Stroke:系统性淀粉样变性,和颅内出血有何关系?

2022-02-21 Freeman MedSci原创

诊断为系统性淀粉样变性后,颅内出血的风险估计增加了3倍。

孤立的淀粉样物质以淀粉样Aβ的形式在大脑中沉积,如脑淀粉样血管病所见,与颅内出血有关。系统性淀粉样病是由不溶性淀粉样纤维的沉积引起的,主要是淀粉样轻链,或肝脏衍生的转甲状腺素,在组织的细胞外空间,导致进行性器官衰竭和死亡。动物研究表明,外周给予错误折叠的淀粉样蛋白聚集物会促进大脑淀粉样蛋白病理沉积。然而,全身性淀粉样变是否会增加颅内出血的风险尚不清楚。

藉此, 康奈尔大学的Dora Chen等人, 使用了2008年至2015年的医疗保险索赔数据的5%的样本。暴露变量是对系统性淀粉样变的诊断。主要结果是非创伤性颅内出血,是脑内出血、蛛网膜下腔出血和硬膜下出血的综合。

暴露和结局是使用国际疾病分类第九修订版的诊断代码确定的。次要结局是颅内出血的亚型,分别评估。他们用老年人中常见的髋部骨折作为阴性对照。Cox比例危害模型针对人口统计学、血管风险因素和Charlson合并症进行了调整。

在180万医疗保险受益人中,有924人被诊断为系统性淀粉样变性。在5.3年的中位随访期间(四分位数范围,2.8-6.7),患有系统性淀粉样变的颅内出血的累积发生率为每1000个病人年19例,而没有系统性淀粉样变的患者为每1000人2例。

在调整后的Cox模型中,系统性淀粉样变与颅内出血的风险增加有关(危险比[HR],3.0[95%CI,2.0-4.5];)。

在调整后的二级分析中,系统性淀粉样变与ICH(HR,3.5[95% CI,2.2-5.4])、蛛网膜下腔出血(HR,6.7[95% CI,4.0-11.4])和硬膜下腔出血(HR,2.7[95% CI,1.5-4.8])的风险增加相关。

系统性淀粉样变与髋部骨折之间没有关联(HR,0.9 [95% CI,0.6-1.4])。

该研究的重要意义在于发现了: 诊断为系统性淀粉样变性后,颅内出血的风险估计增加了3倍。重要的是,这种升高的风险存在于所有的颅内出血亚型。

 


原文出处:
Chen D, Zhang C, Parikh N, et al. Association Between Systemic Amyloidosis and Intracranial Hemorrhage. :2.

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    2022-02-22 ms2000001545439177

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    2022-02-19 huangdf

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