Veldeman Michael, Ridwan Hani, Alzaiyani Mohamed, Pjontek Rastislav, Kremer Benedikt, Hoellig Anke, Clusmann Hans, Hamou Hussam
Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, 52062 Aachen, Germany.
J Clin Med. 2024 Aug 6;13(16):4591. doi: 10.3390/jcm13164591.
Chronic subdural hematoma (cSDH) is a common disease of growing significance due to the increasing use of antithrombotic drugs and population aging. There exists conflicting observational evidence that previous treatment with angiotensin-converting enzyme (ACE) inhibitors reduces the rate of cSDH recurrence. This study assesses the hypothesis that ACE inhibitors may affect recurrence rates by altering hematoma membrane formation. All patients with chronic subdural hematoma who were operated upon in a single university hospital between 2015 and 2020 were considered for inclusion. Hematomas were classified according to their structural appearance in computed tomography (CT) imaging into one of eight subtypes. Patients' own medication, prior to hospitalization for cSDH treatment, was noted, and the use of ACI-inhibitors was identified. Of the included 398 patients, 142 (35.9%) were treated with ACE inhibitors before admission for cSDH treatment. Of these, 115 patients (81.0%) received ramipril, 13 received patients lisinopril (11.3%), and 11 patients (9.6%) received enalapril. Reflecting cardiovascular comorbidity, patients on ACE inhibitors were more often simultaneously treated with antithrombotics (63.4% vs. 42.6%; ≤ 0.001). Hematomas with homogenous hypodense (OR 11.739, 95%CI 2.570 to 53.612; = 0.001), homogenous isodense (OR 12.204, 95%CI 2.669 to 55.798; < 0.001), and homogenous hyperdense (OR 9.472, 95%CI 1.718 to 52.217; < 0.001) architectures, as well as the prior use of ACE inhibitors (OR 2.026, 95%CI 1.214 to 3.384; = 0.007), were independently associated with cSDH recurrence. Once corrected for hematoma architecture, type of surgery, and use of antithrombotic medication, preoperative use of ACE inhibitors was associated with a twofold increase in the likelihood of hematoma recurrence.
慢性硬膜下血肿（cSDH）是一种因抗血栓药物使用增加和人口老龄化而日益重要的常见疾病。有相互矛盾的观察证据表明，既往使用血管紧张素转换酶（ACE）抑制剂治疗可降低cSDH复发率。本研究评估ACE抑制剂可能通过改变血肿膜形成来影响复发率这一假说。纳入2015年至2020年在一所大学医院接受手术的所有慢性硬膜下血肿患者。根据计算机断层扫描（CT）成像中的结构外观将血肿分为八种亚型之一。记录患者在因cSDH治疗住院前的自用药物，并确定ACE抑制剂的使用情况。在纳入的398例患者中，142例（35.9%）在因cSDH治疗入院前接受了ACE抑制剂治疗。其中，115例患者（81.0%）接受雷米普利治疗，13例患者（11.3%）接受赖诺普利治疗，11例患者（9.6%）接受依那普利治疗。反映心血管合并症的情况，使用ACE抑制剂的患者更常同时接受抗血栓药物治疗（63.4%对42.6%；P≤0.001）。具有均匀低密度（比值比[OR]11.739，95%置信区间[CI]2.570至53.612；P = 0.001）、均匀等密度（OR 12.204，95%CI 2.669至55.798；P < 0.001）和均匀高密度（OR 9.472，95%CI 1.718至52.217；P < 0.001）结构的血肿，以及既往使用ACE抑制剂（OR 2.026，95%CI 1.214至3.384；P = 0.007），均与cSDH复发独立相关。一旦校正血肿结构、手术类型和抗血栓药物的使用，术前使用ACE抑制剂与血肿复发可能性增加两倍相关。
