老年人群自发性脑出血病因演变规律的多中心前瞻性趋势研究OA

Objective To analyze the changing trends in the etiologic spectrum of spontaneous intracerebral hemorrhage(ICH)in the older adults.Methods A multicenter ambispective cohort study was conducted.120 ICH patients among older adults admitted to Department of Neurosurgery of First People's Hospital of Yancheng City,People's Hospital of Jianhu County,and Dafeng People's Hospital of Yancheng City from April 2021 to March 2025 were enrolled.They were divided into early cohort(April2021 to March2023,n=60)and late cohort(April 2023 to March 2025,n=60)based on enrollment time.Etiology was determined using a unified etiological evaluation process and blinded review.The etiological composition and bleeding sites were compared between the two cohorts.Multivariate Logistic regression was used to analyze factors influencing non-hypertensive spontaneous ICH.Results There was a statistically significant difference in the etiological composition between the two cohorts(χ2=14.021,P=0.007).C ompared with the early cohort,the late cohort had a significantly lower proportion of hypertension-related ICH and significantly higher proportions of cerebral amyloid angiopathy-related ICH and antithrombotic drug-related ICH(P＜0.05).There was also a statistically significant difference in the distribution of bleeding sites between the two cohorts(χ2=8.813,P=0.012).Compared with the early cohort,the late cohort showed more lobar hemorrhages and fewer deep hemorrhages(P＜0.05).Multivariate Logistic regression analysis showed that age≥75 years(OR=1.850,95%CI:1.010-3.400),history of atrial fibrillation(OR=2.410,95%CI:1.150-5.070),history of antithrombotic drug use(OR=3.120,95%CI:1.540-6.320),and imaging features of cerebral amyloid angiopathy(OR=4.280,95%CI:1.760-10.400)were independently associated with non-hypertensive spontaneous ICH(P＜0.05).Conclusion The etiologic spectrum of spontaneous ICH in the older adults is evolving from a hypertension-dominant pattern to a multifactorial pattern.In clinical practice,in addition to strengthening blood pressure management,special attention should be paid to identifying patients with hemorrhagic risks such as advanced age,atrial fibrillation and antithrombotic therapy.