亚洲与非亚洲脑出血临床结局差异：降压试验IPD分析
本研究基于急性卒中降压协作数据，汇总16项随机对照试验的6221例脑出血患者个体数据，比较亚洲与非亚洲区域患者的临床结局。结果显示，亚洲患者90天死亡或依赖、严重残疾及7天内神经功能恶化风险显著降低，但血肿扩大与死亡无差异；降压治疗与区域间无显著交互作用。
要点
- 亚洲ICH患者90天死亡或依赖风险显著低于非亚洲（IPTW加权OR 0.67）
- 亚洲患者严重残疾和7天神经功能恶化风险更低（OR 0.67/0.70）
- 降压治疗疗效在亚洲与非亚洲间无显著差异（交互作用不显著）
核心结论
- 东亚和南亚脑出血患者经混杂校正后功能恢复更佳且神经功能恶化风险更低，24小时血肿扩大无差异
- 未来脑出血临床结局研究应考虑区域差异
研究设计与样本
- 观察性分析，汇总16项已完成急性脑出血降压治疗随机对照试验的个体数据
- 来自急性卒中降压协作数据集，共6221例患者（年龄63.3±13.0岁，女性36.4%）
- 使用广义线性混合模型和逆概率治疗加权（IPTW）评估区域关联
主要发现
- 亚洲患者90天死亡或依赖风险显著降低（未调整OR 0.44，95%CI 0.39-0.51；IPTW加权OR 0.67，95%CI 0.58-0.77）
- 严重残疾风险降低（未调整OR 0.49，95%CI 0.42-0.56；IPTW加权OR 0.67，95%CI 0.57-0.78）
- 7天神经功能恶化风险降低（未调整OR 0.63，95%CI 0.52-0.77；IPTW加权OR 0.70，95%CI 0.56-0.89）
关键数值与推荐
- 血肿扩大定义为24小时绝对≥6 mL或相对≥33%，亚洲与非亚洲无差异（P=0.97）
- 90天死亡无差异（P=0.23）
- 死亡或依赖定义为改良Rankin量表评分3-6，严重残疾为3-5
临床怎么用
- 临床解读亚洲ICH患者预后时应考虑区域差异，但降压治疗策略无需因区域调整
局限性
- 主要为东亚和南亚，可能不代表亚洲全部地区
- 观察性分析可能存在残余混杂
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: Evidence of regional differences in clinical outcomes after intracerebral hemorrhage (ICH) is still scarce. We quantified differential outcomes and response to early intensive blood pressure lowering treatment by region in the Blood pressure in Acute Stroke Collaboration ICH data set.
METHODS: This was an observational analysis of pooled individual participant data from 16 completed randomized controlled trials of blood pressure-lowering treatment in acute ICH, based on the Blood pressure in Acute Stroke Collaboration data set. Generalized linear mixed models with inverse probability of treatment weighting (IPTW) were used to determine the association between regions (Asia [primarily East and South Asia] versus non-Asia) and clinical outcomes including neurological deterioration within 7 days, hematoma expansion at 24 hours (absolute ≥6 mL or relative ≥33%), and death or dependency (modified Rankin Scale scores, 3-6), major disability(modified Rankin Scale score, 3-5), death alone at 90 days.
RESULTS: Among 6221 patients (age, 63.3±13.0 years; female 36.4%), 3494 (56.2%) were from Asia. ICH participants from Asia had a significantly reduced risk of death or dependency (unadjusted odds ratio [OR], 0.44 [95% CI, 0.39-0.51]; IPTW-weighted OR, 0.67 [95% CI, 0.58-0.77]); and major disability (unadjusted OR, 0.49 [95% CI, 0.42-0.56]; IPTW-weighted OR, 0.67 [95% CI, 0.57-0.78]) at 90 days, neurological deterioration (unadjusted OR, 0.63 [95% CI, 0.52-0.77]; IPTW-weighted OR, 0.70 [95% CI, 0.56-0.89]) within 7 days, in comparison to those from non-Asia regions. However, there were no differences for hematoma expansion (P=0.97) at 24 hours or death (P=0.23) at 90 days using IPTW. Additionally, there were no significant interactions between blood pressure-lowering treatment and region (Asia versus non-Asia) for either outcome using IPTW.
CONCLUSIONS: Participants from East and South Asia had a favorable functional recovery and a lower risk of neurological deterioration compared with those from non-Asian regions after adjustment for confounders, with no differences in hematoma expansion at 24 hours after ICH. These findings suggest that future ICH studies on clinical outcomes should consider regional differences.
引用
- You, Ouyang, Moullaali, et al. Clinical Outcome Differences in Asia Versus Non-Asia Intracerebral Hemorrhage: IPD Analysis From BP-Lowering Clinical Trials. Stroke. 2026. PMID: 42872327. doi:10.1161/STROKEAHA.126.055677
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。