PDF(Pubmed)
Abstract：
OBJECTIVE: Cerebral amyloid angiopathy (CAA)-associated lobar intracerebral hemorrhage (ICH) has a high risk of recurrence, but the underlying mechanisms remain uncertain. We, therefore, aimed to characterize patterns of recurrent ICH.
METHODS: We investigated early recurrent ICH (≥1 recurrent ICH event within 90 days of the index event) and ICH clusters (≥2 ICH events within 90 days at any time point) in 2 large cohorts of consecutive patients with first-ever ICH and available MRI.
RESULTS: In 682 included patients (median age 68 years, 40.3% female, median follow-up time 4.1 years), 18 (2.6%) had an early recurrent ICH, which was associated with higher age and CAA. In patients with probable CAA, the risk of early recurrent ICH was increased 5-fold within the first 3 months compared with during months 4-12 (hazard ratio 5.41, 95% CI 2.18-13.4) while no significant difference was observed in patients without CAA. In patients with an ICH cluster, we observed spatial clustering (recurrent ICH within close proximity of index ICH in 63.0%) and a tendency for multiple sequential hemorrhages (≥3 ICH foci within 3 months in 44.4%).
CONCLUSIONS: Our data provide evidence of both temporal and spatial clustering of ICH in CAA, suggesting a transient and localized active bleeding-prone process.
METHODS: We investigated early recurrent ICH (≥1 recurrent ICH event within 90 days of the index event) and ICH clusters (≥2 ICH events within 90 days at any time point) in 2 large cohorts of consecutive patients with first-ever ICH and available MRI.
RESULTS: In 682 included patients (median age 68 years, 40.3% female, median follow-up time 4.1 years), 18 (2.6%) had an early recurrent ICH, which was associated with higher age and CAA. In patients with probable CAA, the risk of early recurrent ICH was increased 5-fold within the first 3 months compared with during months 4-12 (hazard ratio 5.41, 95% CI 2.18-13.4) while no significant difference was observed in patients without CAA. In patients with an ICH cluster, we observed spatial clustering (recurrent ICH within close proximity of index ICH in 63.0%) and a tendency for multiple sequential hemorrhages (≥3 ICH foci within 3 months in 44.4%).
CONCLUSIONS: Our data provide evidence of both temporal and spatial clustering of ICH in CAA, suggesting a transient and localized active bleeding-prone process.
摘要：
目的：脑淀粉样血管病（CAA）相关的大叶性脑出血（ICH）具有很高的复发风险，但是潜在的机制仍然不确定。我们,因此,旨在表征复发性ICH的模式。
方法：我们研究了2个大型队列中的早期复发性ICH（在指示事件后90天内≥1例复发性ICH事件）和ICH集群（在任何时间点90天内≥2例ICH事件）。
结果：在682名患者中（中位年龄68岁，40.3%女性，中位随访时间4.1年)，18例（2.6%）早期复发性ICH，这与较高的年龄和CAA有关。在可能患有CAA的患者中，与第4~12个月相比,前3个月内早期复发性ICH的风险增加了5倍(风险比5.41,95%CI2.18~13.4),而在无CAA的患者中没有观察到显著差异.在ICH集群的患者中，我们观察到空间聚集性(63.0%的指数ICH附近复发ICH)和多次序贯出血的趋势(44.4%的3个月内≥3个ICH病灶).
结论：我们的数据提供了CAA中ICH的时间和空间聚类的证据，提示一个短暂的和局部的活动性出血倾向的过程。
方法：我们研究了2个大型队列中的早期复发性ICH（在指示事件后90天内≥1例复发性ICH事件）和ICH集群（在任何时间点90天内≥2例ICH事件）。
结果：在682名患者中（中位年龄68岁，40.3%女性，中位随访时间4.1年)，18例（2.6%）早期复发性ICH，这与较高的年龄和CAA有关。在可能患有CAA的患者中，与第4~12个月相比,前3个月内早期复发性ICH的风险增加了5倍(风险比5.41,95%CI2.18~13.4),而在无CAA的患者中没有观察到显著差异.在ICH集群的患者中，我们观察到空间聚集性(63.0%的指数ICH附近复发ICH)和多次序贯出血的趋势(44.4%的3个月内≥3个ICH病灶).
结论：我们的数据提供了CAA中ICH的时间和空间聚类的证据，提示一个短暂的和局部的活动性出血倾向的过程。
