点征联合混合征对行立体定向颅内血肿穿刺引流术的脑出血患者血肿扩大的预测价值  

A Predictive Value of the Spot Sign Combined with Blend Sign for Hematoma Expansion in Patients with Intracerebral Hemorrhage Treated with Stereotactic Minimally Invasive Surgery

作　　者：车炜 吴倩 王丽琨 任思颖 伍国锋 CHE Wei;WU Qian;WANG Li-kun;REN Si-ying;WU Guo-feng(School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,China;Department of Emergency Neurology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学临床医学院,贵阳550004 [2]贵州医科大学附属医院急诊神经科,贵阳550004

出　　处：《神经损伤与功能重建》2023年第4期208-212,共5页Neural Injury and Functional Reconstruction

基　　金：国家自然科学基金(No.81971126、82260244);贵州省科技计划项目(黔科合支撑[2021]一般项目和平台人才项目)。

摘　　要：目的:探讨点征、混合征及两者联合征象对行立体定向颅内血肿穿刺引流术的脑出血患者血肿扩大的预测价值。方法:连续纳入2018年1月至2022年8月接受微创手术治疗的脑出血患者196例,根据是否发生血肿扩大分为血肿扩大组和血肿未扩大组;患者入院后行头部CT和头部CT血管成像(CTA)检查,记录混合征、点征和两者联合征象等影像学征象;入院后24 h复查头部CT及术后头部CT。用二元Logistic回归分析血肿扩大的影响因素,采用ROC曲线分析各影像学征象的预测价值。结果:共纳入脑出血患者196例,分为血肿扩大组59例和血肿未扩大组137例,血肿扩大组的联合征象比例较血肿未扩大组明显高(59.3%vs.29.9%,P<0.001)。二元logistic回归显示,联合征象为血肿扩大的独立危险因素(OR=2.582,95%CI 1.308~5.094,P<0.05)。ROC曲线分析显示,联合征象预测血肿扩大的约登指数较单一点征、单一混合征象更高(22.0%vs.5.9%和4.7%);联合征象的灵敏度、特异度、阳性预测值、阴性预测值和约登指数分别为59.3%、70.1%、46.1%、80.0%、29.4%。结论:点征联合混合征的联合征象可能是行立体定向颅内血肿穿刺引流术的脑出血患者血肿扩大的预测因素。Objective:To explore and analyze the predictive value of simple spot sign,simple blend sign and spot signs combined with blend sign in patients with intracerebral hemorrhage treated with stereotactic minimal-ly invasive surgery.Methods:A total of 196 consecutive patients with acute intracerebral hemorrhage hospitalized in the Department of Emergency Neurology,the Affiliated Hospital of Guizhou Medical University from January 2018 to August 2022,were continuously enrolled and retrospectively analyzed.Based on whether hematoma expansion had occurred,cases were divided into hematoma expansion and hematoma non-expansion group.All the patients were treated with stereotactic minimally invasive surgery.All the patients underwent head CT and CTA on admission.Imaging signs such as blend sign,spot sign and their combination were recorded.Head CT was reperformed 24 h after admission and after operation.The risk factors of hematoma expansion were analyzed by binary Logistic regression,and the predictive value of each imaging sign was analyzed by ROC curve.Results:Fifty-nine cases were enrolled in hematoma expansion group and 137 in hematoma non-expansion group.The proportion of blend signs combined with spot sign in hematoma expansion group was significantly higher than that in the hematoma non-expansion group(59.3%vs.29.9%,P<0.001).Binary Logistic regression showed that the blend signs combined with spot sign was an independent risk factor for hematoma expansion(OR=2.582,95%CI 1.308~5.094,P<0.05).ROC curve analysis showed that the combined sign was higher than the single blend sign(22.0%vs.5.9%and 4.7%);with a sensitivity of 59.3%,a specificity of 70.1%,a positive predictive value of 46.1%,a negative predictive value of 80.0%and Youden index of 29.4%.Conclusion:Spot signs combined with blend sign could predict hematoma expansion in patients with intracerebral hem-orrhage treated with stereotactic minimally invasive surgery.

关 键 词：脑出血 立体定位技术 血肿扩大 点征联合混合征 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学] R743R816R651