Stroke:极低脑血容量为脑实质血肿**预测因子

　　法国一项研究表明，在急性卒中患者中，极低脑血容量（CBV）为脑实质血肿（PH）的唯一预测因子。论文于5月30日在线发表于《卒中》（Stroke）。

　　此项研究共纳入110例急性卒中患者。在急性弥散加权成像病变内计算CBV≤正常半球第2.5百分位数的脑组织体积。依据欧洲急性卒中协作研究II，在第2天利用MRI评估出血性转化。在随访3小时利用MRI评估再通和再灌注。

　　结果显示，59例患者发生出血性转化，其中包括7例PH。在单变量分析中，急性NIHSS评分、急性加权弥散成像病变体积和溶栓与出血性转化具有相关性，但极低CBV则非如此。极低CBV脑组织体积为PH的唯一预测因素（P=0.007）。早期再灌注和再通对出血性转化和PH均无影响。

Very Low Cerebral Blood Volume Predicts Parenchymal Hematoma in Acute Ischemic Stroke

Background and Purpose—Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to explore the impact of early reperfusion and recanalization.

Methods—The volume of cerebral tissue with CBV ≤2.5th percentile of the normal hemisphere was calculated within the acute diffusion-weighted imaging lesion. Hemorrhagic transformation was assessed on day 2 MRI according to the European Cooperative Acute Stroke Study II criteria. Recanalization and reperfusion were assessed on 3-hour follow-up MRI.

Results—Of the 110 patients, hemorrhagic transformation occurred in 59 patients, including 7 PH. In univariate analysis, the acute National Institutes of Health Stroke Scale score (P=0.002), acute diffusion-weighted imaging lesion volume (P=0.02), and thrombolysis (P=0.03), but not very low CBV (P=0.52), were associated with hemorrhagic transformation. The volume of very low CBV was the only predictor of PH (P=0.007). Early reperfusion and recanalization had no influence on either hemorrhagic transformation or PH

Conclusion—Very low CBV was the only independent predictor of PH in patients with acute stroke.