脑室下腔隙脑海绵畸形可能是症状性出血和症状出现过早的风险因素:一项多中心、倾向评分匹配、病例对照研究。

Gustavo da Fontoura Galvão, Ricardo Castro Filho, Alexandre Alexandre Martins Cunha, Andre Guimarães Soares, Marcos Antônio Dellaretti Filho, Jorge Marcondes de Souza
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引用次数: 0

摘要

背景:脑空洞畸形(CCM)是中枢神经系统血管畸形中最常见的类型之一。脑出血、癫痫发作和病灶增生是其主要临床表现。目的:在此,我们对一个多中心 CCM 队列进行了分析,以寻找患有脑室上和/或脑室下海绵畸形的患者的不同临床数据,从而更好地了解这种独特神经外科疾病的解剖位置所涉及的风险因素:我们介绍了一项多中心、倾向评分匹配(PSM)、病例对照研究,包括2017年5月至2022年12月期间在三个不同神经外科中心接受临床评估的149例连续CCM病例。流行病学数据是在每次临床评估时定义的。逻辑回归用于确定每个可能的风险因素对出血风险的独立贡献。为了平衡有症状和无症状患者之间的基线协变量,特别是有症状出血和无症状出血患者之间的协变量,我们采用了PSM策略。我们绘制了 Kaplan-Meier 曲线,以评估是否存在脑室下病变的患者在生命早期出血的几率更大:结果:在将出血风险与纯粹无症状者进行比较的多变量分析中,存在脑室下病变是一个风险因素(OR:3.23,95% CI 1.43 - 7.26,P = 0.005)。此外,在 PSM 后,脑室下 CCM 也是一个风险因素(OR:4.56,95% CI 1.47 - 14.10,P = 0.008)。在总体队列中(P = 0.0328)和 PSM 组中(P = 0.03),将首次出血时间与所有其他临床表现进行比较,发现存在脑室下病变与症状的早发有关:在此,我们提供了一些证据,证明脑室内脑腔畸形的临床表现可能更具侵袭性,是出现症状性出血和出血过早的危险因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Infratentorial Cerebral Cavernous Malformation May be a Risk Factor for Symptomatic Bleeding and Precocity of Symptoms: A Multicenter, Propensity Score Matched, Case-Control Study.

Background: Cerebral Cavernous Malformation (CCM) is one of the most common types of vascular malformation of the central nervous system. Intracerebral hemorrhage, seizures, and lesional growth are the main clinical manifestations. Natural history studies have tried to identify many risk factors; however, the clinical course remains highly unpredictable.

Objective: Here, we have analyzed a multicenter CCM cohort looking for the differential clinical data regarding the patients harboring supra and/or infratentorial cavernous malformations in order to better understand risk factors involved in the anatomical location of the unique neurosurgical disease.

Methods: We have presented a multicenter, Propensity Score Matched (PSM), case-control study including 149 consecutive CCM cases clinically evaluated from May 2017 to December 2022 from three different neurosurgical centers. Epidemiological data were defined at each clinical assessment. Logistic regression was used to identify the independent contribution of each possible risk factor to the bleeding risk. To balance baseline covariates between patients with and without symptoms, and specifically between those with and without symptomatic bleeding, we used a PSM strategy. The Kaplan-Meier curve was drawn to evaluate if patients with infratentorial lesions had a greater chance of bleeding earlier in their life.

Results: The presence of infratentorial lesions was a risk factor in the multivariate analysis comparing the bleeding risk with pure asymptomatic individuals (OR: 3.23, 95% CI 1.43 - 7.26, P = 0.005). Also, having an infratentorial CCM was a risk factor after PSM (OR: 4.56, 95% CI 1.47 - 14.10, P = 0.008). The presence of an infratentorial lesion was related to precocity of symptoms when the time to first bleed was compared to all other clinical presentations in the overall cohort (P = 0.0328) and in the PSM group (P = 0.03).

Conclusion: Here, we have provided some evidence that infratentorial cerebral cavernous malformation may have a more aggressive clinical course, being a risk factor for symptomatic haemorrhage and precocity of bleeding.

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