脑出血患者伴皮质下含铁血黄素沉积的相关危险因素分析及预后的前瞻性研究
Analysis of risk factors and prognosis of cerebral hemorrhage patients accompanied by cortical superficial siderosis
Received date: 2019-02-20
Online published: 2019-04-25
目的：探讨皮质下含铁血黄素沉积（cortical superficial siderosis, cSS）在脑血管淀粉样变性（cerebral amyloid angiopathy, CAA）相关脑出血患者中的相关因素，及其对患者预后的影响。方法：采用前瞻性研究方法，入组在发病3 d内经CT诊断为脑出血的患者，所有患者均在发病5 d内行MRI检查，以明确cSS、脑微出血（cerebral microbleeds, CMBs）和脑白质疏松症（leukoaraiosis，LA）等，并在发病后1年内定期随访后续的临床脑血管事件。结果：共入组241例脑出血患者，其中深部出血185例，脑叶出血56例。脑叶出血患者中伴cSS的百分比多于深部出血者[23.2%（13/56）比 6.5%（12/185）, P<0.001]。根据改良Boston的CAA诊断标准判断，其中可能CAA患者占17.4%（42例）。在随访的1年内，241例脑出血患者中共有35例（14.5%）发生了临床脑血管事件或死亡，在可能CAA患者中有13例（13/42，31.0%）再发脑出血，在16例伴cSS的可能CAA患者中有9例于1年内死亡或再发脑出血，其相关脑出血发生率高于无cSS的可能CAA患者（P=0.015）。Kaplan-Meier显示，伴cSS的可能CAA患者再发脑出血的风险较高（χ2=7.466，P=0.006）。经多因素COX回归模型分析后发现，cSS仍为可能CAA患者再发脑出血的独立预测因素（HR=4.45;95% CI 为1.37~14.48，P=0.013）。结论：脑叶出血患者中伴发cSS的百分比高于深部出血患者;而伴有cSS 的可能CAA患者未来1年内再发脑出血的风险增加。
关键词： 皮质下含铁血黄素沉积; 淀粉样脑血管病; 脑小血管病; 核磁共振
陈洁, 胡进, 杨康, 傅毅 . 脑出血患者伴皮质下含铁血黄素沉积的相关危险因素分析及预后的前瞻性研究[J]. 诊断学理论与实践, 2019 , 18(2) : 133 -138 . DOI: 10.16150/j.1671-2870.2019.02.003
Objective: To investigate the related factors of cortical superficial siderosis (cSS) in cerebral hemorrhage patients associated with cerebral amylodid angiopathy (CAA) and its prognosis. Methods: A prospective study was performed on patients diagnosed as cerebral hemorrhage by CT within 3 days after onset and MRI was performed within 5 days for detecting cortical superficial siderosis (cSS ), cerebral microbleeds (CMBs) and leukoaraiosis (LA). Patients were followed up 1 year for observation of subsequent clinical cerebrovascular events. Result: Altogether 241 patients with cerebral hemorrhage were enrolled, including 185 cases of deep hemorrhage and 56 cases of lobar hemorrhage. The occurrence of cSS in lobar hemorrhage was more than that in deep hemorrhage (13/56, 23.2% vs 12/185, 6.5%, P<0.001). According to the modified Boston criteria, 42 patients (17.4%) were possible CAA. During the 1-year follow-up, 35 (14.5%) patients had clinical cerebrovascular events or death, and 13(31.0%) possible CAA patients had recurrent cerebral hemorrhage. Kaplan-Meier showed a higher risk of recurrent cerebral hemorrhage in possible CAA accompanied by cSS ( χ2=7.466, P=0.006). The multivariate COX regression model found that cSS was an independent predictor of recurrent cerebral hemorrhage in patients with possible CAA (HR 4.45; 95% CI 1.3714.48, P=0.013). Conclusions: The prevalence of cSS in patients with lobar hemorrhage was higher than that in deep bleeding. Possible CAA accompanied by cSS had an increased risk of recurrent cerebral hemorrhage within one year.
| [1] | 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2014)[J]. 中华神经科杂志, 2015, 48(6):435-444. |
| [2] | 中华医学会神经外科学分会, 中国医师协会急诊医师分会, 国家卫生和计划生育委员会脑卒中筛查与防治工程委员会. 自发性脑出血诊断治疗中国多学科专家共识[J]. 中华神经外科杂志, 2015, 31(12): 1189-1194. |
| [3] | Caetano A, Ladeira F, Barbosa R, et al. Cerebral amyloid angiopathy - The modified Boston criteria in clinical practice[J]. J Neurol Sci, 2018, 384:55-57. |
| [4] | DeSimone CV, Graff-Radford J, El-Harasis MA, et al. Cerebral Amyloid Angiopathy: Diagnosis, Clinical Implications, and Management Strategies in Atrial Fibrillation[J]. J Am Coll Cardiol, 2017, 70(9):1173-1182. |
| [5] | Charidimou A, Gang Q, Werring DJ. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum[J]. J Neurol Neurosurg Psychiatry, 2012, 83(2):124-137. |
| [6] | 冯玉兰, 蒋爱华, 颜静, 等. 脑血肿体积评估3种方法的比较研究[J]. 实用临床医药杂志, 2014, 18(11):26-30,36. |
| [7] | Greenberg SM, Vernooij MW, Cordonnier C, et al. Cerebral microbleeds: a guide to detection and interpretation[J]. Lancet Neurol, 2009, 8(2):165-174. |
| [8] | Cheng CY, Cheng HM, Chen SP, et al. White matter hyperintensities in migraine: Clinical significance and central pulsatile hemodynamic correlates[J]. Cephalalgia, 2018, 38(7):1225-1236. |
| [9] | Gupta A, Giambrone AE, Gialdini G, et al. Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis[J]. Stroke, 2016, 47(3):719-725. |
| [10] | Charidimou A, Linn J, Vernooij MW, et al. Cortical superficial siderosis: detection and clinical significance in cerebral amyloid angiopathy and related conditions[J]. Brain, 2015, 138(Pt 8):2126-2139. |
| [11] | Broderick JP, Adeoye O, Elm J. Evolution of the Modified Rankin Scale and Its Use in Future Stroke Trials[J]. Stroke, 2017, 48(7):2007-2012. |
| [12] | Yaghi S, Rostanski SK, Boehme AK, et al. Imaging Parameters and Recurrent Cerebrovascular Events in Patients With Minor Stroke or Transient Ischemic Attack[J]. JAMA Neurol, 2016, 73(5):572-578. |
| [13] | 时景璞, 滕卫禹, 王海龙, 等. 高血压高发区人群脑卒中患病现状的流行病学调查[J]. 中国卫生统计, 2006, 23(1):47-49. |
| [14] | Pantoni L. Cerebral small vessel disease: from pathoge-nesis and clinical characteristics to therapeutic challenges[J]. Lancet Neurol, 2010, 9(7):689-701. |
| [15] | Cordonnier C, Al-Shahi Salman R, Wardlaw J. Spontaneous brain microbleeds: systematic review, subgroup analyses and standards for study design and reporting[J]. Brain, 2007, 130(Pt 8):1988-2003. |
| [16] | Greenberg SM, Nandigam RN, Delgado P, et al. Microbleeds versus macrobleeds: evidence for distinct entities[J]. Stroke, 2009, 40(7):2382-2386. |
| [17] | Linn J, Herms J, Dichgans M, et al. Subarachnoid hemosiderosis and superficial cortical hemosiderosis in cerebral amyloid angiopathy[J]. Am J Neuroradiol, 2008, 29(1):184-186. |
| [18] | Linn J, Michl S, Katja B, et al. Cortical vein thrombosis: the diagnostic value of different imaging modalities[J]. Neuroradiology, 2010, 52(10):899-911. |
| [19] | Kumar S, Goddeau RP, Jr, Selim MH, et al. Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies[J]. Neurology, 2010, 74(11):893-899. |
| [20] | Na HK, Park JH, Kim JH, et al. Cortical superficial siderosis: a marker of vascular amyloid in patients with cognitive impairment[J]. Neurology, 2015, 84(8):849-855. |
| [21] | Samarasekera N, Smith C, Al-Shahi Salman R. The association between cerebral amyloid angiopathy and intrace-rebral haemorrhage: systematic review and meta-analysis[J]. J Neurol Neurosurg Psychiatry, 2012, 83(3):275-281. |
| [22] | Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intrace-rebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke, 2015, 46(7):2032-2060. |
| [23] | Wermer MJH, Greenberg SM. The growing clinical spectrum of cerebral amyloid angiopathy[J]. Curr Opin Neurol, 2018, 31(1):28-35. |
| [24] | Wieberdink RG, Poels MM, Vernooij MW, et al. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study[J]. Arterioscler Thromb Vasc Biol, 2011, 31(12):2982-2989. |
| [25] | Phuah CL, Raffeld MR, Ayres AM, et al. Subacute decline in serum lipids precedes the occurrence of primary intracerebral hemorrhage[J]. Neurology, 2016, 86(22):2034-2041. |
| [26] | Shoamanesh A, Martinez-Ramirez S, Oliveira-Filho J, et al. Interrelationship of superficial siderosis and microbleeds in cerebral amyloid angiopathy[J]. Neurology, 2014, 83(20):1838-1843. |
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