Underlying microangiopathy and functional outcome of simultaneous multiple intracerebral hemorrhage.
Underlying microangiopathy and functional outcome of simultaneous multiple intracerebral hemorrhage.
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DOI：
10.3389/fnagi.2022.1000573
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发表时间：
2022
影响因子：
4.8
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中科院分区：
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确定脑小血管病（SVD）的主要类型和同时多发性脑内出血（SMICH）患者的结局。对来自一个单中心前瞻性队列的连续性脑出血（ICH）患者进行回顾性分析。根据SMASH-U标准对假定病因进行分类。比较原发性SMICH和单纯ICH患者的人口统计学、临床和实验室变量以及神经影像学数据。在ICH后90天使用改良的兰金量表评估功能结局。在598例入组患者中，37例（6.2%）符合SMICH标准。SMICH的风险因素包括脑深部微出血（CMB）的高负担（比值比[OR] 1.06，95%置信区间[CI]，1.00-1.12; p = 0.040），白色高信号评分（OR 1.27，95% CI 1.04-1.57; p = 0.021）、ICH病史（OR 3.38，95% CI 1.31-8.05; p = 0.008）和低血清镁水平（OR 0.01，95% CI 0.00-0.25; p = 0.007）。根据SMASH-U分类，15例（40.5%）SMICH被归类为高血压，而17例（45.9%）被归类为病因不明。为了进一步探讨潜在的微血管病变的潜在原因不明的SMICH，这些患者的病因不明，脑淀粉样血管病-ICH进行了比较，并与更高的负荷深CMB，但不太严重的半卵圆中心扩大血管周围空间。同样，与高血压-ICH患者相比，未确定的SMICH患者始终与较高的深部CMB计数相关。此外，多变量分析显示，SMICH与不良结局独立相关（OR 2.23，95%CI 1.03-4.76; p = 0.038）。我们的研究结果表明，大多数原发性SMICH患者以高血压SVD为主要血管病变。SMICH患者结局不良的风险较高。（ClinicalTrials.gov标识符：NCT 04803292）。
To identify the predominant type of cerebral small vessel disease (SVD) and outcomes in patients with simultaneous multiple intracerebral hemorrhages (SMICH). Consecutive patients with intracerebral hemorrhage (ICH) from a single-center prospective cohort were retrospectively reviewed. Presumed etiology was classified according to the SMASH-U criteria. Demographics, clinical and laboratory variables, and neuroimaging data were compared between patients with primary SMICH and those with single ICH. Functional outcomes were assessed using the modified Rankin scale 90 days after ICH. Of the 598 enrolled patients, 37 (6.2%) met the criteria for SMICH. Risk factors for SMICH included a high burden of deep cerebral microbleeds (CMBs) (odds ratio [OR] 1.06, 95% confidence interval [CI], 1.00–1.12; p = 0.040), white matter hyperintensity scores (OR 1.27, 95% CI 1.04–1.57; p = 0.021), history of ICH (OR 3.38, 95% CI 1.31–8.05; p = 0.008), and low serum magnesium levels (OR 0.01, 95% CI 0.00–0.25; p = 0.007). Based on the SMASH-U classification, 15(40.5%) SMICH were classified as hypertension, whereas 17 (45.9%) as undetermined-etiology. To further explore the potential microangiopathy underlying undetermined-SMICH, these patients with undetermined-etiology were compared to those with cerebral amyloid angiopathy-ICH, and were associated with a higher burden of deep CMBs but less severe centrum semiovale enlarged perivascular spaces. Likewise, compared with hypertension-ICH patients, those with undetermined SMICH were consistently associated with a higher deep CMB counts. Moreover, multivariate analysis revealed that SMICH was independently associated with poor outcomes (OR 2.23, 95%CI 1.03–4.76; p = 0.038). Our results suggest that most patients with primary SMICH harbor hypertensive-SVD as principal angiopathy. Patients with SMICH are at a high risk of poor outcomes. (ClinicalTrials.gov Identifier: NCT 04803292).