原始脑出血评分量表在脑动静脉畸形脑出血预后评估中的应用  

Application of the original intracerebral hemorrhage score in the evaluation of prognosis of patients with arteriovenous malformation–associated intracerebral hemorrhage

作　　者：崔桂云[1] 陈晨[2] 叶新春[1] 王小鹏[1] 董丽果[1] 祖洁[1] 张伟[1] 

机构地区：[1]徐州医学院附属医院神经内科,徐州221000 [2]徐州医学院附属医院神经外科,徐州221000

出　　处：《上海医药》2013年第23期19-22,共4页Shanghai Medical & Pharmaceutical Journal

基　　金：国家自然基金资助项目(编号:81271344)

摘　　要：目的 :评价原始脑出血量表在预测脑动静脉畸形脑出血患者预后中的可行性。方法 :收集徐州医学院附属医院2005-2012年76名脑动静脉畸形出血患者,并取得人口学、影像学等临床资料。采用改良的Rankin Scale法对3个月时的临床结果进行评估。当结果不良(mRS≥3)时,使用最大的Youden指数区分与预测准确性相关的年龄及出血量的分界值。脑动静脉畸形-脑出血评分量表在oICH量表的基础上使用了新的年龄和出血量的分界值,应用受者作用特征分析法评价两者的预测能力。结果 :①患者平均年龄为(31±18)岁,平均脑出血量为(24±10)ml。随访3个月时,2例(2.5%)患者死亡,14例(18%)恶化。②以出血量35 ml、年龄37岁作为预测结果差的最佳分界值,AVMICH及oICH两个量表曲线下面积为0.922和0.885,均有较为准确的预测性(P=0.153),两者具有相接近的灵敏度(P=1.00),但前者特异性较高(P<0.05)。结论 :oICH量表可较为准确地预测脑动静脉畸形破裂所致脑出血的不良结果,对其年龄和脑出血量的分界值进行简单调整可提高该评分的效果,并能在一定程度上防止对不良结果的风险估计过高。Objective： To evaluate the effect of original intracerebral hemorrhage score（oICH） on predicting the prognosis of patients with arteriovenous malformation-associated intracerebral hemorrhage（AVM-ICH）. Methods： Seventy- six patients with AVM-ICH were selected from our college during the period 2005-2012. Clinical data on demographics and radiographics were obtained through retrospective chart review. Clinical outcome at 3 months was assessed by the modified Rankin Scale（mRS）. Maximum Youden Index was used to identify cutoffs for age and ICH volume that are associated with optimal predictive accuracy for an unfavorable outcome （mRS ≥3）. Arteriovenous malformation-associated original intracerebral hemorrhage score（AVM-oICH） based on olCH has the cutoff points of new age and ICH volume. The predictive ability of both olCH and AVM-olCH was evaluated by analysis of receiver operating characteristic （ROC）. Results： ①The mean age for patients was （31±18）yeas, and mean ICH volume was （24±10） ml. When follow-up was carried out for 3 months, 2 patients（2.5%） were dead; 14 patients（18%） had a poor outcome. ② ICH volume of 35 ml and age of 37 years were identified as optimal cutoffs for predicting poor outcome. AVM-olCH and olCH showed good predictive accuracy with area under the curve（AUC） of 0.922 and 0.885（P=0.153）, and similarly high sensitivity（P=-1.00）, but the former had a higher specificity（P〈0.05）. Conclusion： olCH has a high accuracy in predicting the functional outcome of AVM-ICH. Simple adjustments of the cutoff points of age and ICH volume can improve its performance and reduce the probability of overestimating the risk of poor outcome after AVM-ICH.

关 键 词：动静脉畸形 脑出血 评估量表 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]