2021年 · 第101卷第31期

CT angiography (CTA) spot sign is associated with hematoma enlargement, mortality and poor functional prognosis in patients with spontaneous supratentorial cerebral hemorrhage. However, there are no related studies to explore the relationship between spot sign and spontaneous cerebellar hemorrhage. To investigate the correlation between spot sign and hematoma enlargement, 90-day mortality, and functional prognosis in spontaneous cerebellar hemorrhage, the researchers collected relevant clinical data of 358 patients with spontaneous cerebellar hemorrhage in three teaching hospitals from 2002 to 2017 (a modified Rankin scale score of 4 to 6 points was defined as poor functional prognosis). The results showed that 181 (51%) of 358 patients with spontaneous cerebellar hemorrhage had CTA examination. Of these 181 patients, 121 (67%) were treated conservatively and 60 (33%) surgically. Fifteen (12%) of conservatively treated patients developed spotty signs, with larger hematoma volumes in patients with spotty signs (P=0.001), and the hematoma expanded faster (P=0.034）。 Multivariate logistic regression analysis showed that the spot sign was independently associated with 90-d case mortality (OR=7.6， 95%CI：1.6~88.0，P=0.037）。 whereas of the surgically treated patients, 14 (23%) developed spotty signs, and the patients who developed spotty signs were older (P=0.047), with more female patients (P=0.033）。 Multivariate logistic regression analysis also showed that the spot sign was independently associated with 90-day mortality (OR=2.1， 95%CI：1.1~4.3，P=0.033）。 The results of this study showed that in patients with spontaneous cerebellar hemorrhage treated conservatively, spotty sign was associated with the speed of hematoma expansion, mortality and poor functional prognosis; Whereas in surgically treated patients, the spotty sign was associated with 90-d mortality.

Most studies have shown that there is no significant correlation between anti-acetylcholine receptor antibody (AChR-Ab) titer and the severity of myasthenia gravis (MG), but can AChR-Ab levels in MG patients be used to monitor changes in MG disease or predict MG prognosis? This study investigated the relationship between drug-induced changes in AChR-Ab levels and MG prognosis in patients with MG after 1 year of immunosuppressive therapy. The study included 53 AChR-Ab-positive MG patients admitted to Chiba University Affiliated Hospital in Japan from January 2013 to December 2018. AChR-Ab was re-tested within 100 days after immunosuppressive therapy, and the detection time was 71 (55~84) days. The AChR-Ab level reduction rate (RR-AChR-Ab, %/d) was adjusted for the time between initiation of treatment, and the AChR-Ab level remeasurement was calculated as follows: (pre-treatment-post-treatment AChR-Ab level) /pre-treatment AChR-Ab level/number of days from initiation of treatment, resulting AChR-Ab level remeasurement ×100. Subjects were divided into two groups based on cutoff values for RR-AChR-Ab, and subject profiling was used to determine the status of achieving minimum performance (MM) or better after 1 year of immunosuppressive therapy. The post-intervention status and MG activity of daily living (MG-ADL) scores of the American Myasthenia Gravis Foundation after 1 year of treatment were compared between the two groups. The results of this study showed a cut-off value of 0.64%/d for RR-AChR-Ab. A higher proportion of MG patients in the high RR-AChR-Ab group achieved MM or better (90% versus 65%,P=0.03), and the MG-ADL score was lower (median 1 to 2,P=0.04), which was lower than the low RR-AChR-Ab group. Kaplan-Meier analysis showed that the high RR-AChR-Ab group was prone to reach MM early (P=0.002, log-rank Inspection). Therefore, the study concluded that high RR-AChR-Ab is associated with a good prognosis 1 year after treatment. Re-measuring AChR-Ab within 100 d of treatment may be useful in predicting the prognosis of AChR-Ab positive MG 1 year after treatment.