Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage.
Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage.
复制标题
血压降低，MRI的扩散降低以及脑出血后的结果。
DOI：
10.1161/strokeaha.111.629493
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发表时间：
2012-01
期刊：
影响因子：
8.3
通讯作者：
Naidech AM
中科院分区：
文献类型：
--
作者：
Garg RK;Liebling SM;Maas MB;Nemeth AJ;Russell EJ;Naidech AM
急性脑出血（ICH）后MRI可检测到与急性缺血一致的弥散功能降低（DD），但其危险因素和对功能结局的影响尚未明确。我们检验了以下假设：ICH后DD与急性血压（BP）降低和血红蛋白（HGB）降低相关，并预示着更差的功能结局。接受MRI的患者由对结局不知情的经认证的神经放射科医生前瞻性评价DD。通过电子查询获得HGB和BP数据。在14天和3个月时使用改良兰金量表（mRS）获得结局，该量表是一种功能量表，评分范围为0（无症状）至6（死亡）。我们对依赖性或死亡（mRS 4至6）进行了逻辑回归。在95例患者中，36例（38%）在MRI上发现了与血肿不同的DD。DD与血压较基线的更大降低相关，并且在ICH评分校正后（每分1.8，95%CI 1.2-3.1，P= 0.01），3个月时的依赖性或死亡风险较高（OR 4.8，95%CI 1.7 - 13.9，P = 0.004）。较低的HGB与较差的ICH评分、较大的血肿体积和较差的结局相关，但与DD无关。在多变量分析中，DD在ICH后常见，与更大的急性BP降低相关，并与3个月时的残疾和死亡相关。急性降压以减少血肿生长的潜在益处可能会受到DD的限制。对表现为DD的脑缺血的预防和治疗是改善预后的潜在方法。
Decreased diffusion (DD) consistent with acute ischemia may be detected on MRI after acute intracerebral hemorrhage (ICH), but its risk factors and impact on functional outcomes are not well defined. We tested the hypotheses that DD after ICH is related to acute blood pressure (BP) reduction and lower hemoglobin (HGB) and presages worse functional outcomes. Patients who underwent MRI were prospectively evaluated for DD by certified neuroradiologists blinded to outcomes. HGB and BP data were obtained via electronic queries. Outcomes were obtained at 14 days and 3 months with the modified Rankin Scale (mRS), a functional scale scored from 0 (no symptoms) to 6 (dead). We used logistic regression for dependence or death (mRS 4 to 6). DD distinct from the hematoma was found on MRI in 36 of 95 patients (38%). DD was associated with greater BP reductions from baseline, and a higher risk of dependence or death at 3 months (OR 4.8, 95% CI 1.7 – 13.9, P=0.004) after correction for ICH Score (1.8 per point, 95%CI 1.2–3.1, P=0.01). Lower HGB was associated with worse ICH score, larger hematoma volume and worse outcomes, but not DD. DD is common after ICH, associated with greater acute BP reductions, and associated with disability and death at 3 months in multivariate analysis. The potential benefits of acute BP reduction to reduce hematoma growth may be limited by DD. The prevention and treatment of cerebral ischemia manifested as DD is a potential method to improve outcomes.