Passero S, Burgalassi L, D'Andrea P, Battistini N
Istituto di Clinica delle Malattie Nervose e Mentali, Università di Siena, Italy.
Stroke. 1995 Jul;26(7):1189-92. doi: 10.1161/01.str.26.7.1189.
Rebleeding in patients with primary intracerebral hemorrhage is considered uncommon, but there are no precise data to support this opinion. The purpose of this study was to assess the incidence and predictors of recurrent bleeding in survivors of primary intracerebral hemorrhage.
As part of a prospective study, 112 survivors of a first primary intracerebral hemorrhage were followed up for a mean period of 84.1 months after their discharge. To ascertain risk factors that may influence rebleeding, several demographic, medical history, clinical, and laboratory variables were collected and analyzed.
Twenty-four percent (27/112) of survivors experienced one or more rebleeding during the follow-up period, in 8 cases (30%) in the first year of follow-up; in the others recurrence occurred later, up to 11.5 years. Rebleeding had a high mortality rate: 70% of patients died as a consequence of their second or third hemorrhage. Univariate and multivariate analyses showed that lobar location of the first hemorrhage was the only significant predictor of rebleeding. Patients with rebleeding were more frequently older, more often had a history of previous transient ischemic attack or ischemic stroke, and less often had hyperlipidemia than patients without rebleeding, although these correlations did not reach statistical significance. During follow-up, poor control of arterial hypertension was found in 7% of hypertensive patients without rebleeding and in 47% of hypertensive patients with rebleeding.
Our study showed that rebleeding after a first primary intracerebral hemorrhage is not as uncommon as is usually believed. The risk of rebleeding seems to be particularly high after hemorrhage at the junction of the gray and white matter, a site regarded as typical of hemorrhages due to amyloid angiopathy, and when arterial hypertension is poorly controlled.
原发性脑出血患者的再出血被认为并不常见，但尚无确切数据支持这一观点。本研究的目的是评估原发性脑出血幸存者再出血的发生率及预测因素。
作为一项前瞻性研究的一部分，对112例首次原发性脑出血幸存者出院后平均随访84.1个月。为确定可能影响再出血的危险因素，收集并分析了若干人口统计学、病史、临床及实验室变量。
24%（27/112）的幸存者在随访期间经历了一次或多次再出血，其中8例（30%）在随访的第一年发生再出血；其他患者的再出血发生在较晚时间，最长达11.5年。再出血的死亡率很高：70%的患者因第二次或第三次出血而死亡。单因素和多因素分析表明，首次出血的脑叶部位是再出血的唯一显著预测因素。与未发生再出血的患者相比，发生再出血的患者年龄更大，既往有短暂性脑缺血发作或缺血性卒中病史的情况更常见，而高脂血症的情况则较少见，尽管这些相关性未达到统计学显著性。在随访期间，未发生再出血的高血压患者中有7%的患者动脉高血压控制不佳，而发生再出血的高血压患者中有47%的患者动脉高血压控制不佳。
我们的研究表明，首次原发性脑出血后的再出血并不像通常认为的那样罕见。在灰质和白质交界处出血后，再出血风险似乎特别高，该部位被认为是淀粉样血管病所致出血的典型部位，且当动脉高血压控制不佳时也是如此。
