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【文摘发布】脑白质缺血和溶栓后脑出血的关系
Author：Palumbo V, Boulanger JM, Hill MD, Inzitari D, Buchan AM; CASES Investigators.
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy. vanessa.palumbo@unifi.it
Resource: Stroke. 2007 Feb;38(2):292-7. Epub 2006 Dec 28.
Abstract：To evaluate whether the presence of leukoaraiosis or multiple lacunes is associated with symptomatic intracerebral hemorrhage (ICH) and 90-day outcome after thrombolytic treatment with tissue plasminogen activator (tPA). METHODS: Data were from a Canadian national registry of thrombolyzed patients with ischemic stroke. A total of 820 scans were assessed, blind to clinical features, for the presence of severe vs no/moderate leukoaraiosis, and of multiple (>2) vs no/single lacunar infarcts. Logistic regression was used to determine if an independent interaction existed between the presence and degree of leukoaraiosis/lacunes and risk of symptomatic ICH, and to evaluate the predictive role of leukoaraiosis and lacunes in relation to 90-day outcome. RESULTS: An overall symptomatic ICH rate of 3.5% was observed. The rate of symptomatic ICH increased up to 10% in patients with severe leukoaraiosis and multiple lacunes. A significant association was observed between ICH risk and either severe leukoaraiosis (RR = 2.7 [95% CI 1.1 to 6.5]) or multiple lacunes (RR = 3.4 [95% CI 1.5 to 7.6]). Patients with multiple lacunes, but not leukoaraiosis, had higher mortality at 90 days compared to those with one or no lacunes (OR = 2.9, 95% CI 1.3 to 6.2, p = 0.008). No difference was observed in the good outcome rate among patients with and without leukoaraiosis or lacunes or both. CONCLUSION: The presence of small vessel disease on CT scan does not affect overall clinical outcome at 3 months in routine community use of tPA for ischemic stroke. A significant increase in the risk of symptomatic ICH is observed.
PMID: 17389306
脑内小血管病变可能对溶栓结果产生影响，应该引起神经科医生的重视。
另，标题的翻译是根据文摘的内容来的。 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Title：Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke.
标题：急性脑卒中患者脑白质缺血和溶栓后脑出血的关系
Author：Palumbo V, Boulanger JM, Hill MD, Inzitari D, Buchan AM; CASES Investigators.
Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy. vanessa.palumbo@unifi.it
Resource: Stroke. 2007 Feb;38(2):292-7. Epub 2006 Dec 28.
Abstract：To evaluate whether the presence of leukoaraiosis or multiple lacunes is associated with symptomatic intracerebral hemorrhage (ICH) and 90-day outcome after thrombolytic treatment with tissue plasminogen activator (tPA).
摘要：为了评估脑白质缺血或多发性腔隙表现是否与症状性脑内出血(ICH)及用组织纤维蛋白溶酶原激活剂(tPA)溶栓治疗90天的结果有关。
METHODS: Data were from a Canadian national registry of thrombolyzed patients with ischemic stroke. A total of 820 scans were assessed, blind to clinical features, for the presence of severe vs no/moderate leukoaraiosis, and of multiple (>2) vs no/single lacunar infarcts. Logistic regression was used to determine if an independent interaction existed between the presence and degree of leukoaraiosis/lacunes and risk of symptomatic ICH, and to evaluate the predictive role of leukoaraiosis and lacunes in relation to 90-day outcome.
方法：资料来源于加拿大国内登记的缺血性脑卒中溶栓患者。撇开临床特征，总评估了820例CT扫描，出现相对严重型脑白质缺血和相对多发性腔隙性梗塞(>2个)的资料。通过逻辑回归来检测脑白质缺血及腔隙性梗塞的出现与程度和症状性脑内出血风险是否有独立的相互联系；同时评估脑白质缺血及腔隙性梗塞与溶栓治疗90天后的相关关系 。
RESULTS: An overall symptomatic ICH rate of 3.5% was observed. The rate of symptomatic ICH increased up to 10% in patients with severe leukoaraiosis and multiple lacunes. A significant association was observed between ICH risk and either severe leukoaraiosis (RR = 2.7 [95% CI 1.1 to 6.5]) or multiple lacunes (RR = 3.4 [95% CI 1.5 to 7.6]). Patients with multiple lacunes, but not leukoaraiosis, had higher mortality at 90 days compared to those with one or no lacunes (OR = 2.9, 95% CI 1.3 to 6.2, p = 0.008). No difference was observed in the good outcome rate among patients with and without leukoaraiosis or lacunes or both.
结果：患者中症状性脑内出血率为3.5% 。而出现严重型脑白质缺血和多发性腔隙性梗塞的患者中症状性脑内出血率增至10% 。观察发现大脑内出血危险度与重型脑白质缺血(RR = 2.7 [95% CI 1.1 to 6.5])或多发性腔隙性梗塞(RR = 3.4 [95% CI 1.5 to 7.6])显著相关。伴多发性腔隙性梗塞而无重型脑白质缺血的患者比那些单发或没有腔隙性梗塞的患者90 天溶栓治疗中死亡率高(OR = 2.9, 95% CI 1.3 to 6.2, p = 0.008)。伴有脑白质缺血或腔隙性梗塞或同时伴有两者的患者当治疗效果好时，没有区别。
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作者:admin@医学,生命科学 2010-10-27 05:11
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