临床可应用和潜在的自发性脑出血后血肿扩大预测因素的研究进展
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摘要
自发性脑出血(ICH)是脑卒中的第二大常见病因,发病率较高,近40%的自发性ICH患者出现血肿扩大,且血肿扩大与不良预后和病死率密切相关。因此,对ICH后血肿扩大的早期预测和早期处置极具重要性。文中总结了近几年公认的ICH后预测血肿扩大的可能因子(主要包括影像学特征以及9分临床预测量表和BRAIN 24分临床预测量表),同时对潜在的预测因子(如血糖、C反应蛋白、白细胞介素6等)的研究进展进行综述,以期为临床ICH患者血肿扩大的早期干预提供帮助。
Spontaneous intracerebral hemorrhage( ICH) is the second most common cause of stroke,and its incidence is high,and nearly 40% of patients will develop hematoma expansion,which is closely related to poor prognosis and mortality. Therefore,early prediction and early management of hematoma enlargement are very important. This review summarized the widely recognized hematoma expansion predictors in recent years,mainly including imaging characteristics and two recently proposed rating scales.Potential predictors,such as blood glucose and inflammatory indexes,were introduced in order to provide help for the early intervention of clinical hematoma expansion.
Spontaneous intracerebral hemorrhage( ICH) is the second most common cause of stroke,and its incidence is high,and nearly 40% of patients will develop hematoma expansion,which is closely related to poor prognosis and mortality. Therefore,early prediction and early management of hematoma enlargement are very important. This review summarized the widely recognized hematoma expansion predictors in recent years,mainly including imaging characteristics and two recently proposed rating scales.Potential predictors,such as blood glucose and inflammatory indexes,were introduced in order to provide help for the early intervention of clinical hematoma expansion.
引文
[1] de Oliveira Manoel AL, Goffi A, Zampieri FG, et al. The critical care management of spontaneous intracranial hemorrhage:a contemporary review[J]. Crit Care, 2016, 20:272
[2] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies:a systematic review[J]. Lancet Neurol, 2009, 8:355-369
[3] Tsai CF, Thomas B,Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations:a systematic review[J]. Neurology, 2013, 81:264-272
[4] Liu J, Wang D, Yuan R,et al. Prognosis of 908 patients with intracerebral hemorrhage in Chengdu, Southwest of China[J].Int J Neurosci, 2017,127:586-591
[5] Dowlatshahi D, Demchuk AM, Flaherty ML, et al. Defining hematoma expansion in intracerebral hemorrhage:relationship with patient outcomes[J]. Neurology, 2011,76:1238-1244
[6] Leira R, Dvalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage:predictors and associated factors[J]. Neurology, 2004, 63:461-467
[7] Delcourt C, Huang Y, Arima H, et al. Hematoma growth and outcomes in intracerebral hemorrhage:the INTERACT1 study[J]. Neurology, 2012, 79:314-31
[8] Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage[J].JAMA Neurol, 2014, 71:158-16
[9] Anderson CS, Qureshi AI. Implications of INTERACT2 and other clinical trials:blood pressure management in acuteintracerebral hemorrhage[J]. Stroke, 2015, 46:291-295
[10]Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage[J]. Stroke, 2003, 34:1717-1722
[11]Fujii Y, Tanaka R, Takeuchi S, et al. Hematoma enlargement in spontaneous intracerebral hemorrhage[J]. J Neurosurg,1994, 80:51-57
[12]Fisher CM. Pathological observations in hypertensive cerebral hemorrhage[J]. J Neuropathol Exp Neurol, 1971, 30:536-550
[13]Ovesen C, Christensen AF, Krieger DW, et al. Time course of early postadmission hematoma expansion in spontaneous intracerebral hemorrhage[J]. Stroke, 2014,45:994-999
[14]Brouwers HB, Falcone GJ, McNamara KA, et al. CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage[J]. Neurocrit Care,2012,17:421-428
[15]Boulouis G, Dumas A, Betensky RA, et al. Anatomic pattern of intracerebral hemorrhage expansion:relation to CT angiography spot signand hematoma center[J]. Stroke, 2014, 45:1154-1156
[16]Ovesen C, Havsteen I, Rosenbaum S, et al. Prediction and observation of post-admission hematoma expansion in patients with intracerebral hemorrhage[J]. Front Neurol, 2014, 5:186
[17]Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage[J]. Lancet, 2009,373:1632-1644.
[18]Dang G, Yang Y, Wu G, et al. Early Erythrolysis in the Hematoma After Experimental Intracerebral Hemorrhage[J].Transl Stroke Res, 2017, 8:174-182
[19]Wan S, Cheng Y, Jin H, et al. Microglia Activation and Polarization After Intracerebral Hemorrhage in Mice:the Role of Protease-Activated Receptor-1[J]. Transl Stroke Res, 2016,7:478-487
[20]Chen M, Sun J, Lu C, et al. The impact of neuronal Notch-1/JNK pathway on intracerebral hemorrhage-induced neuronalinjury of rat model[J]. Oncotarget, 2016,7:73903-73911
[21]Wang J, Tsirka SE. Neuroprotection by inhibition of matrix metalloproteinases in a mouse model of intracerebral haemorrhage[J]. Brain, 2005, 128:1622-1633
[22]郑佳骏,吴刚,胡枢坤.脑出血后凝血酶诱导自噬细胞的种类研究[J].中国临床神经科学,2019, 27:16-21
[23]Peng WJ, Reis C, Reis H, et al. Predictive Value of CTA Spot Sign on Hematoma Expansion in Intracerebral Hemorrhage Patients[J]. Biomed Res Int, 2017,2017:4137210
[24]Hotta K, Sorimachi T, Osada T, et al. Risks and benefits of CT angiography in spontaneous intracerebral hemorrhage[J]. Acta Neurochir(Wien), 2014, 156:911-917
[25]Xu X, Zhang J, Yang K, et al. Accuracy of spot sign in predicting hematoma expansion and clinical outcome:A metaanalysis[J]. Medicine(Baltimore), 2018,97:e11945
[26]Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, et al.Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign(PREDICT):a prospective observational study[J]. Lancet Neurol, 2012,11:307-314
[27]Brouwers HB, Falcone GJ, McNamara KA, et al. CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage[J]. Neurocrit Care,2012, 17:421-428
[28]Romero JM, Heit JJ, Delgado Almandoz JE, et al. Spot sign score predicts rapid bleeding in spontaneous intracerebral hemorrhage[J]. Emerg Radiol, 2012,19:195-202
[29]Peng WJ, Reis C, Reis H, et al. Predictive Value of CTA Spot Sign on Hematoma Expansion in Intracerebral Hemorrhage Patients[J]. Biomed Res Int, 2017, 2017:4137210
[30]Orito K, Hirohata M, Nakamura Y, et al. Leakage Sign for Primary Intracerebral Hemorrhage:A Novel Predictor of Hematoma Growth[J]. Stroke, 2016, 47:958-963
[31]汤奉琼.影像学特征对预测急性期脑出血血肿扩大的研究进展[J].医学影像学杂志,2018,28:322-325
[32]Dowlatshahi D, Smith EE, Flaherty ML, et al. Small intracerebral haemorrhages are associated with less haematoma expansion and better outcomes[J]. Int J Stroke, 2011, 6:201-206
[33]Dowlatshahi D, Yogendrakumar V, Aviv RI, et al. Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand[J]. Int J Stroke, 2016,11:191-197
[34]Chen S, Zhao B, Wang W, et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J].Oncotarget, 2017, 8:89348-89363
[35]Zimmerman RA, Bilaniuk LT. Computed tomographic staging of traumatic epidural bleeding[J]. Radiology, 1982,144:809-812
[36]Zhang D, Chen J, Xue Q, et al. Heterogeneity Signs on Noncontrast Computed Tomography Predict Hematoma Expansion after Intracerebral Hemorrhage:A Meta-Analysis[J]. Biomed Res Int, 2018, 2018:6038193
[37]Xiong X, Li Q, Yang WS, et al. Comparison of Swirl Sign and Black Hole Sign in Predicting Early Hematoma Growth in Patientswith Spontaneous Intracerebral Hemorrhage[J]. Med Sci Monit, 2018,24:567-573
[38]Li Q, Zhang G, Xiong X, et al. Black Hole Sign:Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage[J]. Stroke, 2016,47:1777-1781
[39]Li Q, Zhang G, Huang YJ, et al. Blend Sign on Computed Tomography:Novel and Reliable Predictor for Early Hematoma Growthin Patients With Intracerebral Hemorrhage[J]. Stroke,2015, 46:2119-2123
[40]Zheng J, Yu Z, Xu Z, et al. The Accuracy of the Spot Sign and the Blend Sign for Predicting Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage[J]. Med Sci Monit,2017,23:2250-2257
[41]Sporns PB, Schwake M, Kemmling A, et al. Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage[J]. J Stroke, 2017, 19:333-339
[42]Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage:Risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII[J]. Neurosurgery, 2006,59:767-773
[43]Hallevi H, Albright KC, Aronowski J, et al. Intraventricular hemorrhage:anatomic relationships and clinical implications[J].Neurology, 2008, 70:848-852
[44]Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage[J].JAMA Neurol, 2014,71:158-164
[45]Wang X, Arima H, Al-Shahi Salman R, et al. Clinical prediction algorithm(BRAIN)to determine risk of hematoma growth in acute intracerebral hemorrhage[J]. Stroke, 2015, 46:376-381
[46]Chen S, Zhao B, Wang W, et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J].Oncotarget, 2017, 8:89348-89363
[47]Adnan I, Qureshi, Yuko Y, et al. Association of serum glucose concentrations during acute hospitalization with hematoma expansion, perihematomal edema, and three month outcome among patients with intracerebral hemorrhage[J]. Neurocrit Care, 2011,15:428-435
[48]Zhang F, Li H, Qian J, et al. Hyperglycemia Predicts Blend Sign in Patients with Intracerebral Hemorrhage[J]. Med Sci Monit, 2018, 24:6237-6244
[49]Koga M, Yamagami H, Okuda S, et al. Blood glucose levels during the initial 72 h and 3-month functional outcomes in acute intracerebral hemorrhage:the SAMURAI-ICH study[J]. J Neurol Sci, 2015,350:75-78
[50]Zheng Y, Hu Q, Manaenko A, et al. 17β-Estradiol attenuates hematoma expansion through estrogen receptorα/silent information regulator 1/nuclear factor-kappa b pathway in hyperglycemic intracerebral hemorrhage mice[J]. Stroke, 2015,46:485-491
[51]Godoy DA, Di Napoli M, Rabinstein AA. Treating hyperglycemia in neurocritical patients:benefits and perils[J].Neurocrit Care, 2010,13:425-438
[52]Di Napoli M, Parry-Jones AR, Smith CJ, et al. C-reactive protein predicts hematoma growth in intracerebral hemorrhage[J]. Stroke, 2014,45:59-65
[53]Silva Y, Leira R, Tejada J, et al. Molecular signatures of vascular injury are associated with early growth of intracerebral hemorrhage[J]. Stroke, 2005, 36:86-91
[2] Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies:a systematic review[J]. Lancet Neurol, 2009, 8:355-369
[3] Tsai CF, Thomas B,Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations:a systematic review[J]. Neurology, 2013, 81:264-272
[4] Liu J, Wang D, Yuan R,et al. Prognosis of 908 patients with intracerebral hemorrhage in Chengdu, Southwest of China[J].Int J Neurosci, 2017,127:586-591
[5] Dowlatshahi D, Demchuk AM, Flaherty ML, et al. Defining hematoma expansion in intracerebral hemorrhage:relationship with patient outcomes[J]. Neurology, 2011,76:1238-1244
[6] Leira R, Dvalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage:predictors and associated factors[J]. Neurology, 2004, 63:461-467
[7] Delcourt C, Huang Y, Arima H, et al. Hematoma growth and outcomes in intracerebral hemorrhage:the INTERACT1 study[J]. Neurology, 2012, 79:314-31
[8] Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage[J].JAMA Neurol, 2014, 71:158-16
[9] Anderson CS, Qureshi AI. Implications of INTERACT2 and other clinical trials:blood pressure management in acuteintracerebral hemorrhage[J]. Stroke, 2015, 46:291-295
[10]Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage[J]. Stroke, 2003, 34:1717-1722
[11]Fujii Y, Tanaka R, Takeuchi S, et al. Hematoma enlargement in spontaneous intracerebral hemorrhage[J]. J Neurosurg,1994, 80:51-57
[12]Fisher CM. Pathological observations in hypertensive cerebral hemorrhage[J]. J Neuropathol Exp Neurol, 1971, 30:536-550
[13]Ovesen C, Christensen AF, Krieger DW, et al. Time course of early postadmission hematoma expansion in spontaneous intracerebral hemorrhage[J]. Stroke, 2014,45:994-999
[14]Brouwers HB, Falcone GJ, McNamara KA, et al. CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage[J]. Neurocrit Care,2012,17:421-428
[15]Boulouis G, Dumas A, Betensky RA, et al. Anatomic pattern of intracerebral hemorrhage expansion:relation to CT angiography spot signand hematoma center[J]. Stroke, 2014, 45:1154-1156
[16]Ovesen C, Havsteen I, Rosenbaum S, et al. Prediction and observation of post-admission hematoma expansion in patients with intracerebral hemorrhage[J]. Front Neurol, 2014, 5:186
[17]Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage[J]. Lancet, 2009,373:1632-1644.
[18]Dang G, Yang Y, Wu G, et al. Early Erythrolysis in the Hematoma After Experimental Intracerebral Hemorrhage[J].Transl Stroke Res, 2017, 8:174-182
[19]Wan S, Cheng Y, Jin H, et al. Microglia Activation and Polarization After Intracerebral Hemorrhage in Mice:the Role of Protease-Activated Receptor-1[J]. Transl Stroke Res, 2016,7:478-487
[20]Chen M, Sun J, Lu C, et al. The impact of neuronal Notch-1/JNK pathway on intracerebral hemorrhage-induced neuronalinjury of rat model[J]. Oncotarget, 2016,7:73903-73911
[21]Wang J, Tsirka SE. Neuroprotection by inhibition of matrix metalloproteinases in a mouse model of intracerebral haemorrhage[J]. Brain, 2005, 128:1622-1633
[22]郑佳骏,吴刚,胡枢坤.脑出血后凝血酶诱导自噬细胞的种类研究[J].中国临床神经科学,2019, 27:16-21
[23]Peng WJ, Reis C, Reis H, et al. Predictive Value of CTA Spot Sign on Hematoma Expansion in Intracerebral Hemorrhage Patients[J]. Biomed Res Int, 2017,2017:4137210
[24]Hotta K, Sorimachi T, Osada T, et al. Risks and benefits of CT angiography in spontaneous intracerebral hemorrhage[J]. Acta Neurochir(Wien), 2014, 156:911-917
[25]Xu X, Zhang J, Yang K, et al. Accuracy of spot sign in predicting hematoma expansion and clinical outcome:A metaanalysis[J]. Medicine(Baltimore), 2018,97:e11945
[26]Demchuk AM, Dowlatshahi D, Rodriguez-Luna D, et al.Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign(PREDICT):a prospective observational study[J]. Lancet Neurol, 2012,11:307-314
[27]Brouwers HB, Falcone GJ, McNamara KA, et al. CTA spot sign predicts hematoma expansion in patients with delayed presentation after intracerebral hemorrhage[J]. Neurocrit Care,2012, 17:421-428
[28]Romero JM, Heit JJ, Delgado Almandoz JE, et al. Spot sign score predicts rapid bleeding in spontaneous intracerebral hemorrhage[J]. Emerg Radiol, 2012,19:195-202
[29]Peng WJ, Reis C, Reis H, et al. Predictive Value of CTA Spot Sign on Hematoma Expansion in Intracerebral Hemorrhage Patients[J]. Biomed Res Int, 2017, 2017:4137210
[30]Orito K, Hirohata M, Nakamura Y, et al. Leakage Sign for Primary Intracerebral Hemorrhage:A Novel Predictor of Hematoma Growth[J]. Stroke, 2016, 47:958-963
[31]汤奉琼.影像学特征对预测急性期脑出血血肿扩大的研究进展[J].医学影像学杂志,2018,28:322-325
[32]Dowlatshahi D, Smith EE, Flaherty ML, et al. Small intracerebral haemorrhages are associated with less haematoma expansion and better outcomes[J]. Int J Stroke, 2011, 6:201-206
[33]Dowlatshahi D, Yogendrakumar V, Aviv RI, et al. Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand[J]. Int J Stroke, 2016,11:191-197
[34]Chen S, Zhao B, Wang W, et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J].Oncotarget, 2017, 8:89348-89363
[35]Zimmerman RA, Bilaniuk LT. Computed tomographic staging of traumatic epidural bleeding[J]. Radiology, 1982,144:809-812
[36]Zhang D, Chen J, Xue Q, et al. Heterogeneity Signs on Noncontrast Computed Tomography Predict Hematoma Expansion after Intracerebral Hemorrhage:A Meta-Analysis[J]. Biomed Res Int, 2018, 2018:6038193
[37]Xiong X, Li Q, Yang WS, et al. Comparison of Swirl Sign and Black Hole Sign in Predicting Early Hematoma Growth in Patientswith Spontaneous Intracerebral Hemorrhage[J]. Med Sci Monit, 2018,24:567-573
[38]Li Q, Zhang G, Xiong X, et al. Black Hole Sign:Novel Imaging Marker That Predicts Hematoma Growth in Patients With Intracerebral Hemorrhage[J]. Stroke, 2016,47:1777-1781
[39]Li Q, Zhang G, Huang YJ, et al. Blend Sign on Computed Tomography:Novel and Reliable Predictor for Early Hematoma Growthin Patients With Intracerebral Hemorrhage[J]. Stroke,2015, 46:2119-2123
[40]Zheng J, Yu Z, Xu Z, et al. The Accuracy of the Spot Sign and the Blend Sign for Predicting Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage[J]. Med Sci Monit,2017,23:2250-2257
[41]Sporns PB, Schwake M, Kemmling A, et al. Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage[J]. J Stroke, 2017, 19:333-339
[42]Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage:Risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII[J]. Neurosurgery, 2006,59:767-773
[43]Hallevi H, Albright KC, Aronowski J, et al. Intraventricular hemorrhage:anatomic relationships and clinical implications[J].Neurology, 2008, 70:848-852
[44]Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage[J].JAMA Neurol, 2014,71:158-164
[45]Wang X, Arima H, Al-Shahi Salman R, et al. Clinical prediction algorithm(BRAIN)to determine risk of hematoma growth in acute intracerebral hemorrhage[J]. Stroke, 2015, 46:376-381
[46]Chen S, Zhao B, Wang W, et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J].Oncotarget, 2017, 8:89348-89363
[47]Adnan I, Qureshi, Yuko Y, et al. Association of serum glucose concentrations during acute hospitalization with hematoma expansion, perihematomal edema, and three month outcome among patients with intracerebral hemorrhage[J]. Neurocrit Care, 2011,15:428-435
[48]Zhang F, Li H, Qian J, et al. Hyperglycemia Predicts Blend Sign in Patients with Intracerebral Hemorrhage[J]. Med Sci Monit, 2018, 24:6237-6244
[49]Koga M, Yamagami H, Okuda S, et al. Blood glucose levels during the initial 72 h and 3-month functional outcomes in acute intracerebral hemorrhage:the SAMURAI-ICH study[J]. J Neurol Sci, 2015,350:75-78
[50]Zheng Y, Hu Q, Manaenko A, et al. 17β-Estradiol attenuates hematoma expansion through estrogen receptorα/silent information regulator 1/nuclear factor-kappa b pathway in hyperglycemic intracerebral hemorrhage mice[J]. Stroke, 2015,46:485-491
[51]Godoy DA, Di Napoli M, Rabinstein AA. Treating hyperglycemia in neurocritical patients:benefits and perils[J].Neurocrit Care, 2010,13:425-438
[52]Di Napoli M, Parry-Jones AR, Smith CJ, et al. C-reactive protein predicts hematoma growth in intracerebral hemorrhage[J]. Stroke, 2014,45:59-65
[53]Silva Y, Leira R, Tejada J, et al. Molecular signatures of vascular injury are associated with early growth of intracerebral hemorrhage[J]. Stroke, 2005, 36:86-91