The Etiology?Clinical Characteristics Analysis And Prognosis Study Of Acute Intracerebral Hemorrhage In Young Adults Based On SMASH-U Classification System

OBJECTIVE: To retrospectively analyze the etiology,clinical features and prognosis of young patients with intracerebral hemorrhage.Exploring the unique clinical characteristics,etiology and prognosis of young patients with intracerebral hemorrhage,and providing scientific evidences for the clinical diagnosis and treatment of intracerebral hemorrhage in young adults in the future.METHODS: From January 2015 to December 2017,1230 patients with intracerebral hemorrhage treated at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology were enrolled.They were divided into youth group(18 to 50 years old)and middle-aged group(older than 50 years old).Clinical data between the two groups:gender,age,hematoma volume,bleeding site,risk factors,scores(NIHSS and GCS scores)were compared.The SMASH-U classification system was used to compare the etiological characteristics between the young and middle-aged groups,to analyze the gender,age,hemorrhage volume,bleeding site,risk factors and stroke scores of the subgroups of the young intracerebral hemorrhage patients in the SMASH-U classification system.All patients were followed up by telephone at 3 months,6 months,and 12 months after onset.The follow-up content was the survival and daily living ability(MRS score)of the patients at 3 months,6 months,and 12 months after onset.MRS?3 is divided into poor prognosis group,that is,death or disability,and MRS<3 is divided into good prognosis group,that is,life can be taken care of by oneself.The prognostic indicators were: mortality at the end of the follow-up period and adverse outcome rate.Binary logistic regression analysis was used to measure the relevant risk factors at the end of different follow-up periods.RESULTS:In the past 3 years,the proportion of young intacerebral hemorrhage in all intracerebral hemorrhage was 32.3% to 34.9%,the ratio of male to female was 2.2:1,the average age of onset was 42.5 years,and the average hematoma volume was 20.4 ml.In the young group,the age of onset of men is earlie,the volume of male bleeding is larger,deep hemisphere hemorrhage is the most common in male patients.Younger patients had less subarachnoid hemorrhage.In the risk factors: hypertension,diabetes,ischemic heart disease,history of related drugs,and history of previous stroke,the incidence of the young group was lower than that of the middle-aged group.There were no differences in stroke scores between the young and middle-aged groups.Hypertensive intracerebral hemorrhage is the main cause of the disease in both groups.In the young group,vascular structural causes such as vascular malformations,aneurysms,and arterial dissections were more common,and moyamoya disease was more common,and rare causes such as drug use,pregnancy,and CADASIL were observed.Based on the etiology of the SMASH-U classification system,young intracerebral hemorrhage is more common in vascular structural,drug-induced,systemic diseases,hypertensive and unexplained hemorrhage,and there is no amyloid angiopathy.There were significant differences in hematoma volume,bleeding site,risk factors,and stroke scores in each subgroup.The mortality rate of the young group at 3months,6 months,and 12 months after onset was lower than that of the middle-aged group,and the prognosis was better.Hematoma volume and NIHSS score at admission were independent risk factors for poor prognosis at 3 months and 6 months after onset in intracerebral hemorrhage of young adults.Hematoma volume is an independent risk factor for poor prognosis at 12 months after onset in intracerebral hemorrhage of young adults.CONCLUSION: There are significant differences in the etiology,clinical features and prognosis of intracerebral hemorrhage in young adults.In intracerebral hemorrhage of young adults,vascular structural causes account for a large proportion,with less drug,systemic,hypertensive and unexplained.And intracerebral hemorrhage caused by hypertensione can not be ignored.The prognosis of young patients with intracerebral hemorrhage is better than that of middle-aged and elderly patients.Hematoma volume and stroke score at admission are factors influencing the prognosis of young patients with intracerebral hemorrhage.