脑白质病变与脑出血迟发性水肿和功能预后相关性研究

Relationship of white matter lesions to delayed perihematomal edema expansion and functional outcome in intra⁃cerebral hemorrhage

目的 探讨脑白质病变与脑出血迟发性水肿和功能预后的关系。方法 回顾性分析郑州大学第一附属医院2021年9月—2023年1月209例幕上脑出血患者临床及影像学资料。使用vSS评分进行脑白质病变分级,迟发性水肿定义为从4~7 d到8~14 d血肿周围水肿绝对体积增长差值(ΔPHE)≥7.5 ml。对影响迟发性水肿和90 d不良转归的因素进行Logistic回归分析,对影响ΔPHE的因素进行多元线性回归分析。结果 209例患者中脑白质病变者93例,迟发性水肿者91例,90 d预后不良者104例。回归分析显示vSS评分、入院NIHSS评分、初始血肿体积是脑出血后迟发性水肿的独立危险因素,也是影响ΔPHE的独立危险因素。vSS评分、入院NIHSS评分、初始血肿体积和年龄是脑出血90 d不良预后的显著影响因素。与无/轻度脑白质病变相比,中/重度脑白质病变更易出现较差的功能结局。结论 脑白质病变程度、入院NIHSS评分、初始血肿体积是脑出血迟发性水肿的危险因素,且与90 d不良预后相关。迟发性水肿可能是脑白质病变影响脑出血预后的一个潜在机制,还需进一步前瞻性研究证实。

Objective To explore the relationship of white matter lesions to delayed perihematomal edema expan-sion and functional outcome in intracerebral hemorrhage.Methods The clinical and imaging data of 209 patients with su-pratentorial intracerebral hemorrhage in the First Affiliated Hospital of Zhengzhou University,from September 2021 to January 2023 were retrospectively analyzed.White matter lesions were graded using the van Swieten Scale(vSS)score.Delayed perihematomal edema expansion was defined as absolute volume growth of perihematomal edema(ΔPHE)≥7.5 ml from 4-7 days to 8-14 days.Logistic regression analysis was performed to identify risk factors for delayed perihematomal edema expansion and 90-day poor outcomes.Multiple linear regression analysis was utilized to identify risk factors forΔPHE.Results Of 209 patients,93 patients had white matter lesions,91 patients had delayed perihematomal edema ex-pansion,and 104 patients had 90-day poor outcomes.Regression analyses showed that vSS score,the National Institutes of Health Stroke Scale(NIHSS)score at admission,and initial hematoma volume were independent risk factors for de-layed perihematomal edema expansion after intracerebral hemorrhage and forΔPHE vSS score,NIHSS score at admission,initial hematoma volume,and age were significant factors affecting the 90-day poor outcome after intracerebral hemor-rhage.Compared with non/mild white matter lesions,moderate/severe white matter lesions were more likely to have poorer functional outcomes.Conclusion Severity of white matter lesions,NIHSS score at admission,and initial hematoma vol-ume were independent risk factors for delayed perihematomal edema expansion after intracerebral hemorrhage,and were correlated with 90-day poor outcomes.Delayed perihematomal edema expansion may be a potential mechanism of white matter lesions affecting the prognosis of intracerebral hemorrhage,which needs to be confirmed by further prospective studies.