Jørgensen H S, Nakayama H, Raaschou H O, Olsen T S
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Ann Neurol. 1995 Jul;38(1):45-50. doi: 10.1002/ana.410380110.
The purpose of this study was to compare stroke severity, risk factors, and prognosis in patients with intracerebral hemorrhage versus infarction. We prospectively studied 1,000 unselected patients with acute stroke of a verified type in the Copenhagen Stoke Study. Neurological deficits and functional disabilities were evaluated weekly from the time of acute admission throughout the rehabilitation period. Eighty-eight (9%) had intracerebral hemorrhage. The relative frequency of intracerebral hemorrhage rose exponentially with increasing stroke severity. In multivariate analyses, stroke type had no influence on mortality, neurological outcome, functional outcome, or the time course of recovery. Initial stroke severity was the all-important prognostic factor. The relative importance of hypertension and blood pressure on admission was not greater for intracerebral hemorrhage than for infarction. No preponderance was found between type of stroke and sex, age, and smoking. Diabetes, ischemic heart disease, and elevated serum total cholesterol level all favored cerebral infarction as opposed to intracerebral hemorrhage. We conclude that the type of stroke per se has no influence on stroke prognosis in general; the extent of the injury is decisive. The poorer prognosis in patients with intracerebral hemorrhage is due to the increase in frequency of intracerebral hemorrhage with increasing stroke severity. The likelihood of cerebral infarction occurring as opposed to intracerebral hemorrhage seems increased fivefold in stroke patients with diabetes. Hypertension and blood pressure on admission were not predictors of stroke type.
本研究的目的是比较脑出血与脑梗死患者的卒中严重程度、危险因素及预后。在哥本哈根卒中研究中，我们对1000例未经筛选的确诊为急性卒中的患者进行了前瞻性研究。从急性入院时起至整个康复期，每周对神经功能缺损和功能障碍进行评估。88例（9%）为脑出血。脑出血的相对发生率随卒中严重程度的增加呈指数上升。在多变量分析中，卒中类型对死亡率、神经功能结局、功能结局或恢复的时间进程没有影响。初始卒中严重程度是最重要的预后因素。脑出血患者入院时高血压和血压的相对重要性并不高于脑梗死患者。在卒中类型与性别、年龄和吸烟之间未发现优势倾向。与脑出血相比，糖尿病、缺血性心脏病和血清总胆固醇水平升高均更易发生脑梗死。我们得出结论，一般而言，卒中类型本身对卒中预后没有影响；损伤程度起决定性作用。脑出血患者预后较差是由于脑出血发生率随卒中严重程度增加而升高。糖尿病卒中患者发生脑梗死而非脑出血的可能性似乎增加了五倍。入院时的高血压和血压不是卒中类型的预测因素。
