The Effect of Aging and Small-Vessel Disease Burden on Hematoma Location in Patients with Acute Intracerebral Hemorrhage
The Effect of Aging and Small-Vessel Disease Burden on Hematoma Location in Patients with Acute Intracerebral Hemorrhage
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DOI：
10.1159/000515411
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发表时间：
2021-04-23
影响因子：
2.9
通讯作者：
Kimura, Kazumi
中科院分区：
文献类型：
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作者：
Sakamoto, Yuki;Sato, Takahiro;Kimura, Kazumi
简介：脑出血（ICH）是一种毁灭性的出血事件，与高死亡率或严重的神经系统后遗症相关。非脑叶性脑出血的血肿位置与脑叶相关的差异尚不清楚。本研究的目的是阐明年龄与血肿位置之间的关系，并评估小血管疾病（SVD）负荷作为不同血肿位置之间长期高血压的潜在替代标志物的差异。研究方法：从2014年9月至2019年7月，从一项前瞻性登记研究中回顾性入组了连续急性自发性ICH患者。入院时进行磁共振成像，并计算总SVD负担评分（包括微出血、腔隙、血管周围间隙扩大和白色高信号）。采用多因素logistic回归分析评估血肿位置与年龄和SVD负荷的关系。结果如下：本研究共入组444例患者（156例女性[35%];中位年龄69岁[四分位数间距59-79];美国国立卫生研究院卒中量表评分9 [17][3-17]）。多因素Logistic回归分析显示，高龄与丘脑-垂体-肾上腺皮质激素水平独立相关。（比值比[OR]：1.48，95%置信区间[CI]：1.19-1.84，10年增量p < 0.001）和脑叶出血（OR：1.58，95%CI：1.19-2.09，p = 0.002），与壳核出血独立负相关（OR：0.55，95%CI：0.44-0.68，p < 0.001）。总SVD负担评分与丘脑出血独立且正相关（OR：1.27，95% CI：1.01-1.59，p = 0.045），与脑叶出血呈负相关（OR：0.74，95% CI：0.55-0.99，p = 0.042），即使在按年龄调整后，但未发生壳核出血（OR：0.91，95% CI：0.73-1.14，p = 0.395）。结论：在特定年龄和SVD状态下容易发生壳核、丘脑和脑叶萎缩：年轻患者为壳核萎缩，老年和高SVD负荷患者为丘脑萎缩，老年和低SVD负荷患者为脑叶萎缩。随着年龄的增长或严重的SVD积累，出血的易感性似乎在大脑部位之间存在很大差异。
Introduction: Intracerebral hemorrhage (ICH) is a devastating hemorrhagic event and is associated with high mortality or severe neurological sequelae. Age-associated differences in hematoma location for nonlobar ICH are not well known. The aims of the present study were to elucidate the relationship between age and hematoma location and to assess the differences in small-vessel disease (SVD) burden as a potential surrogate marker for longstanding hypertension among various hematoma locations. Methods: From September 2014 through July 2019, consecutive patients with acute, spontaneous ICH were retrospectively enrolled from a prospective registry. Magnetic resonance imaging was performed during admission, and the total SVD burden score (including microbleeds, lacunes, enlarged perivascular spaces, and white matter hyperintensities) was calculated. The relationships of hematoma location with aging and SVD burden were assessed by using multivariate logistic regression analyses. Results: A total of 444 patients (156 women [35%]; median age 69 [interquartile range 59-79] years; National Institutes of Health Stroke Scale score 9 [17][3-17]) were enrolled in the present study. Multivariate logistic regression analyses showed that advanced age was independently associated with thalamic (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.19-1.84, p < 0.001 for 10-year increment) and lobar hemorrhage (OR: 1.58, 95% CI: 1.19-2.09, p = 0.002) and was independently and negatively related to putaminal hemorrhage (OR: 0.55, 95% CI: 0.44-0.68, p < 0.001). The total SVD burden score was independently and positively associated with thalamic hemorrhage (OR: 1.27, 95% CI: 1.01-1.59, p = 0.045) and negatively with lobar hemorrhage (OR: 0.74, 95% CI: 0.55-0.99, p = 0.042), even after adjusting by age, but not with putaminal hemorrhage (OR: 0.91, 95% CI: 0.73-1.14, p = 0.395). Conclusion: Putaminal, thalamic, and lobar hemorrhages are prone to occur in specific ages and SVD states: putaminal in young patients, thalamic in old and high SVD burden patients, and lobar hemorrhages in old and low SVD burden patients. Susceptibility to bleeding with aging or severe SVD accumulation seems to differ considerably among brain locations.