DECIPHER

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• 批准号: 7329739
• 负责人: CHELSEA S KIDWELL
• 金额: $ 71.5万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7329739
• 关键词: Acute; Animals; Apolipoprotein E; Blood Vessels; Blood specimen; Cerebral Amyloid Angiopathy; Cerebral hemisphere hemorrhage; Cerebrum; Chronic; Cohort Studies; DNA; DNA analysis; Data; Development; Digit structure; Disease Progression; Enrollment; Ethnic Origin; Etiology; Event; Future; General Population; Genetic; Goals; Hemorrhage; Hypertension; Impaired cognition; Incidence; Intervention Trial; Ischemic Stroke; Lesion; Leukoaraiosis; Magnetic Resonance Imaging; Measures; Mutation; Names; Natural History; Neurologic; Neurological outcome; Numbers; Patients; Population; Prevalence; Prophylactic treatment; Race; Rate; Recurrence; Risk; Risk Factors; Score; Secondary Prevention; Sickle Cell Anemia; Testing; Time; Underserved Population; cerebrovascular; day; design; disabling disease; follow-up; functional outcomes; genetic risk factor; insight; mortality; notch protein; prognostic; prospective; racial/ethnic difference

The overall goal of DECIPHER is to investigate whether racial/ethnic differences exist in the underlying risk factors for chronic cerebral microbleeds in patients with primary ICH and to determine the prognostic impact of microbleeds in a predominantly underserved ICH population. Intracerebral hemorrhage (ICH) is a devastating and disabling disease with 30 day mortality rates estimated at 35-52%. Primary ICH is 2-3 times more common in many underserved populations, including blacks. Hypertension and cerebral amyloid angiopathy have been identified as common risk factors for primary ICH in the general population. Microbleeds, clinically silent small, chronic hemorrhages identified on gradient echo (GRE) MRI, are present in approximately 70% of patients with primary ICH and are hypothesized to be a marker of a hemorrhageprone vasculopathy. In patients with cerebral amyloid angiopathy, the number of microbleeds has significant prognostic value, predicting future risk of ICH, poor long-term neurologic outcome, and cognitive decline. Our recent pilot data suggest that black patients presenting with ICH have a significantly greater number of chronic microbleeds compared to whites. However, the underlying etiology and significance of this finding are unknown. The 4 specific aims of this longitudinal, MR imaging cohort study are: 1) To quantify by race/ethnicity the prevalence, lesion burden and risk factors of chronic cerebral microbleeds in patients with primary ICH; 2) To quantify the prognostic impact of initial microbleed burden by race/ethnicity; 3) To quantify the long-term rate of development of new microbleeds by race/ethnicity and to correlate this rate with neurologic and functional outcome; and 4) To perform a genetic substudy to explore genetic risk factors for ICH and microbleeds in this underserved population. A total of 189 patients with primary ICH will be enrolled and followed for up to 4 years. Repeat MRIs including GRE sequences will be performed at years 1 and 3 and evaluated for progression of disease (new microbleeds, recurrent ICH, ischemic stroke, and leukoaraiosis). Additional measures to be evaluated will include demographic information, presence and control of vascular risk factors including hypertension, apolipoprotein E status, and functional outcome. This project will not only provide insight into the significance of microbleeds in underserved ICH populations, but will also provide pilot data for design of future intervention trials of secondary prevention measures.

DECIPHER的总体目标是调查潜在风险是否存在种族/民族差异 原发性ICH患者慢性脑微出血的因素并确定预后影响 微出血的风险。脑出血（ICH）是一种 毁灭性和致残性疾病，30天死亡率估计为35- 52%。原发性脑出血为2-3倍 在包括黑人在内的许多服务不足的人群中更为常见。高血压与脑淀粉样蛋白 血管病已被确定为一般人群中原发性ICH的常见风险因素。 存在微出血，即梯度回波（GRE）MRI上发现的临床无症状的小慢性出血 在大约70%的原发性ICH患者中， 血管病变在患有脑淀粉样血管病的患者中，微出血的数量显著增加。 预后价值，预测ICH的未来风险，不良的长期神经学结局和认知能力下降。我们 最近的试验数据表明，表现为ICH的黑人患者有显著更多的 慢性微出血的比例然而，这一发现的潜在病因和意义 是未知的。这项纵向MR成像队列研究的4个具体目标是：1）通过 种族/种族慢性脑微出血患者的患病率、病变负担和风险因素 原发性ICH; 2）根据人种/种族量化初始微出血负荷的预后影响; 3） 按人种/种族量化新发微出血的长期发生率，并将该发生率与 进行遗传亚组研究以探索遗传风险因素 脑出血和微出血的风险共189例原发性ICH患者将接受 入组并随访长达4年。将在第1年进行包括GRE序列在内的重复MRI 和3，并评估疾病进展（新发微出血、复发性ICH、缺血性卒中和 脑白质疏松症）。有待评价的其他措施将包括人口资料、存在和 控制血管危险因素，包括高血压、载脂蛋白E状态和功能结局。这 该项目不仅将深入了解微出血在服务不足的ICH人群中的意义， 还将为设计未来二级预防措施的干预试验提供试点数据。