目的:对脑淀粉样血管病(CAA)伴和不伴脑出血(ICH)之间的差异了解有限。本文旨在描述多中心队列中CAA的特征并确定CAA-ICH的危险因素。
方法:连续入选国家多中心前瞻性脑小血管病队列研究的符合波士顿CAA或CAA相关炎症诊断标准的患者纳入本研究。收集人口学特征和临床资料。比较有和没有ICH的CAA之间的临床和影像学差异,以确定CAA-ICH的危险因素。
结果:共纳入219例CAA患者,平均年龄为67.12±9.93。在所有患者中,26.0%的CAA合并ICH。单因素分析显示,CAA-ICH与携带更多APOEε2等位基因有关,脑叶微出血(CMBs)较少,皮质浅表铁质沉着症(cSS),较低的Fazekas规模,步态障碍的倾向,急性起病(P<0.05)。广义线性混合模型在CAA与ICH和携带APOEε2等位基因之间产生了统计学上的显着关联,cSS,叶形CMB的数量越少,和较低的Fazekas量表(P<0.05)。
结论:对有和没有ICH的CAA进行分类是有意义的,因为两者之间可能有不同的机制。具有ICH的CAA对携带APOEε2,cSS,和相对较少数量的CMB。较少的CMBs并不意味着CAA对ICH的易感性较低。需要进行更大规模的前瞻性队列研究以进一步阐明这些结论。
OBJECTIVE: There is limited understanding of the differences between cerebral amyloid angiopathy (CAA) with and without intracerebral hemorrhage (ICH). This article aimed to describe the characteristics of CAA and identify the risk factors of CAA-ICH in a multicenter cohort.
METHODS: Patients consecutively enrolled in the national multicenter prospective Cerebral Small Vessel Disease Cohort Study who met the Boston diagnostic criteria for CAA or CAA-related inflammation were included in this study. The demographic characteristics and clinical data were collected. The clinical and radiographic differences between CAA with and without ICH were compared to identify the risk factors for CAA-ICH.
RESULTS: A total of 219 CAA patients were included, with an average age of 67.12 ± 9.93. Of all patients, 26.0% were CAA with ICH. Univariate analysis showed that CAA-ICH is associated with carrying more APOE ε2 allele, less lobar cerebral microbleeds (CMBs), cortical superficial siderosis (cSS), lower Fazekas scale, a tendency of gait disorder, and acute onset (P < 0.05). The generalized linear mixed model yielded statistically significant associations between CAA with ICH and carrying the APOE ε2 allele, cSS, the lower number of lobar CMBs, and the lower Fazekas scale (P < 0.05).
CONCLUSIONS: It is meaningful to classify CAA with and without ICH, as there may be different mechanisms between the two. CAA with ICH has a susceptibility to carrying APOE ε2, cSS, and a relatively small number of CMBs. Fewer CMBs do not mean lower susceptibility to ICH in CAA. Larger prospective cohort studies are necessary to further clarify these conclusions.