水摄取率在预测急性前循环大面积脑梗死患者恶性水肿发生中的价值  

Net water uptake in predicting the development of malignant edema in patients of acute large hemispheric infarction

作　　者：徐海滨 付博文 陈万莉 陶霖 侯晓雯 齐守良[3] 陈会生 Xu Haibin;Fu Bowen;Chen Wanli;Tao Lin;Hou Xiaowen;Qi Shouliang;Chen Huisheng(Postgraduate Training Base of General Hospital of Northern Theater Command of Jinzhou Medical University,Shenyang 110016,China;Department of Neurology,General Hospital of Northern Theater Command,Shenyang 110016,China;College of Medicine and Biological Information Engineering,Northeastern University,Shenyang 110015,China)

机构地区：[1]锦州医科大学北部战区总医院研究生培养基地,沈阳110016 [2]北部战区总医院神经内科,沈阳110016 [3]东北大学医学与生物信息工程学院,沈阳110015

出　　处：《中华神经科杂志》2020年第9期681-686,共6页Chinese Journal of Neurology

基　　金：辽宁省科技攻关计划项目(2018225023,2019JH2/10300027)。

摘　　要：目的:探讨急性前循环大面积脑梗死患者的水摄取率对恶性水肿发生的预测价值。方法:回顾性分析2017年9月至2018年7月在北部战区总医院就诊的56例大面积脑梗死患者,测算其水摄取率。根据是否发生恶性水肿(定义为发病7 d内因脑水肿所致脑疝需实施去骨瓣减压术或因脑疝死亡),分成恶性水肿组和非恶性水肿组。分析两组患者的特征并绘制受试者工作特征(ROC)曲线,以确定水摄取率及其他因素的价值。结果:多因素Logistic回归分析结果表明,调整心房颤动、入院美国国立卫生研究院卒中量表评分、发病到初次影像时间后,水摄取率与恶性水肿的发生显著相关(OR=1.226,95%CI 1.040~1.446,P=0.015)。基于ROC曲线,水摄取率≥13.08%时,高度怀疑恶性水肿的发生,敏感度为0.64,特异度为0.94,曲线下面积为0.813。结论:水摄取率是前循环大面积脑梗死患者发生恶性水肿的一个重要预测指标,可以帮助识别具有恶性水肿风险的患者。Objective To investigate the value of net water uptake(NWU)in predicting malignant edema(ME)in large hemispheric infarction(LHI).Methods Fifty-six patients suffering from LHI in the General Hospital of Northern Theater Command from September 2017 to July 2018 were retrospectively analyzed,and their NWU was calculated separately.Patients were divided into two groups according to the occurrence of ME,which was defined as space-occupying infarct requiring decompressive craniectomy or death resulting from cerebral hernia in seven days from onset.The clinical characteristics were analyzed,and receiver operating characteristic(ROC)curve and respective area under curve(AUC)were used to assess the value of NWU and other factors.Results After adjusting for atrial fibrillation,National Institutes of Health Stroke Scale scores at admission,and time from onset to imaging,multivariable analysis showed that NWU was an independent predictor of ME(OR=1.226,95%CI 1.040-1.446,P=0.015).According to the ROC curve,NWU≥13.08%identified ME with great predictive power(AUC=0.813;sensitivity 0.64,specificity 0.94).Conclusions NWU is an important predictor of ME in patients with LHI.It can help identify patients at risk of ME.

关 键 词：脑梗塞 脑水肿 水摄取率 曲线下面积 

分 类 号：R743.33[医药卫生—神经病学与精神病学]