| Objective: Hematoma enlargement in spontaneous intracerebral hemorrhage (ICH) is an important reason of the patients'early neurological deterioration,and associated closely with patients'prognosis, so it is increasingly concerned by medical workers. We conducted this prospective study to determine the possible mechanisms of hematoma enlargement and identify potential predictors and risk factors related with hematoma enlargement through contrast analyses between patients with and without hematoma enlargement. In order to make some guidances on causes of clinical deterioration and selecting efficiently therapy to prevent hematoma enlargement in time, the clinical features, biochemical parameters, hemodynamic measurement, platelet function, coagulation function, neuroimaging, plasma interleukin-6(IL-6) and so on were analyzed in patients with ICH. It might be possible to reduce the brain injury to a less degree and decrease the disabling rate and mortality rate and improve the patients'life qualities through performing the study.Methods: Seventy-four patients with ICH who were admitted to our hospital within 3 hours after onset from April, 2005 to December, 2006 were studied. All of the patients with ICH were matched with diagnosis by clinical standards referred to the standards revised in the Fourth National Cerebrovascular Diseases Meeting in 1995 and confirmed by computerized tomography (CT). All patients were performed the first CT scan immediately on admission, the second CT scan were performed immediately when the patients'clinical symptom deteriorated progressively, or at 24 hours after onset if patients'clinical symptom were stable. ICH volume was determined in the following manner: on the CT slice with the largest area of ICH, the longest diameter (A) of the hematoma was measured from the centimeter scale on the film, the largest possible diameter perpendicular to the longest diameter represented the second diameter (B),the height of the hematoma was calculated by multiplying the number of slices involved by slice thickness, providing the third diameter (C).Each diameter was determined to half a centimeter, the hematoma volume V(cm3)=π/6×(A×B×C). According to ROC curve analyses which was used by Kauzi, enlargement of hematoma was defined as an increase in the volume of V2/V1≥1.4 or V2-V1≥12.5cm3. Seventy-four patients were divided into the Enlarged (n=19) and Non-enlarged(n=55) groups. We performed statistical analysis of them such as general parameters (sex, age, consciousness, histories of other diseases, smoking, drinking, taking oral medicines which influence coagulation function), blood pressure, biochemical parameters (liver function, fasting plasma glucose, blood-lidpoids), hemorheology measurement, platelet function, coagulation function, plasma interleukin-6(IL-6), brain CT characteristics (hematoma shape and hematoma site) between the enlarged and non-enlarged groups. Statistical analyses were performed with the SPSS for windows package (version 12.0). Numerical variables were assessed by the t test and categorical variables were performed with theχ2 test.Results: 1 The results of univariate analysis in general parameters showed: there were 14 patients (73.68%) with alcohol abuse, 9 patients (47.37%) taking oral enteric coated aspirin and 11 coma patients (57.89%) in 19 patients with hematoma enlargement, while there were 13 patients (23.64%) with alcohol abuse, 11 patients (20.00%) taking oral enteric coated aspirin and 15 coma patients (27.27%) in 55 patients without hematoma enlargement. There were significant differences in these parameters between two groups (P<0.05), but there were no significant differences in sex, age, histories of hypertension, brain infarction, coronary heart disease, diabetes mellitus and smoking(P>0.05).2 Blood pressure: the maximium value of systolic blood pressure (Msbp) was 216.84±15.85mmHg, the mean value of systolic blood pressure (SBP) was 182.62±7.22mmHg and the mean arterial blood pressure (MAP) was 126.66±3.23mmHg in 24 hours after onset, which were significantly higher in the enlarged group than that in the non-enlarged group [Msbp was 180.60±6.62mmHg, the mean value of SBP was 168.21±4.05 mmHg and MAP was 121.30±1.67mmHg] (P<0.05).3 Biochemical parameters: the mean value of alanine aminotransferase(ALT) was 53.58±19.93U/L, aspartate aminotrans -ferase(AST) was 38.74±12.40U/L andγ-glutamyl transferase (GGT) was 63.16±28.82U/L in enlarged group,while the mean value of ALT was 33.29±16.97U/L,AST was 22.51±12.79U/L and GGT was 36.35±18.53U/L in non-enlarged group. There were significant differences in these parameters between two groups (P<0.05), but there were no significant differences in fasting plasma glucose and blood-lidpoids(P>0.05).4 Hemorheology measurement: there were no statistical significance differences in blood viscosity, plasma viscosity between two groups(P>0.05).5 Platelet functions: the mean platelet count was (148.00±34.41)×109/L, platelet aggregation(1) was 27.35±5.66%, platelet aggregation (3) was 29.61±6.88% and platelet aggregation(M) was 31.17±9.67% in the enlarged group; While the mean platelet count was (224.27±69.40)×109/L, platelet aggregation (1) was 46.32±6.23%, platelet aggregation (3) was 44.90±9.44% and platelet aggregation(M) was 42.88±9.04% in the non-enlarged group,there were significant differences between two groups (P<0.05).6 Coagulation function: the mean fibrinogen 1.91±0.41g/L in the enlarged group was lower than the mean fibrinogen 3.21±0.49g/L in the non-enlarged group, there was significant difference between two groups (P < 0.05). There were no significance differences in prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) between two groups(P>0.05).7 Plasma IL-6: plasma IL-6 level of the enlarged group on admission was 21.62±4.43pg/mL, which was higher than 15.08±1.88pg/mL in the non-enlarged group. there was significant differences between two groups (P<0.05).8 Brain CT: The site of hematoma enlargement was all in basal ganglia areas. 14 patients (73.68%) with hematoma enlargement happened in 6 hours after onset, and 5 patients (26.32%) with hematoma enlargement in 6 to 24 hours after onset. There were 12 patients (63.16%) whose hematoma shape were irregularly in the enlarged group and 14 patients (25.45%) in the non-enlarged group, there were significant differences between two groups (P<0.05).Conclusions: 1 Alcohol abuse and taking oral enteric coated aspirin for a long time may be risk factors of hematoma enlargement in ICH.2 Liver dysfunction, the relatively insufficient of platelet count, decreased platelet aggregation and a low level of fibrinogen were risk factors of hematoma enlargement in ICH.3 Elevated systolic blood pressure and the mean arterial blood pressure in 24 hours after onset were risk factors of hematoma enlargement in ICH.4 Plasma IL-6 elevated highly in the enlarged group than that in the non-enlarged group, it's possible to be a predictor of progressive hematoma enlargement in ICH.5 Irregular hematoma shape in brain CT can be used as a predictive factor of hematoma enlargement in ICH.6 More severe consciousness disturbance in early period after onset and progressive neurological deterioration may have predictive value for hematoma enlargement.7 Multiple risk factors and mechanisms result in hematoma enlargement in ICH such as coagulation dysfunction, elevated blood pressure, so earlier hemostatic therapy and efforts to lower blood pressure may prevent hematoma enlargement. |
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