Clinical Analysis Of 125 Young Patients With Intracerebral Hemorrhage

BackgroundWith high morbidity, mortality and disability, intracerebral hemorrhag(eICH) is one of the most common severe neurological disease, seriously threatening human life and health. In recent years, the onset age of ICH is becoming younger, for the change of life style and environmental factors. Young ICH is gradually noted as spontaneous hemorrhage of the intracranial parenchyma caught by people who are 45 years old and below. This disease influences the life quality of young people so generally and seriously, that the harmfulness to patients and the burden on the family and society are more serious than that of the old, even though the morbidity of young ICH is lower.Therefore, the study on how to prevent and cure young ICH is extremely important.ObjectiveTo investigate the risk factors, epidemiology, etiological factors, clinical features, hemorrhagic locations, hematoma shape and prognostic factors in young ICH patients, we retrospectively analyzed the clinical information of them. This study can provide some guidance for the primary or secondary prevention of disease, and early diagnosis of the disease, which can help decreasing the morbidity and mortality as well as improving the quality of life.Methods1. The intact clinical data of the 125 young ICH patients admitted to the First Affiliated Hospital of Chongqing Medical University from July 2006 to January 2010 were collected. Other 120 people without ICH aged 45 years old and below were selected as control group in the same period, whose detailed medical information was collected simultaneously.2. In order to analyze the possible risk factors of young ICH, all of the young ICH patients and the young examiners were investigated in a case control study.3. Multitude parameters were studied, including general information, etiological factors, clinical features, neuroimaging features, laboratory parameters, prognosis and prognostic factors. The differences between the different age and etiological factors groups were analyzed at the same time.4. Based on age: 14~34 yrs. group, 35~45 yrs. group; according to gender: male group, female group; according to etiology the young ICH patients were divided into four groups: hypertension, intracerebral vascular malformations, other causes and cryptogenic ICH.5. For statistical analysis, the differences between groups were tabulated and analyzed using the SPSS16.0 program. The numeration data was conducted by Chi-square test or Fisher's exact test. The measurement data were analyzed by Two-sample t-test for independent samples. And single sample analysis adopted Non-parametric test. A univariate analysis and multivariate regression analysis was respectively performed to determine prognostic factors for young ICH. P≤0.05 was statistic value.Results1. The risk factors: high BMI, smoking, drinking, stroke family history, hypertension history, high cholesterol and triglycerides were positively associated with young ICH(P <0.05 ).2. Epidemiological investigation: Young ICH patients in 12.7% of all ICH patients in the same period. The acute mortality rate was 19.2%. Among all cases, male in 70.4%, female in 29.6%, and the ratio of sex was 2.38:1. 14~34 yrs. cases in 8.8%, 35~45 yrs. cases in 17.6%, while 35~45 yrs. cases in 72.8%. The cases fell ill in working days in 69.6%, in spring and winter in 61.6%. Male cases with smoking were 31(96.88%) and with alcohol consumption were 30(93.75%).3. Etiological factors: hypertension in 65 (52.0%), cryptogenic ICH in 38(30.4%),vascular malformations in 11(49%).4. Clinical features: More than half (54.4%) of young patients were attacked in activity. The clinical manifestations were not specific, headache in 71.1%, allolalia in 57.6%, paralysis of limbs in 56.8%, and pathological signs in 48.8%. After CT scan, the locations of ICH were mainly at basal ganglia (45.6%), and differernt lobes (36.0%). Hypertension was found mainly in patients with the former hemorrhagic location and with the highest proportion of breaking into the ventricles. Other causes including intracerebral vascular malformations may lead to the hemorrhage in lobes. Among the all cases, irregular hematoma in 62.4%, and unilateral hemorrhage in 90.4%.There was no significance between left and right hemorrhage. The overall incidence of complications was 60%, of which the incidence of hypokalemia, brain hernia, pulmonary infection was 21.6%, 17.6% and 16.0% respectively.5. Comparison between groups: For the 35~45 yrs. group, the most common cause of ICH was hypertension, and the hemorrhage mainly located in the basal ganglia. While, the admission blood pressure, FGB, HCT was much lower in 14~34 yrs. group. Cryptogenic ICH and intracerebral vascular malformation were the most common causes in 14~34 yrs. group, and the hemorrhage mainly located in lobes.6. Prognostic factors: Univariate analysis(α=0.5) showed that age, the course of disease, blood volume, admission GCS score, breaking into ventricles, breaking into subarachnoid cavity, acute hydrocephalus, hemorrhagic side, BG, WBC and complications associated with the death of young ICH (P<0.05). The results calculated by multivariate stepwise logistic regressions(α=0.05) demonstrated that admission GCS score and BG enter the model, and Odds Ratio was 0.484 and 2.428 respectively. Conclusions1. High body mass index, smoking, drinking, stroke family history, hypertension history, high cholesterol and triglycerides were the possible risk factors of young ICH.2. Young ICH mainly involve the ganglion and result from hypertension with the highest proportion of breaking into the ventricles,which occurred Commonly in 35~45yrs patients, followed by cryptogenic ICH and cerebral vascular malformations occurring mainly in 14~34 yrs. patients of which major hemorrhagic location were lobes.3. Age, the course of disease, blood volume, admission GCS score, breaking into ventricles, breaking into subarachnoid cavity, acute hydrocephalus, hemorrhagic side, BG, WBC and complications associated with the death of young ICH. Admission GCS score and BG were the independent prognostic predictors. Lower admission GCS score and upper BG, higher the risk of death in young ICH patients.