原发性脑出血超急性期血肿增长速度与临床预后的关系研究  

Analysis of Association between Ultraearly Hematoma Growth and Outcome after Acute Spontaneous Intracerebral Hemorrhage

作　　者：王文娟[1,2] 陆菁菁[1,2] 陈胜云[2,3] 张佳 王玉 张晓丽[2,3] 赵性泉 WANG Wen-Jua;LU Jing-Jing;CHEN Sheng-Yun;ZHANG Jia;WANG Yu;ZHANG Xiao-Li;ZHAO Xing-Quan(Department of Vascular Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China, 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;3China National Clinical Research Center for Neurological Diseases Beijing 100050, Chin)

机构地区：[1]首都医科大学附属北京天坛医院血管神经病学科,北京100050 [2]首都医科大学附属北京天坛医院神经病学中心 [3]国家神经系统疾病临床医学研究中心

出　　处：《中国卒中杂志》2018年第5期437-443,共7页Chinese Journal of Stroke

基　　金：首都卫生发展科研专项项目(重点攻关)-北京地区以病因为基础的脑出血医疗质量评价与微创治疗技术的研究(首发2011-2004-03);"首都临床特色应用研究"专项-脑出血急性期一站式多模式CT应用规范的研究(Z131107002213009)

摘　　要：目的探讨超急性期血肿增长速度(ultraearly hematoma growth,UHG)与急性原发性脑出血(intracerebral hemorrhage,ICH)血肿扩大及临床预后的关系。方法连续收集发病6 h内就诊的ICH患者。患者完成基线及(24±2)h颅脑计算机断层扫描(computed tomography,CT),记录临床信息及结局信息。UHG定义为基线血肿体积除以发病至头CT扫描时间。血肿扩大定义为发病24 h血肿体积较基线血肿体积增加>33%或者>6 ml。90 d及1年预后不良定义为改良Rankin量表评分>2分。多元Logistic回归分析UHG与血肿扩大及ICH临床预后的关系。结果研究共纳入148例发病6h内到院的ICH患者。所有ICH患者的UHG为5.3(2.3,12.9)ml/h。UHG在完成头CT较早(P<0.001)、血肿扩大(P=0.019)、90 d预后不良(P<0.001)及1年预后不良(P<0.001)的患者中数值较大。UHG>4.7 ml/h是1年不良预后的独立危险因素,比值比为17.5,95%可信区间为1.44～21.23(P=0.025)。其预测1年不良预后的灵敏度为61.5%,特异度为65.1%,阳性预测率为68.4%,阴性预测率为58%。结论 UHG是ICH患者1年不良预后的独立危险因素。Objective To investigate the association of ultraearly hematoma growth （UHG） with the hematoma growth （HG） and clinical outcomes in patients with acute spontaneous intracerebral hemorrhage （ICH）.Methods Acute ICH patients who went for consultation within 6 hours after onset were enrolled into study consecutively. Patients underwent baseline and 24-hour computed tomography （CT） scans. The clinical data and outcome were recorded. UHG was defined as the relation between baseline ICH volume/onset-to-imaging time （OIT）. Hematoma enlargement was defined as HG volume 〉33% or 〉6 ml at 24 hours after onset. And poor outcome was defined as modified Rankin Scale score 〉2 at 90 days and l year after onset. The multivariable logistic regression analysis was used to investigate the association of UHG with HG and clinical outcomes after ICH.Results A total of 148 patients with acute （〈6 h） ICH were enrolled. The median speed of UHG was 5.3 （interquartile range 2.3-12.9） ml/h. The UHG was significantly faster in patients who scanned earlier （P〈0.001）, as well as in patients who experienced HG （P=0.019）, 90-day poor outcome （P〈0.001） and l-year poor outcome （P〈0.001）. UHG〉4.7 ml/h was an independent risk factor for 1-year poor outcome （odds ratio 17.5; 95% confidence interval 1.44-21.23, P=0.025）. For UHG to predict 1-year poor outcome, the sensitivity, specificity, positive predictive value and negative predictive value were 61.5%, 65.1%, 68.4% and 58%, respectively. Conclusion UHG was an independent risk factor for 1-year poor outcome after acute ICH.

关 键 词：脑出血 超急性期血肿增长速度 血肿扩大 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]