晚期就诊脑出血患者血肿扩大的靶向扩大标准
本研究为多中心国际回顾性队列研究，纳入492例发病2-12小时的脑出血患者，排除脑干出血、抗凝及基线血肿>100 mL者。基于高极早期血肿增长、NCCT低密度征和CTA点征构建4分靶向扩大评分，评分≥2可识别血肿扩大高危患者，可能扩大临床试验入选人群。
要点
- 靶向扩大评分≥2提示晚就诊ICH患者血肿扩大风险高。
- 评分包含高uHG（1分）、NCCT低密度（1分）、CTA点征（2分）。
- 评分0至4分，血肿扩大频率从9.8%升至87.5%。
核心结论
- 基于影像的靶向扩大标准定义为评分≥2，可识别晚就诊ICH中血肿扩大高危患者。
- 该标准可能为未来针对血肿扩大的试验提供参考，并扩大合格患者池。
研究设计与样本
- 多中心、国际、回顾性队列研究。
- 共纳入492例患者，随机分为开发队列（345例）和验证队列（147例）。
- 排除脑干出血、抗凝治疗及基线血肿体积>100 mL的患者。
主要发现
- 4分评分由三个独立预测因子构成：高uHG 1分、NCCT低密度1分、CTA点征2分。
- 开发队列AUC 0.77（95%CI 0.71-0.83），验证队列AUC 0.79（95%CI 0.71-0.87）。
- 评分0至4分，血肿扩大频率分别为9.8%、17.1%、48.3%、70.8%、87.5%。
- 平均绝对血肿增长分别为0.9、3.9、11.5、13.0、26.9 mL。
- 评分≥2预测血肿扩大的敏感性0.61/0.64，特异性0.85/0.84（开发/验证）。
关键数值与推荐
- 高uHG定义为基线体积除以发病至影像时间>10 mL/h。
- 主要结局为血肿扩大>33%或6 mL。
- 靶向扩大评分≥2作为识别高危患者的阈值。
- 评分构成：高uHG=1分，NCCT低密度=1分，CTA点征=2分，总分4分。
临床怎么用
- 该标准可能用于识别适合参加血肿扩大治疗试验的晚期ICH患者。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND AND OBJECTIVES: The benefit of therapies targeting hematoma expansion (HE) in acute intracerebral hemorrhage (ICH) is highly time dependent and greatest within the first 2 hours after onset. We aimed to develop imaging-based "target expansion criteria" to identify late presenters (2-12 hours from onset/last seen well) who remain at high risk of HE. To achieve this goal, a practical risk score (target expansion score) was developed.
METHODS: We conducted a multicenter, international, retrospective cohort study. To mirror a clinical trial population, we excluded patients with brainstem ICH, anticoagulation, and baseline ICH volume >100 mL. The primary outcome was HE (>33%/6 mL). The following imaging predictors of HE were analyzed: high ultra-early hematoma growth (uHG) (baseline volume/onset to imaging time >10 mL/h), hypodensities on noncontrast CT (NCCT), and spot sign on CT angiography (CTA). The study population was randomly divided into development and validation cohorts, and a weighted score was derived from estimates from multivariable logistic regression.
RESULTS: Overall, 492 patients were included: 345 (70.1%) in the development and 147 (29.9%) in the validation cohort. A 4-point score was created, based on independent predictors of HE (high uHG: 1 point, NCCT hypodensities: 1 point, and CTA spot sign: 2 points). The score showed good discrimination in the development and validation cohorts (area under the curve [AUC] 0.77, 95% CI 0.71-0.83, and AUC 0.79, 95% CI 0.71-0.87, respectively). We observed a nonlinear increase in the frequency of HE and mean absolute hematoma growth with higher scores: 9.8% and 0.9 mL (score 0), 17.1% and 3.9 mL (score 1), 48.3% and 11.5 mL (score 2), 70.8% and 13.0 mL (score 3), and 87.5% and 26.9 mL (score 4). These findings were confirmed in the validation cohort. A dichotomized score greater than or equal to 2 predicted HE with 0.61 sensitivity and 0.85 specificity in the development cohort and 0.64 sensitivity with 0.84 specificity in the validation cohort.
DISCUSSION: Imaging-based target expansion criteria, defined as a target expansion score ≥2, identified late-presenting patients with ICH at high risk of HE. These findings might inform future trials targeting HE and increase the pool of eligible patients.
引用
- Morotti, Pensato, Nawabi, et al. Intracerebral Hemorrhage Expansion in Late Presenters: Proposed Target Expansion Criteria. Neurology. 2026. PMID: 42879724. doi:10.1212/WNL.0000000000218675
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。