18 matched controls), admitted between January 1, 2009 and October 31, 2018, were included in our study. There was no significant association between SFU patients and non-SFU patients on PHE volumes [15.4 (7.4-50.2 ml) vs. 8.0 (3.1-22.1) ml, = 0.100]. Compared to non-SFU patients, the SFU patients had significantly lower rPHE [0.8 (0.7-1.3) vs. 1.5 (1.2-1.9), = 0.006]. After we adjusted the confounding factors, we found that sulfonylureas can significantly reduce both PHE volume (regression coefficient: -13.607, 95% CI: -26.185 to -1.029, = 0.035) and rPHE (regression coefficient: -0.566, 95% CI: -0.971 to -0.161, = 0.009). However, we found no significant improvement in clinical outcomes at discharge, in the event of pretreatment of SFUs before the onset of ICH, even after we adjusted the confounding factors. For diabetic patients with acute basal ganglia hemorrhage, pretreatment of sulfonylureas may associate with lower PHE and relative PHE on admission. No significant effect was found on the clinical outcomes when the patients were discharged. Future studies are needed to assess the potential clinical benefits using sulfonylureas for ICH patients.
磺脲类受体1-瞬时受体电位香草酸亚家族成员4（SUR1-TRPM4）通道是脑水肿的关键靶点和介质。磺脲类药物（SFUs）是SUR1-TRPM4通道的阻滞剂。我们对SFUs预处理进行了两项评估：（1）它是否与较低的血肿周围水肿（PHE）相关；（2）它是否与急性基底节出血的糖尿病患者临床结局改善相关。这项回顾性病例对照研究在脑出血（ICH）发作前接受常规SFUs治疗的糖尿病成年人中进行。所有患者均经临床诊断为自发性基底节出血。出血后7天内通过CT扫描确诊。对于每例患者，我们根据入院时间（≤5年）和年龄差异（≤5岁）、相同性别和相似血肿体积，选择两名匹配的基底节出血对照。主要结局是PHE体积，次要结局是相对PHE（rPHE）、出院时根据改良Rankin量表评分和Barthel指数评估的功能独立性以及医院死亡率。2009年1月1日至2018年10月31日期间共纳入27例患者（9例病例和18例匹配对照）。SFU患者和非SFU患者的PHE体积之间无显著关联[15.4（7.4 - 50.2 ml）对8.0（3.1 - 22.1）ml，P = 0.100]。与非SFU患者相比，SFU患者的rPHE显著更低[0.8（0.7 - 1.3）对1.5（1.2 - 1.9），P = 0.00
