Chen Bixia, Lahl Kirstin, Saban Dino, Lenkeit Annika, Rauschenbach Laurèl, Santos Alejandro N, Li Yan, Schmidt Boerge, Zhu Yuan, Jabbarli Ramazan, Wrede Karsten H, Kleinschnitz Christoph, Sure Ulrich, Dammann Philipp
Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Front Neurol. 2023 Jan 4;13:1010170. doi: 10.3389/fneur.2022.1010170. eCollection 2022.
Recurrent intracerebral hemorrhage (ICH) poses a high risk for patients with cerebral cavernous malformations (CCMs). This study aimed to assess the influence of medication intake on hemorrhage risk in sporadic CCMs.
From a database of 1,409 consecutive patients with CCM (2003-2021), subjects with sporadic CCMs and complete magnetic resonance imaging data were included. We evaluated the presence of ICH as a mode of presentation, the occurrence of ICH during follow-up, and medication intake, including beta blockers, statins, antithrombotic therapy, and thyroid hormones. The impact of medication intake on ICH at presentation was calculated using univariate and multivariate logistic regression with age and sex adjustment. The longitudinal cumulative 5-year risk for (re-)hemorrhage was analyzed using the Kaplan-Meier curves and the Cox regression analysis.
A total of 1116 patients with CCM were included. Logistic regression analysis showed a significant correlation (OR: 0.520, 95% CI: 0.284-0.951, = 0.034) between antithrombotic therapy and ICH as a mode of presentation. Cox regression analysis revealed no significant correlation between medication intake and occurrence of (re-)hemorrhage (hazard ratios: betablockers 1.270 [95% CI: 0.703-2.293], statins 0.543 [95% CI: 0.194-1.526], antithrombotic therapy 0.507 [95% CI: 0.182-1.410], and thyroid hormones 0.834 [95% CI: 0.378-1.839]).
In this observational study, antithrombotic treatment was associated with the tendency to a lower rate of ICH as a mode of presentation in a large cohort of patients with sporadic CCM. Intake of beta blockers, statins, and thyroid hormones had no effect on hemorrhage as a mode of presentation. During the 5-year follow-up period, none of the drugs affected the further risk of (re-)hemorrhage.
复发性脑出血（ICH）对脑海绵状血管畸形（CCM）患者构成高风险。本研究旨在评估药物摄入对散发性CCM患者出血风险的影响。
从一个包含1409例连续CCM患者（2003 - 2021年）的数据库中，纳入患有散发性CCM且有完整磁共振成像数据的受试者。我们评估了作为一种表现形式的ICH的存在情况、随访期间ICH的发生情况以及药物摄入情况，包括β受体阻滞剂、他汀类药物、抗血栓治疗和甲状腺激素。使用单因素和多因素逻辑回归并对年龄和性别进行调整，计算药物摄入对初诊时ICH的影响。使用Kaplan - Meier曲线和Cox回归分析来分析（再）出血的纵向累积5年风险。
共纳入1116例CCM患者。逻辑回归分析显示抗血栓治疗与作为一种表现形式的ICH之间存在显著相关性（比值比：0.520，95%置信区间：0.284 - 0.951，P = 0.034）。Cox回归分析显示药物摄入与（再）出血的发生之间无显著相关性（风险比：β受体阻滞剂1.270 [95%置信区间：0.703 - 2.293]，他汀类药物0.543 [95%置信区间：0.194 - 1.526]，抗血栓治疗0.507 [95%置信区间：0.182 - 1.410]，甲状腺激素0.834 [95%置信区间：0.378 - 1.839]）。
在这项观察性研究中，在一大群散发性CCM患者中，抗血栓治疗与作为一种表现形式的ICH发生率较低的趋势相关。β受体阻滞剂、他汀类药物和甲状腺激素的摄入对作为一种表现形式的出血无影响。在5年随访期内，没有一种药物影响（再）出血的进一步风险。
