Katano Hiroyuki, Nishikawa Yusuke, Uchida Mitsuru, Yamanaka Tomoyasu, Hayashi Yuki, Yamada Shigeki, Tanikawa Motoki, Yamada Kazuo, Mase Mitsuhito
Department of Neurosurgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Department of Medical Informatics and Integrative Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan.
Front Neurol. 2023 Aug 15;14:1205091. doi: 10.3389/fneur.2023.1205091. eCollection 2023.
Trends regarding the locations of hypertensive cerebral hemorrhages are unclear. To clarify hypertensive hemorrhage trends, we investigated intracerebral hemorrhages (ICHs) over an 18-year period, focusing on thalamic hemorrhages compared with other sites of hemorrhages.
We reviewed the cases of patients hospitalized for hypertensive ICH in 2004-2021 at our hospital; 1,320 eligible patients were registered with a primary ICH/intraventricular hemorrhage. After exclusion criteria were applied, we retrospectively analyzed 1,026 hypertensive ICH cases.
The proportions of thalamic and subcortical hemorrhages increased over the 18-year period, whereas putaminal hemorrhage decreased. Multivariate logistic regression analyses revealed that for thalamic hemorrhage, ≥200 mmHg systolic blood pressure ( = 0.031), bleeding <15 mL ( = 0.001), and higher modified Rankin scale (mRS) score ≥ 4 at discharge ( = 0.006) were significant variables in the late period (2013-2021) versus the early period (2004-2012), whereas for putaminal hemorrhage, significant factors in the late period were triglyceride <150 mg/dL ( = 0.006) and mRS score ≥ 4 at discharge ( = 0.002). Among the features of the thalamic hemorrhages in the late period revealed by our group comparison with the putaminal and subcortical hemorrhages, the total and subcortical microbleeds were more notable in the thalamic hemorrhages than in the other two types of hemorrhage, whereas cerebellar microbleeds were more prominent when compared only with subcortical hemorrhages.
Our findings revealed an increasing trend for thalamic hypertensive hemorrhage and a decreasing trend for putaminal hemorrhage. The thalamic hemorrhage increase was observed in both young and older patients, regardless of gender. The main features of thalamic hemorrhage in the late period versus the early period were decrease in larger hemorrhage (≥15 mL) and an increase in cases with higher systolic blood pressure (at least partially involved a small number of untreated hypertensive patients who developed major bleeding). The total and subcortical microbleeds were more notable in the thalamic hemorrhages of the late period than in the putaminal and subcortical hemorrhages. These results may contribute to a better understanding of the recent trends of hypertensive ICHs and may help guide their appropriate treatments for this condition.
高血压性脑出血的发病部位趋势尚不清楚。为了阐明高血压性脑出血的趋势，我们对18年间的脑出血（ICH）病例进行了调查，重点关注丘脑出血与其他出血部位的比较。
我们回顾了2004年至2021年在我院因高血压性ICH住院的患者病例；1320例符合条件的患者被登记为原发性ICH/脑室内出血。应用排除标准后，我们对1026例高血压性ICH病例进行了回顾性分析。
在这18年期间，丘脑和皮质下出血的比例增加，而壳核出血减少。多因素逻辑回归分析显示，对于丘脑出血，收缩压≥200 mmHg（P = 0.031）、出血量<15 mL（P = 0.001）以及出院时改良Rankin量表（mRS）评分≥4（P = 0.006）是晚期（2013 - 2021年）与早期（2004 - 2012年）相比的显著变量；而对于壳核出血，晚期的显著因素是甘油三酯<150 mg/dL（P = 0.006）和出院时mRS评分≥4（P = 0.002）。在我们将丘脑出血与壳核和皮质下出血进行组间比较时发现，晚期丘脑出血的总体和皮质下微出血比其他两种类型的出血更明显，而小脑微出血仅与皮质下出血相比时更突出。
我们的研究结果显示丘脑高血压性出血呈增加趋势，壳核出血呈减少趋势。在年轻和老年患者中均观察到丘脑出血增加，且与性别无关。晚期与早期丘脑出血的主要特征是较大出血量（≥15 mL）减少，以及收缩压较高的病例增加（至少部分涉及少数未治疗的高血压患者发生大出血）。晚期丘脑出血的总体和皮质下微出血比壳核和皮质下出血更明显。这些结果可能有助于更好地理解高血压性ICH的近期趋势，并可能有助于指导针对这种情况的适当治疗。
