Helsinki CT评分和CONUT评分预测重度颅脑损伤患者28 d预后情况的价值  

Assessment of prediction value of Helsinki CT score and CONUT score for 28-day prognosis in patients with severe traumatic brain injury

作　　者：张军[1] 张红伟[2] 朱艺 范承启 韩瑞璋[2] ZHANG Jun;ZHANG Hongwei;ZHU Yi;FAN Chengqi;HAN Ruizhang(Department of Radiology,the Chinese PLA 72nd Group Army Hospital,Huzhou 313000,China)

机构地区：[1]中国人民解放军陆军第七十二集团军医院医学影像科,湖州313000 [2]中国人民解放军陆军第七十二集团军医院脑外一科,湖州313000

出　　处：《浙江医学》2023年第18期1952-1956,共5页Zhejiang Medical Journal

摘　　要：目的通过倾向性评分匹配(PSM)分析赫尔辛基(Helsinki)CT评分和控制营养状况(CONUT)评分预测重度颅脑损伤(sTBI)患者28 d预后情况的价值。方法选取2018年1月1日至2021年12月31日中国人民解放军陆军第七十二集团军医院收治的sTBI患者196例,追踪患者入院28 d临床结局,分为死亡组68例和存活组128例。使用PSM对两组患者基线资料进行1∶1匹配,对匹配后两组患者Helsinki CT评分、CONUT评分进行分析,采用多因素logistic回归分析两种评分与患者28 d预后相关性,绘制ROC曲线评价两种评分单独及联合使用预测sTBI患者预后的效能。结果PSM前,两组患者年龄、合并多发伤、蛛网膜下腔出血、糖尿病、乳酸水平、格拉斯哥昏迷评分(GCS)比较差异均有统计学意义(均P<0.05)。PSM后匹配成功48对,死亡组患者Helsinki CT评分、CONUT评分均明显高于存活组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,Helsinki CT评分和CONUT评分均是影响患者预后的独立危险因素(均P<0.05)。ROC曲线分析显示,两种评分联合使用预测患者预后不良的AUC大于两者单独使用(均P<0.05),而两者单独使用之间AUC的差异无统计学意义(P>0.05)。结论Helsinki CT评分和CONUT评分可以作为预测sTBI患者预后不良的指标,两种评分联合使用预测效能更高。Objective To assess the predictive value of Helsinki CT score and CONUT score for 28-day survival in patients with severe traumatic brain injury(sTBI)based on propensity score matching(PSM).Methods A total of 196 patients with sTBI admitted in the Chinese PLA 72nd Group Army Hospital from January 1,2018 to December 31,2021 were enrolled in the study.According to 28-day prognosis patients were divided into fatal group(n=68)and survival group(n=128),and 1∶1 PSM was performed to match the baseline data between two groups.The Helsinki CT score and CONUT score were compared between two matched groups.Multivariate logistic regression was used to analyze the correlation of the results of two scoring systems with 28-day prognosis and ROC curve was used to evaluate the prognostic value of the two scoring systems and the combination of two systems.Results There were significant differences in age,multiple injuries,subarachnoid hemorrhage,comorbid diabetes,lactate level and GCS score between the two groups(all P<0.05)before PSM;and 48 pairs were successfully matched by PSM.The Helsinki CT score and CONUT score in fatal group were significantly higher than those in survival group(all P<0.05).Multivariate logistic regression analysis showed that Helsinki CT score and CONUT score were independent risk factors for the 28-day prognosis(all P<0.05).The area under the ROC curve(AUC)of the combination of two scoring system for predicting 28-day survival were greater than that of Helsinki CT score or CONUT score alone(all P<0.05),and there was no significant difference in AUC between Helsinki CT score and CONUT score(P>0.05).Conclusion Helsinki CT score and CONUT score can be used to predict the 28-day prognosis in patients with sTBI,and the combination of two system can increase predictive effectiveness.

关 键 词：倾向性评分匹配 重度颅脑损伤 赫尔辛基CT评分 控制营养状况评分 28 d预后 

分 类 号：R651.15[医药卫生—外科学]