Ikeda Shuhei, Yakushiji Yusuke, Tanaka Jun, Nishihara Masashi, Ogata Atsushi, Eriguchi Makoto, Ono Shohei, Kosugi Masafumi, Suzuyama Kohei, Mizoguchi Megumi, Shichijo Chika, Ide Toshihiro, Nagaishi Yukiko, Ono Natsuki, Yoshikawa Masaaki, Katsuki Yoshiko, Irie Hiroyuki, Abe Tatsuya, Koike Haruki, Hara Hideo
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Department of Neurology, Kansai Medical University, Hirakata, Japan.
Hypertens Res. 2025 Jan;48(1):233-243. doi: 10.1038/s41440-024-01906-1. Epub 2024 Sep 19.
We investigated the effects of individual and cumulative cerebral small vessel disease (SVD) markers on long-term clinical outcomes in spontaneous intracerebral hemorrhage (sICH) patients. This prospective, single-center cohort study was conducted from 2012 to 2019. SVD markers, including lacunae, cerebral microbleeds, white matter hyperintensity (WMH), and perivascular spaces in the basal ganglia, were assessed to calculate a summary SVD score. Patients were categorized into severe (score ≥3) and non-severe (score 0-2) SVD burden groups. Functional prognosis was defined as recovery, no change, or decline based on modified Rankin Scale changes at 2 years after discharge, excluding death. Associations of SVD burden and individual SVD markers with outcomes were evaluated using Cox proportional hazards modeling for recurrent stroke and all-cause mortality, and using ordinal logistic regression for functional prognosis. Among 155 sICH patients who underwent MRI, 98 showed severe SVD burden. Recurrent stroke and all-cause mortality rates were 2.2 and 8.3 per 100 patient-years, respectively, over a median 2.1-year follow-up. In terms of functional prognosis, 57 patients (51.8%) recovered, 32 (29.1%) showed no change, and 21 (19.1%) declined. A significant association was apparent between severe SVD burden and poorer functional prognosis (odds ratio [OR] 2.48, 95% confidence interval [CI] 1.04-6.04; p = 0.042), particularly with moderate-to-severe WMH (OR 2.54, 95%CI 1.02-6.54; p = 0.048). The cumulative effects of SVD markers inhibited long-term functional recovery in sICH patients. Severe SVD burden, as well as moderate-to-severe WMH, can be indicators of long-term prognosis after sICH.
我们研究了个体及累积性脑小血管病（SVD）标志物对自发性脑出血（sICH）患者长期临床结局的影响。这项前瞻性单中心队列研究于2012年至2019年进行。评估了包括腔隙、脑微出血、白质高信号（WMH）以及基底节区血管周围间隙等SVD标志物，以计算SVD综合评分。患者被分为严重（评分≥3）和非严重（评分0 - 2）SVD负担组。功能预后根据出院后2年基于改良Rankin量表变化定义为恢复、无变化或恶化，不包括死亡。使用Cox比例风险模型评估SVD负担和个体SVD标志物与复发性卒中及全因死亡率结局的关联，使用有序逻辑回归评估功能预后。在155例接受MRI检查的sICH患者中，98例显示严重SVD负担。在中位2.1年的随访期间，复发性卒中和全因死亡率分别为每100患者年2.2例和8.3例。在功能预后方面，57例患者（51.8%）恢复，32例（29.1%）无变化，21例（19.1%）恶化。严重SVD负担与较差的功能预后之间存在显著关联（优势比[OR] 2.48，95%置信区间[CI] 1.04 - 6.04；p = 0.042），特别是与中度至重度WMH（OR 2.54，95%CI 1.02 - 6.54；p = 0.048）。SVD标志物的累积效应抑制了sICH患者的长期功能恢复。严重SVD负担以及中度至重度WMH可作为sICH后长期预后的指标。
