烟雾病性脑出血与高血压性脑出血特征及预后对比
| 作者: |
1杨百元,
1刘艳,
1钟成清,
1马雯,
1杨怡,
2邢冬梅
1 成都市第七人民医院神经内科，成都 610041 2 云南省第三人民医院，昆明 650032 |
| 通讯: |
邢冬梅
Email: 694317487@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.11.013 |
| 基金: | 云南省教育厅科学研究基金(2018JS237)；昆明市卫生与计划生育委员会医药卫生科技计划项目(2017-03-07-001)。 |
摘要
目的：探讨烟雾病性脑出血与高血压性脑出血患者的临床及影像学特征，以及预后和影响因素。方法：回顾性连续纳入2017年1月至2019年1月在神经内科、神经外科住院治疗的烟雾病性脑出血和高血压性脑出血患者。收集患者的人口学资料、临床特征和影像学特征等资料，随访发病后3个月死亡及神经功能结局。将影响脑出血预后的因素作为自变量，3个月不良神经功能结局作为应变量进行logistic回归分析。结果：共纳入30例烟雾病性脑出血患者，同时期按照1:3的比例纳入90例高血压性脑出血患者。烟雾病性脑出血与高血压性脑出血患者相比，年龄较轻、男性及高血压病史比例更低，入院时收缩压、舒张压、美国国立卫生研究院中风量表(National Institutes of Health Stroke Scale，NIHSS)评分及血红蛋白更低、血肿体积更小，发生脑叶及侧脑室出血比例更高(P<0.05)。烟雾病性脑出血患者3个月时不良神经功能结局比例为20.00%，明显低于高血压性脑出血患者(47.78%)。病因(OR=0.27；95%CI：0.10~0.73)、发病年龄(OR=1.05；95%CI：1.02~1.09)、GCS评分(OR=0.76；95%CI：0.67~0.86)、NIHSS评分(OR=1.21；95%CI：1.13~1.32)、呼吸道感染(OR=8.36；95%CI：2.85~24.51)、血肿体积(OR=1.05；95%CI：1.02~1.07)等因素与脑出血3个月不良神经功能相关。结论：烟雾病性脑出血临床特征、影像学特征和预后与高血压性脑出血患者存在显著地差异。在临床工作需完善MRI血管造影、CT血管成像、数字减影血管造影等检查明确脑出血的病因，根据其病因给予特异性的治疗。
关键词：
烟雾病；脑出血；高血压性脑出血；神经功能结局；相关因素
Comparison between the characteristics and prognosis of intracerebral hemorrhage caused by moyamoya disease and hypertensive intracerebral hemorrhage
CorrespondingAuthor: XING Dongmei Email: 694317487@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.11.013
Foundation: This work was supported by the Scientific Research Fund of Education Department of Yunnan Province (2018JS237) and Kunming Municipal Commission of Health and family Planning Medical and Health Science and Technology Project (2017-03-07-001), China.
Abstract
Objective: To investigate the clinical and imaging features, prognosis and influencing factors of moyamoya disease (MMD) intracerebral hemorrhage (ICH) and hypertensive ICH. Methods: Patients admitted to neurosurgery department from January 2017 to January 2019 with MMD-ICH were consecutively and retrospectively included. Demographic data, clinical characteristics and radiologic features, as well as mortality and functional outcome at 3 months after onset were collected and analyzed. The regression was used to determine related factors associated with poor clinical outcome. Results: A total of 30 patients with MMD-ICH were included, and 90 patients with hypertensive ICH were included according to the ratio of 1:3 during the same period. Compared with patients with hypertensive ICH, MMD-ICH patients were younger, lower proportion of male and hypertension, lower systolic and diastolic blood pressure at admission, lower NIHSS score and hemoglobin, smaller hematoma volume, and higher proportion of lobar lobe and intraventricular hemorrhage (P<0.05). The proportion of poor functional outcome in patients with MMD-ICH at 3 months was 20.00%, which was significantly lower than the patients with hypertensive ICH (47.78%). The etiology (OR =0.27; 95% CI, 0.10–0.73), age of onset (OR =1.05; 95% CI, 1.02–1.09), GCS score (OR =0.76; 95% CI, 0.67–0.86), NIHSS score (OR =1.21; 95% CI, 1.13–1.32), respiratory tract infection (OR =8.36; 95% CI, 2.85–24.51), and hematoma volume (OR =1.05; 95%CI: 1.02–1.07) were correlated with the poor functional function at 3 months after ICH. Conclusion: The clinical and imaging features, and prognosis of patients with MMD-ICH were significantly different from those with hypertensive ICH. In clinical, MRA, CTA, or DSA should be taken to clarify the etiology of ICH. The specific treatment should be given according to ICH etiology.
Keywords：
moyamoya disease; intracerebral hemorrhage; hypertensive intracerebral hemorrhage; functional outcome; influencing factors