Neurology:脑皮质表面铁沉积或可预测脑淀粉样血管病脑出血风险

2013-11-08 佚名 丁香园

该研究的是探索MRI显示的皮质表面铁沉积,尤其是受累面积超过3个脑回的弥漫性铁沉积症,是否增加脑淀粉样血管病患者症状性脑叶出血的风险。 该研究共纳入欧洲多中心队列研究中根据Boston诊断标准诊断的118例脑淀粉样血管病患者(其中104例在基线研究时即有症状性脑叶出血)。记录纳入研究时的临床表现,MRI表现及随访的症状性脑叶出血的情况。使用Kaplan-Meier生存

该研究的是探索MRI显示的皮质表面铁沉积,尤其是受累面积超过3个脑回的弥漫性铁沉积症,是否增加脑淀粉样血管病患者症状性脑叶出血的风险。

该研究共纳入欧洲多中心队列研究中根据Boston诊断标准诊断的118例脑淀粉样血管病患者(其中104例在基线研究时即有症状性脑叶出血)。记录纳入研究时的临床表现,MRI表现及随访的症状性脑叶出血的情况。使用Kaplan-Meier生存曲线和Cox回归分析皮质表面铁沉积与脑出血的风险,并根据已知的混杂因素进行调整。

在平均随访24个月内(四分位间距为9到44个月),118例患者中23例(19.5%)出现了症状性脑叶出血。结果显示皮质表面铁沉积和弥漫性皮质表面铁沉积对初次脑出血或脑出血复发有预测价值。无铁沉积的患者4年内出血的风险为25%,局灶性铁沉积患者的风险为28.9%,而弥漫性皮质表面铁沉积的患者出血风险为74%。Cox回归模型显示,在调整微出血灶大于2个和年龄的因素后,任何的皮质表面铁沉积和弥漫性皮质表面铁沉积都与脑叶出血风险增加独立相关。当对基线研究时有脑出血的患者进行独立研究时,这些结果仍然显示强的敏感性。

该研究显示,皮质表面铁沉积,尤其是弥漫性的铁沉积,与症状性脑叶出血的风险增加相关。脑皮质表面铁沉积或可对脑淀粉样血管病出血风险进行分层,从而对预后和治疗有重大意义。

研究背景:

散发性脑淀粉样血管病是一类发病率较高的年龄相关的小血管病,往往由淀粉样蛋白在皮质及软脑膜血管壁沉积引起。脑淀粉样血管病是脑叶出血的主要原因,特别是在老年患者。自发性脑出血是卒中的一种重要类型,往往危害较大,具有较高的复发率。但是脑淀粉样血管病的再出血风险较难预测。中枢神经系统表面铁沉积症的诊断主要依靠磁共振T2加权成像上看到脑和脊髓表面出现线性低信号。最近的一项研究表明磁共振磁敏感加权成像(SWI)显示的含铁血黄素沉积较T2加权成像上的更明显,另外SWI还能发现一些脑内的出血,从而为研究脑皮质表面铁沉积与脑淀粉样血管病的再出血风险的关系提供了线索。

原文出处:

Charidimou A, Peeters AP, Jäger R, Fox Z, Vandermeeren Y, Laloux P, Baron JC, Werring DJ.Cortical superficial siderosis and intracerebral hemorrhage risk in cerebral amyloid angiopathy.Neurology. 2013 Nov 5;81(19):1666-73. doi: 10.1212/01.wnl.0000435298.80023.7a. 

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    2014-09-19 yinhl1978
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