| Objective:At present,the etiology,risk factors and prognosis of re-current cerebral hemorrhage have not been determined and the differe-nces among previous studies are significant.SMASH-U[1]is a new class-ification system for the pathogenesis of intracerebral hemorrhage.The purpose of this study was to investigate the etiological characteris-tics,risk factors and prognosis of recurrent intracerebral hemorrhag-e by using the SMASH-U classification system.Methods:This study collected the information of 1356 acute intracer-ebral hemorrhage cases who got treatrd in neurology department of To-ngji Hospital affiliated Tongji Medical College of Huazhong Universi-ty of Science and Technology from January 2015 to December 2017,the information includes demographic characteristics,blood pressure,past medical history,laboratory testing results,brain imaging studies,neu-rological function score and the treatment method,etc.the ICH pathog-enesis of each patient was classified using SMASH-U method.Patients were followed up（including death,neurological function recovery,recu-rrent stroke,risk factor control,neuropsychological conditions,etc）,and the etiological characteristics,risk factors and prognosis of re-current intracerebral hemorrhage were statistically analyzed.Results:In this study,987 patients with intracerebral hemorrhage we-re finally included,including 48 patients with recurrent intracerebr-al hemorrhage（4.9%）,the average interval between the first bledding and the second bledding is（8.9±13.1）months,range from one month to46 months.According to SMASH-U method,67 cases are classified as st-ructural lesion with 7 cases recurrence（10.45%）,8 cases are classifi-ed as medication with 1 case recurrence（12.5%）,28 cases are classifi-ed as amyloid angiopathy with 4 cases recurrence（14.29%）,19 cases are classified as systemic disease with 1 case recurrence（5.26%）,722 cas-es are classified as hypertension with 29 cases recurrence（4.02%）,143cases are classified as undetermined with 6 cases recurrence（4.23%）.The mortality of different pathogenesises is different,the structural lesion is the highest,followed by medication,amyloid angiopathy,syst-emic disease,hypertension,undetermined.Age（p=0.007）,history of hyper-tension（p=0.018）,blood triglyceride level（p=0.027）and ALT（p=0.045）were associated with recurrent intracerebral hemorrhage.Gender,bleed-ing site,history of diabetes,history of ischemic heart disease,use of anticoagulant and antithrombotic drugs,history of stroke,smoking,dri-nking,renal function and platelet count were not significantly assoc-iated with recurrent intracerebral hemorrhage.In multivariate analys-is,age>65（OR 2.351,p=0.010,95%CI 1.226-4.508）was a risk factor for recurrent intracerebral hemorrhage.Among the patients with recurrent intracerebral hemorrhage,there were 21 deaths（43.75%）,all within th-ree months of rebleeding,and 184 deaths（19.6%）in the single intrace-rebral hemorrhage,the difference was statistically significant（p=0.001）.Among the survivors,9 cases（33.3%）of recurrent intracerebral hem-orrhage had mRS>3 and 86 cases（11.5%）of single cerebral hemorrhage,and the difference was statistically significant（p=0.001）.There were21 cases（43.75%）of death in patients with recurrent cerebral hemorr-hage after three months of rebleeding and 142 cases（15.12%）in sing-le intracerebral hemorrhage after three months of bleeding,and the d-ifference was statistically significant（p<0.001）.There were 8 patie-nts（29.63%）of recurrent intracerebral hemorrhage with mRS>3 three m-onths after rebleeding,and 154 patients（19.59%）of single intracereb-ral hemorrhage with mRS>3 three months after bleeding,and the differ-ence was not statistically significant.The mortality of recurrent in-tracerebral hemorrhage of different pathogenesises was also different（p=0.044）,among which the mortality of amyloid angiopathy and system-ic disease was higher.The interval between two bleedings of no longer than 12 months（HR 6.053,p=0.019,95%CI 1.347-12.130）is a risk fact-or for death of recurrent intracerebral hemorrhage.Conclusion:Recurrent intracerebral hemorrhage accounted for 4.9%of the patients with intracerebral hemorrhage in the same period.Accord-ing to SMASH-U method,hypertensive cerebral hemorrhage is the most c-ommon pathogenesis of intracerebral hemorrhage,and amyloid angiopathy related intracerebral hemorrhage has the highest recurrence rate,at the same time,structural lesion has the highest mortality rate.Age>65 is a significant risk factor for recurrent intranetcerebral hemorr-hage.The prognosis of recurrent intracerebral hemorrhage is poor.The interval between two bleeding of no longer than 12 months was a sign-ificant risk factor for death of recurrent intracerebral hemorrhage. |
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