动脉瘤性蛛网膜下腔出血后脑体积变化及其对患者预后的影响  

Correlation between changes of brain volume and prognosis after aneurysmal subarachnoid hemorrhage

作　　者：覃彬[1] 黄志坚[1] 余金辉 郭宗铎[1] 何朝晖[1] 孙晓川[1] QIN Bin;HUANG Zhijian;YU Jinhui;GUO Zongduo;HE Zhaohui;SUN Xiaochuan(Department of Nrurosurpery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016;Department of Neurosurgery,Yubei District People's Hospital,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]重庆市渝北区人民医院神经外科,重庆401120

出　　处：《第三军医大学学报》2021年第9期790-797,共8页Journal of Third Military Medical University

摘　　要：目的探究动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)后患者1周内脑体积(brian volume,BV)的变化规律,以及脑体积变化差值(change of brain volume,COBV)与脑体积变化率(change rate of brain volume,CRBV)对患者预后的影响。方法回顾性分析2019年1-8月我科收治的aSAH患者的临床资料。运用3D-Slicer测量患者出血后第1、5、7天的脑体积、脑体积变化差值(COBV=出血后1周内最大脑体积值BVmax-最小脑体积值BVmin)以及脑体积变化率(CRBV=COBV/颅腔体积×100%)。应用改良Rankin量表(Modified Rankin Scale,mRS)评估患者出院3个月后的恢复情况,将aSAH患者分为预后良好组(mRS评分1~2分)和预后不良组(mRS评分3~5分)。采用多因素Logistic回归分析影响患者发生不良预后的独立危险因素,运用ROC曲线评估COBV以及CRBV对患者发生不良预后的预测价值。结果共纳入患者89例。在aSAH早期,出血后第5天的脑体积为(1193.9±108.7)mL,其数值明显高于另外两个时间点(P<0.05)。多因素Logistic回归分析显示:COBV及CRBV为患者发生不良预后的独立危险因素。ROC曲线显示:COBV及CRBV的曲线下面积(AUC)分别为0.878和0.882,最佳诊断界值分别为72.1 mL和5.6%,对应的敏感度分别为79.4%和79.4%,特异度分别为87.3%和89.1%。结论aSAH早期,出血后第5天的脑体积明显大于出血后第1、7天的脑体积;COBV及CRBV是aSAH患者发生不良预后的独立危险因素。Objective To investigate the rule of change of brain volume(COBV)in 1 week after aneurysmal subarachnoid hemorrhage(aSAH),and determine the influences of COBV and change rate of brain volume(CRBV)on the prognosis of patients.Methods The clinical data of spontaneous aSAH patients admitted to the Neurosurgery Intensive Care Unit(NSICU)of the First Affiliated Hospital of Chongqing Medical University from January to August 2019 were retrospectively collected and analyzed.3D-Slicer biomedical image computing platform was used to measure the brain volume(BV)on the 1st,5th and 7th days after hemorrhage according to CT scans.The COBV was defined as maximum brain volume(BVmax)minus minimum brain volume(BVmin)within 1 week after bleeding,and the CRBV was the proportion of the COBV to the volume of cranial cavity×100%.According to the results of modified Rankin scale(mRS)in 3 months after bleeding,the patients were divided into good prognosis group(mRS:1~2)and poor prognosis group(mRS:3~5).Multivariate logistic regression analysis was adopted to analyze the independent risk factors for poor prognosis.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of COBV and CRBV for poor prognosis.Results For the 89 enrolled aSAH patients,the BV on the 5th day after hemorrhage(early stage after aSAH)was 1193.9±108.7 mL,significantly larger than those at the other 2 time points(P<0.05).Multivariate logistic regression analysis showed that COBV and CRBV were independent risk factors for poor prognosis in the patients.ROC curve analysis indicated that for COBV and CRBV,the area under curve(AUC)was 0.878 and 0.882,the best predictive cut-off values were 72.1 mL and 5.6%,with a sensitivity of 79.4% and 79.4% and specificity of 87.3% and 89.1%,respectively.Conclusion In the early stage of aSAH,the BV on the 5th day is significantly larger than that on the 1st and 7th days after hemorrhage.COBV and CRBV are independent risk factors for poor prognosis in aSAH patients.

关 键 词：动脉瘤性蛛网膜下腔出血 3D-Slicer 脑体积变化 预后 

分 类 号：R449[医药卫生—诊断学] R743.35[医药卫生—临床医学]