基于CT图像推断钝力性颅脑损伤成伤机制的logistic回归分析  

Logistic Regression Analysis of the Mechanism of Blunt Brain Injury Inference Based on CT Images

作　　者：孙雪阳 杨琦帆 朱运良 王彦斌[3] 董贺文 杨明真 田志岭 万雷 邹冬华 于笑天 刘宁国 SUN Xue-yang;YANG Qi-fan;ZHU Yun-liang;WANG Yan-bin;DONG He-wen;YANG Ming-zhen;TIAN Zhi-ling;WAN Lei;ZOU Dong-hua;YU Xiao-tian;LIU Ning-guo(Department of Forensic Medicine,School of Basic Medical Sciences,Zhengzhou University,Zhengzhou 450000,China;Shanghai Key Laboratory of Forensic Medicine,Key Laboratory of Forensic Science,Minis-try of Justice,Shanghai Forensic Service Platform,Academy of Forensic Science,Shanghai 200063,China;China National Accreditation Service for Conformity Assessment,Beijing 100062,China)

机构地区：[1]郑州大学基础医学院法医学系,河南郑州450000 [2]司法鉴定科学研究院,上海市法医学重点实验室,司法部司法鉴定重点实验室,上海市司法鉴定专业技术服务平台,上海200063 [3]中国合格评定国家认可中心,北京100062

出　　处：《法医学杂志》2022年第2期217-222,共6页Journal of Forensic Medicine

基　　金：中央级公益性科研院所项目(GY2020Z-4,GY2021G-4);2021年度中国科技期刊卓越行动选育高水平办刊人才子项目-青年人才支持项目(2021ZZ052807);国家自然科学基金资助项目(82171872);上海市法医学重点实验室资助项目(21DZ2270800);上海市司法鉴定专业技术服务平台资助项目(19DZ2292700);司法部司法鉴定重点实验室资助项目;上海市法医学重点实验室暨司法部司法鉴定重点实验室开放课题(KF202120)。

摘　　要：目的研究加、减速性颅脑损伤的CT影像学特征与损伤程度的关联性。方法收集典型加、减速性颅脑损伤案例299例,按致伤方式分为加速性颅脑损伤组与减速性颅脑损伤组,将蛛网膜下腔出血(subarachnoid hemorrhage,SAH)和格拉斯哥昏迷指数(Glasgow coma scale,GCS)与位于受力点同侧以及对侧的颅骨骨折、硬脑膜外血肿(epidural hematoma,EDH)、硬脑膜下血肿(subdural hematoma,SDH)、脑挫伤作为筛选指标,使用χ^(2)检验预筛选和二分类logistic回归分析二次筛选,选出与加、减速性致伤方式关联性最强的指标。结果经χ^(2)检验,受力点同侧的颅骨骨折、EDH,受力点对侧的EDH、SDH、脑挫伤,SAH,GCS,与加、减速性致伤方式具有关联性(P<0.05)。经二分类logistic回归分析,得出受力点同侧EDH[比值比(odds ratio,OR)为2.697]、受力点对侧脑挫伤(OR为0.043)以及GCS(OR为0.238)有统计学意义(P<0.05)。结论受力点同侧EDH、对侧脑挫伤以及GCS可以作为判别加、减速性致伤方式的关键指标,受力点同侧颅骨骨折、对侧SDH、对侧EDH以及SAH判别加、减速性致伤方式的作用相对较弱。Objective To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree.Methods A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism.Subarachnoid hemorrhage(SAH)and Glasgow coma scale(GCS),combined with skull fracture,epidural hematoma(EDH),subdural hematoma(SDH)and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes.χ^(2) test was used for primary screening,and binary logistic regression analysis was used for secondary screening.The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected.Results χ^(2) test showed that skull fracture and EDH on the same side of the stress point;EDH,SDH and brain contusion on the opposite of the stress point;SAH,GCS were correlated with acceleration and deceleration injury(P<0.05).According to binary logistic regression analysis,the odds ratio(OR)of EDH on the same side of the stress point was 2.697,the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238,suggesting there was statistically significant(P<0.05).Conclusion EDH on the same side of the stress point,brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism.In addition,skull fracture on the same side of the stress point,EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.

关 键 词：法医学 加速性脑损伤 减速性脑损伤 LOGISTIC回归 计算机断层扫描 致伤方式 

分 类 号：DF795.1[医药卫生—法医学]