Analysis of risk factors and prognosis of cerebral hemorrhage patients accompanied by cortical superficial siderosis

doi:10.16150/j.1671-2870.2019.02.003

Abstract

Abstract:

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.

Key words: Cortical superficial siderosis, Cerebral amylodid angiopathy, Cerebral small vessel diseases, Magnetic resonance imaging

CLC Number:

R743.34

CHEN Jie, HU Jin, YANG Kang, FU Yi. Analysis of risk factors and prognosis of cerebral hemorrhage patients accompanied by cortical superficial siderosis[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(2): 133-138.

Figures/Tables 3

References 26

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参数	深部出血组（n=185）	脑叶出血组（n=56）	P 值
基础情况年龄（岁）	61±12	66±12	0.007
性别（男性）	121 (65.4%)	39 (69.6%)	0.556
吸烟	62 (33.5%)	18 (32.1%)	0.839
饮酒	46 (24.9%)	14 (25.0%)	1.000
糖尿病	26 (14.1%)	11 (19.6%)	0.309
高血压病	175 (94.6%)	43 (76.8%)	<0.001
口服药物
降压药物	160 (86.5%)	39 (69.6%)	0.004
抗血小板药物	21 (11.4%)	7 (12.5%)	0.814
实验室数据
胆固醇（mmol/L）	4.7±1.1	4.7±1.1	0.777
三酰甘油（mmol/L）	1.9±1.5	1.5±0.9	0.011
高密度脂蛋白（mmol/L）	1.2±0.8	1.3±0.3	0.797
低密度脂蛋白（mmol/L）	3.0±0.9	3.0±0.8	0.618
空腹血糖（mmol/L）	6.1±2.3	6.1±1.7	0.890
尿素氮（mmol/L）	5.5±3.3	5.3±1.5	0.607
肌酐（μmol/L）	69.0 (56.0~81.0)	69.0 (56.5~83.7)	0.407
同型半胱氨酸（mmol/L）	16.7±10.6	14.6±6.5	0.205
入院血压（mmHg）
收缩压	155.6±22.2	145.0±21.9	0.002
舒张压	89.6±12.7	82.4±15.5	0.001
平均动脉压	111.0±16.5	101.7±21.0	0.001
影像学数据
脑血肿量（mL）	4.0 (1.2~9.7)	9.9 (3.3~20)	<0.001
cSS	12 (6.5%)	13 (23.2%)	<0.001
白质高信号	147 (79.5%)	45 (80.4%)	0.884
无症状性脑梗死灶	55 (29.7%)	22 (39.3%)	0.179
CMB存在	123 (66.5%)	33 (58.9%)	0.300
CMBs（个）	2 (0~5)	1 (0~5)	0.246
3个月mRS评分>2分	29 (15.8%)	7 (12.5%)	0.550

参数	cSS (-)（n=26）	cSS (+)（n=16）	P值
基础情况年龄（岁）	71±10	68±10	0.293
性别（男性）	18 (69.2%)	14 (87.5%)	0.177
吸烟	11 (42.3%)	5 (31.3%)	0.474
饮酒	7 (26.9%)	5 (31.3%)	1.000
糖尿病	4 (15.4%)	4 (25.0%)	0.441
高血压病	17 (65.4%)	12 (75.0%)	0.756
口服药物
降压药物	17 (65.4%)	12 (75.0%)	0.756
抗血小板药物	2 (7.7%)	4 (25.0%)	0.270
入院血压（mmHg）
收缩压	150.8±23.4	146.4±15.2	0.508
舒张压	81.0±11.6	86.5±11.2	0.135
平均动脉压	104.3±13.4	93.5±37.9	0.288
影像学数据
脑血肿量（mL）	11.0 (2.2~20.0)	14.4 (1.0~24.8)	0.742
白质高信号	26 (100%)	16 (100%)
无症状性脑梗死	11 (42.3%)	7 (43.8%)	0.927
CMB存在	15 (57.7%)	16 (100%)	0.008
CMBs数目(个)	1 (0~3)	2 (1~7)	0.053
3个月mRS评分>2分	4 (15.4%)	4 (25.0%)	0.714
1年内死亡或再发	4 (15.4%)	9 (56.3%)	0.015