自发性脑出血患者血肿形态分析对早期血肿扩大的预测与诊断价值  

Hematoma morphology analysis on predicting and diagnosis hematoma expansion in patients With Spontaneous Intracerebral Hemorrhage.

作　　者：彭佳华[1] 龙少好 黄兰青 邓青志[1] 黄允省 李廷阳[2] Peng jiahua;Long Shaohao;Huang Lanqing;Deng Qingzhi;Huang Yunsheng;Li Tingyang(Department of Critical Care Medicine,the People’s Hospital of Baise,Baise 533000,Guangxi,China;Department of neurosurgery,the people’s hospital of baise,Baise 533000,Guangxi,China)

机构地区：[1]广西百色市人民医院重症医学科,533000 [2]广西百色市人民医院神经外科

出　　处：《中华急诊医学杂志》2020年第4期565-572,共8页Chinese Journal of Emergency Medicine

基　　金：广西省临床重点专科建设项目(桂卫医发201505);广西医药卫生计划课题(Z20180341);百色市科计计划项目(百科计20184412);白求恩医学科研基金(190118)。

摘　　要：目的通过有限元(finite element analysis,FEA)方法对自发性脑出血(spontaneous intracrebral hemorrhage,SICH)患者颅内血肿形态进行重建与分析,获取形态相关参数,考查形态相关参数与常规临床评估相比对血肿扩大(hematoma expansion,HE)的预测与诊断优势。方法采用回顾性、病例对照方法,纳入百色市人民医院急诊科2015年6月至2017年12月期间符合研究标准的SICH患者。收集患者入院临床参数,对同一患者的常规头颅CT影像采用两种不同的分析方法。常规评估:临床调查员根据血肿断层影像判别血肿边缘是否规则,出血量计算采用简化多田公式(ABC/2)。FEA分析:FEA调查员进行血肿腔FEA分析,得到血肿空间形态和血肿体积、表面积、血肿腔每平方毫米表面积三角片数量(the quantity of triangles per square millimeter surface,TQOT/mm2)等参数。出血量或血肿体积较基线水平增加>33%认为发生血肿扩大,根据两种出血量评估方法(ABC/2,FEA)将患者分为各自的HE组与非HE组,单因素比较和Logistic多因素分析分别筛选FEA法、ABC/2法HE的危险因素,ROC曲线分析各自危险因素对HE的诊断能力。结果共有127例患者纳入研究。平均发病至首次CT时间为3.08±1.34 h,ABC/2法判别HE34(26.77%)例,FEA法31(24.41%)例,虽然两种方法判别血肿扩大差异有统计学意义(pearsonχ2=53.66,P=0.000),但仍有中度一致性(Kappa=0.65)。FEA实现所有患者血肿的三维重建,大体观察提示TQOT/mm2与形态相关。Logistic分析显示,ABC/2法仅有ICH评分为HE的危险因素(OR=1.79,95%CI:1.19~2.68);FEA法HE危险因素为TQOT/mm2≥1.95个/mm2(OR=16.99,95%CI:5.98~48.33)和血肿生长速度(Ultraearly Hematoma Growth,uHG),(OR=1.05,95%CI:1.01~1.09)。ROC曲线结果:ICH评分对HE(ABC/2法)诊断的曲线下面积(Area under the curve,AUC)为0.64。uHG(FEA法)为0.67,诊断能力低。而TQOT/mm2诊断HE(FEA法)的AUC为0.9,取值1.95(个/mm2)时敏感性和特异性分别为77%和83%�Objective To obtain the parameters associated with hematoma morpholoy by finite element analysis(FEA)and investigated their performance on predicting and diagnosis hematoma expansion(HE)in patients with spontaneous intracrebral hemorrhage(SICH).Methods Patients with SICH who met research criteria were retrospective enrolled between June 2015 and December 2017.Clinical parameters on admission were collected,Perform 2 independent methodology on same patient to analysis the hematoma shape base on computed tomography(CT):Clinical routine method that performed by clinical investigator to identified margin irregularity of hematoma by CT,and calculated the volume of hematoma by simplify Tada formula(ABC/2);The FEA method performed by FEA investigator and gain the hematoma 3 dimensional morphology and variables,include Volume,Surface area,and The quantity of triangles per square milimet surface(TQOT/mm2).The HE was defined as volume enlargement of>33%compared with that on addmission.All patients were divided into HE and none HE group,respectively,ABC/2 and FEA generated thire own HE and none HE group as different volume calcuation.The HE risk factors of ABC/2 and FEA were assessed in univariate and multivariable Logistic regression models.and the risk fators diagnosis value for HE were determined by the receiver operating characteristic(ROC)curves.Results Total of 127 patients were enrolled,The mean time of symptom onset to hospital admitted was 3.08±1.34 h.There were 34(26.77%)cases HE identifed by ABC/2 and 31(24.41%)by FEA.Althought there are significant different(pearsonχ2=53.66,P<0.01)of HE identification between ABC/2 and FEA,the 2 methods has moderate consistency(Kappa=0.65).All patients’hematoma 3D reconstruction were performed by FEA and general observation show that TQOT/mm2 most likely correlate to irregularity of hematoma 3D shape.Multivariable Logistic regression models indicated that ICH score(OR=1.79,95%CI:1.19~2.68)was independent HE risk factor for ABC/2,respectively,TQOT/mm2≥1.95/mm2(OR=16.99,95%C

关 键 词：自发性脑出血 血肿扩大 血肿形态 有限元分析 每平方毫米表面积三角片数量 

分 类 号：R74[医药卫生—神经病学与精神病学]