Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.
Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage.
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DOI：
10.1161/strokeaha.112.659094
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发表时间：
2012-08
期刊：
影响因子：
8.3
通讯作者：
Goldstein JN
中科院分区：
文献类型：
--
作者：
Brouwers HB;Biffi A;McNamara KA;Ayres AM;Valant V;Schwab K;Romero JM;Viswanathan A;Greenberg SM;Rosand J;Goldstein JN
CT血管造影（CTA）斑点征可预测原发性脑出血（ICH）患者的血肿扩大和不良结局。斑点征的生物学基础仍然知之甚少;可能是潜在的血管病变影响了它的存在。因此，我们进行了一项研究，以确定遗传预测的斑点迹象。在一项正在进行的前瞻性队列研究中，我们分析了371例有CTA和遗传学数据的患者。根据经验证的标准，由两名对临床数据不知情的经验丰富的阅片者对CTA的斑点征进行审查。分析按ICH地点分层。在多变量分析中，无论ICH位置如何，接受华法林治疗的患者更可能出现斑点征：深部ICH的OR 3.85（95% CI 1.33 - 11.13）和脑叶ICH的OR 2.86（95% CI 1.33 - 6.13）。APOE ε2而非ε4与脑叶性脑出血的斑点征相关（OR 2.09; 95%CI 1.05 - 4.19）。在深部ICH中，对ε2或ε4无影响。服用华法林的ICH患者更可能出现斑点征，无论ICH的位置如何。在脑叶性脑出血患者中，具有APOE ε2等位基因的患者更可能出现斑点征。鉴于APOE ε2和脑淀粉样血管病血管病变之间的关系，我们的研究结果表明，止血因素和血管病理学影响斑点征的存在。
The CT angiography (CTA) spot sign predicts hematoma expansion and poor outcome in patients with primary intracerebral hemorrhage (ICH). The biological underpinnings of the spot sign remain poorly understood; it may be that the underlying vasculopathy influences its presence. Therefore, we conducted a study to identify genetic predictors of the spot sign. In an ongoing prospective cohort study, we analyzed 371 patients with CTA and genetic data available. CTAs were reviewed for the spot sign by two experienced readers, blinded to clinical data, according to validated criteria. Analyses were stratified by ICH location. In multivariate analysis, patients on warfarin were more likely to have a spot sign regardless of ICH location: OR 3.85 (95% CI 1.33 - 11.13) in deep ICH and OR 2.86 (95% CI 1.33 - 6.13) in lobar ICH. APOE ε2, but not ε4, was associated with presence of a spot sign in lobar ICH (OR 2.09; 95% CI 1.05 - 4.19). There was no effect for ε2 or ε4 in deep ICH. ICH patients on warfarin are more likely to present with a spot sign, regardless of ICH location. Among patients with lobar ICH, those who possess the APOE ε2 allele are more likely to have a spot sign. Given the established relationship between APOE ε2 and vasculopathic changes in cerebral amyloid angiopathy, our findings suggest that both hemostatic factors and vessel pathology influence spot sign presence.