高敏C反应蛋白对脑出血患者血肿增大的预测价值  

Predictive value of high-sensitivity C-reactive protein for hematoma enlargement in patients with intracerebral hemorrhage

作　　者：刘双 刘学友[1] 周国胜[1] 王正锋[1] Liu Shuang;Liu Xueyou;Zhou guosheng;Wang Zhengfeng(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450000

出　　处：《国际脑血管病杂志》2021年第5期342-346,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨入院时高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)对原发性脑出血患者早期血肿增大的预测价值。方法回顾性纳入2014年1月至2019年1月期间郑州大学第一附属医院神经外科收治的脑出血患者。在发病后6 h内入院并经头颅CT证实脑出血诊断,在首次头颅CT后24 h内复查头颅CT。血肿增大定义为复查血肿体积较基线增加>6 ml或相对体积增大>33%。应用多变量logistic回归分析探讨影响早期血肿增大的独立危险因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线评估hs-CRP对血肿增大的预测能力。结果共纳入154例脑出血患者,男性99例(64.3%),年龄(58.7±11.1)岁,基线中位格拉斯格昏迷量表评分为13分,发病至首次CT时间为(2.92±1.35)h,首次CT至复查CT时间为(16.05±4.40)h。基线血肿体积为(21.82±11.08)ml,其中27例(17.5%)血肿破入脑室。40例(26.0%)存在血肿增大。血肿增大组入院时平均hs-CRP水平显著高于无血肿增大组[(11.56±3.72)mg/L对(9.51±4.31)ml;t=-2.669,P=0.008]。多变量logistic回归分析显示,入院时hs-CRP[优势比(odds ratio,OR)1.123,95%置信区间(confidence interval,CI)1.017~1.241;P=0.022]、血肿形状不规则(OR 4.160,95%CI 1.714~10.098;P=0.002)以及发病至首次CT检查时间(OR 0.510,95%CI 0.323~0.803;P=0.004)与血肿增大存在显著独立相关性。Pearson相关分析显示,hs-CRP与基线血肿体积呈显著正相关(r=0.237,P=0.003)。ROC曲线分析显示,hs-CRP预测血肿增大的曲线下面积为0.678(95%CI 0.584~0.772);最佳截断值为10.55 mg/L,预测血肿增大的敏感性和特异性分别为86.9%和60.0%。结论对入院时hs-CRP≥10.55 mg/L、血肿形状不规则和入院至首次CT检查时间<3 h的患者要着重管理,警惕早期血肿增大的发生。Objective To investigate the predictive value of high-sensitive C-reactive protein(hs-CRP)for early hematoma enlargement in patients with primary intracerebral hemorrhage.Methods Patients with intracerebral hemorrhage admitted to the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from January 2014 to January 2019 were enrolled retrospectively.The patients were sent to hospital within 6 h after onset,and the diagnosis of cerebral hemorrhage was confirmed by head CT.The head CT was reexamined within 24 h after the first head CT.Hematoma enlargement was defined as hematoma volume increase>6 ml or relative volume increase>33%.Multivariate logistic regression analysis was used to investigate the independent risk factors for influencing early hematoma enlargement.Receiver operating characteristic(ROC)curve was used to evaluate the predictive ability of hs-CRP for hematoma enlargement.Results A total of 154 patients with intracerebral hemorrhage were included,including 99 males(64.3%),aged 58.7±11.1 years.The median baseline Glasgow Coma Scale score was 13.The time from onset to first CT scan was 2.92±1.35 h.The time from the first CT to the second one was 16.05±4.40 h.The baseline volume of hematoma was 21.82±11.08 ml.Among them,27 patients(17.5%)had hematoma that broke into the ventricle,40(26.0%)had hematoma enlargement.The average hs-CRP level at admission in the enlarged hematoma group was significantly higher than that in the non-enlarged hematoma group(11.56±3.72 mg/L vs.9.51±4.31 ml;t=-2.669,P=0.008).Multivariate logistic regression analysis showed that hs-CRP at admission(odds ratio[OR]1.123,95%confidence interval[CI]1.017-1.241;P=0.022),irregular hematoma shape(OR 4.160,95%CI 1.714-10.098;P=0.002)and the time from onset to the first CT scan(OR 0.510,95%CI 0.323-0.803;P=0.004)were significantly correlated with hematoma enlargement.Pearson correlation analysis showed that hs-CRP was positively correlated with baseline hematoma volume(r=0.237,P=0.003).ROC curve analysis sho

关 键 词：脑出血 血肿 C-反应蛋白质 体层摄影术 X线计算机 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]