脑出血患者伴皮质下含铁血黄素沉积的相关危险因素分析及预后的前瞻性研究  

Analysis of risk factors and prognosis of cerebral hemorrhage patients accompanied by cortical superficial siderosis

作　　者：陈洁[1] 胡进 杨康[1] 傅毅[1] CHEN Jie;HU Jin;YANG Kang;FU Yi(Department of Neurology & Institute of Neurology,Ruijin Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China;Department of Neurology,The First Hospital of Jiaxing,Zhejiang Jiaxing 314000,China)

机构地区：[1]上海交通大学医学院附属瑞金医院神经内科,上海200025 [2]嘉兴市第一医院神经内科,浙江嘉兴314000

出　　处：《诊断学理论与实践》2019年第2期133-138,共6页Journal of Diagnostics Concepts & Practice

摘　　要：目的 :探讨皮质下含铁血黄素沉积(cortical superficial siderosis, cSS)在脑血管淀粉样变性(cerebral amyloid angiopathy, CAA)相关脑出血患者中的相关因素,及其对患者预后的影响。方法:采用前瞻性研究方法,入组在发病3 d内经CT诊断为脑出血的患者,所有患者均在发病5 d内行MRI检查,以明确cSS、脑微出血(cerebral microbleeds, CMBs)和脑白质疏松症(leukoaraiosis,LA)等,并在发病后1年内定期随访后续的临床脑血管事件。结果 :共入组241例脑出血患者,其中深部出血185例,脑叶出血56例。脑叶出血患者中伴cSS的百分比多于深部出血者[23.2%(13/56)比6.5%(12/185), P<0.001]。根据改良Boston的CAA诊断标准判断,其中可能CAA患者占17.4%(42例)。在随访的1年内,241例脑出血患者中共有35例(14.5%)发生了临床脑血管事件或死亡,在可能CAA患者中有13例(13/42,31.0%)再发脑出血,在16例伴cSS的可能CAA患者中有9例于1年内死亡或再发脑出血,其相关脑出血发生率高于无cSS的可能CAA患者(P=0.015)。Kaplan-Meier显示,伴cSS的可能CAA患者再发脑出血的风险较高(χ~2=7.466,P=0.006)。经多因素COX回归模型分析后发现,cSS仍为可能CAA患者再发脑出血的独立预测因素(HR=4.45;95%CI为1.37～14.48,P=0.013)。结论:脑叶出血患者中伴发cSS的百分比高于深部出血患者;而伴有cSS的可能CAA患者未来1年内再发脑出血的风险增加。Objective: To investigate the related factors of cortical superficial siderosis(cSS) in cerebral hemorrhage patients associated with cerebral amylodid angiopathy(CAA) and its prognosis. Methods: A prospective study was performed on patients diagnosed as cerebral hemorrhage by CT within 3 days after onset and MRI was performed within 5 days for detecting cortical superficial siderosis(cSS), cerebral microbleeds(CMBs) and leukoaraiosis(LA). Patients were followed up 1 year for observation of subsequent clinical cerebrovascular events. Result: Altogether 241 patients with cerebral hemorrhage were enrolled, including 185 cases of deep hemorrhage and 56 cases of lobar hemorrhage. The occurrence of c SS in lobar hemorrhage was more than that in deep hemorrhage(13/56, 23.2% vs 12/185, 6.5%, P<0.001).According to the modified Boston criteria, 42 patients(17.4%) were possible CAA. During the 1-year follow-up, 35(14.5%) patients had clinical cerebrovascular events or death, and 13(31.0%) possible CAA patients had recurrent cerebral hemorrhage. Kaplan-Meier showed a higher risk of recurrent cerebral hemorrhage in possible CAA accompanied by cSS(χ^2=7.466, P =0.006). The multivariate COX regression model found that cSS was an independent predictor of recurrent cerebral hemorrhage in patients with possible CAA(HR 4.45;95% CI 1.3714.48, P=0.013). Conclusions: The prevalence of cSS in patients with lobar hemorrhage was higher than that in deep bleeding. Possible CAA accompanied by cSS had an increased risk of recurrent cerebral hemorrhage within one year.

关 键 词：皮质下含铁血黄素沉积 淀粉样脑血管病 脑小血管病 核磁共振 

分 类 号：R743.34[医药卫生—神经病学与精神病学]