Fundamental research to develop the multi-faced diagnostic criteria of intracerebral hemorrhage for Japanese: correspondence to cerebral amyloid angiopathy

2018 Fiscal Year Final Research Report

• Project/Area Number: 15K10364
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Neurosurgery
• Research Institution: Saga University
• Principal Investigator: Yakushiji Yusuke 佐賀大学, 医学部, 講師 (80418813)
• Research Collaborator: Hara Hideo ; Kawashima Masatou ; Aishima Shinichi
• Project Period (FY): 2015-10-21 – 2019-03-31
• Keywords: 脳卒中 / 脳アミロイド血管症 / 高血圧性細動脈障害

Outline of Final Research Achievements

Prevalence of intracerebral hemorrhage (ICH) is higher in Eastern than in Western population, suggesting ICH is one of the target diseases should be tackled to control in Japan. Major pathogenesis of ICH (including cerebral micro bleeds [CMBs] ) include cerebral amyloid angiopathy (CAA) and other(mainly hypertensive arteriopathy). We demonstrated that there was no difference in the prevalence of CAA-related CMBs between Eastern and Western population. While Eastern populations had higher odds of hypertensive CMBs :adjusted odds ratio 2.78, 95% confidence interval [CI] 1.77-4.35) compared to Western populations. In hospital based-cohort, the estimated incidence (/100,000 year-person) of CAA-related ICH was similar between Eastern and Western patients (10.3 vs. 11.0), while that of hypertensive ICH was higher in Eastern compared to Western (41.5 vs 13.2). We also validated the Boston criteria, which was a clinical diagnostic tool for CAA in Japanese ICH patients.

Free Research Field

脳小血管病

Academic Significance and Societal Importance of the Research Achievements

日本人をはじめとした東アジア人種が、他人種よりも脳出血発症数が多い原因は、脳アミロイド血管症関連脳出血の差ではなく、高血圧性脳出血の発症数の差であることが示唆された。脳アミロイド血管症関連脳出血の診断であるボストン基準は日本人でも有用であることが示された。
高血圧性脳出血の診断基準は未だ策定されていない。今後、眼底検査、尿検査、心臓超音波検査などでの慢性の高血圧性血管障害をバイオマーカーにして診断基準を設けることで、適切な診断や治療の方針の決定につながるよう研究していきたい。