凝血指标对中型创伤性脑损伤患者进展性出血性损伤的预测能力  

Predictive ability of coagulation tests for progressive hemorrhagic injury in patients with moderate traumatic brain injury

作　　者：王如海 曹祥记 王绅 张敏 韩超 于强 胡海成 李习珍 Wang Ruhai;Cao Xiangji;Wang Shen;Zhang Min;Han Chao;Yu Qiang;Hu Haicheng;Li Xizhen(Department of Neurosurgery,the Second Affiliated Hospital of Fuyang Normal University,Fuyang 236000,China;Department of Neurosurgery,Ningbo Hangzhou Bay Hospital,Ningbo 315336,China;Department of Clinical Laboratory,Fuyang Hospital of Anhui Medical University,Fuyang 236112,China)

机构地区：[1]阜阳师范大学附属第二医院神经外科,阜阳236000 [2]宁波市杭州湾医院神经外科,315336 [3]安徽医科大学附属阜阳医院检验科,阜阳236112

出　　处：《中华神经创伤外科电子杂志》2023年第6期343-349,共7页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

基　　金：阜阳市卫生健康委科研项目(FY2021-081、FY2023-019)。

摘　　要：目的探讨凝血指标对中型创伤性脑损伤(mTBI)患者进展性出血性损伤(PHI)的预测价值。方法回顾性分析2018年1月至2023年6月阜阳师范大学附属第二医院神经外科收治的270例mTBI患者的临床资料。根据mTBI患者伤后72 h内是否发生PHI将患者分为PHI组和非PHI组。根据是否纳入凝血指标分别构建3个PHI预测模型:模型1包括mTBI患者一般资料及影像学资料等标准变量;模型2基于模型1标准变量基础上添加凝血指标;模型3仅包括凝血指标。通过单因素及多因素Logistic回归分析,评估mTBI患者发生PHI的独立影响因素。使用受试者特征工作(ROC)曲线及曲线下面积(AUC)评价不同预测模型对PHI的预测能力。使用bootstrap法对预测模型进行内部验证。结果270例mTBI患者中,43例发生PHI,PHI发生率为15.9%。PHI组与非PHI组首次CT扫描时间、入院GCS评分、颅骨骨折、创伤性脑内血肿、创伤性硬膜外血肿、纤维蛋白原(FIB)、D-二聚体比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,首次CT扫描时间、入院GCS评分、创伤性脑内血肿、FIB、D-二聚体是PHI发生的独立影响因素。3种预测模型对比显示,模型2(AUC=0.908,95%CI:0.868~0.940)较模型1(AUC=0.848,95%CI:0.800~0.889)和模型3(AUC=0.805,95%CI:0.752~0.850)具有更好的预测能力。结论凝血指标作为mTBI患者发生PHI的独立影响因素,对PHI具有较好的预测能力。Objective To explore the predictive ability of coagulation tests for progressive hemorrhagic injury(PHI)in patients with moderate traumatic brain injury(mTBI).Methods Clinical data of 270 patients with mTBI admitted to Neurosurgery Department of the Second Affiliated Hospital of Fuyang Normal University from January 2018 to June 2023 were retrospectively analyzed.The mTBI patients were divided into PHI group and non-PHI group deponding on whether PHI occurred within 72 h after injury.Three prediction models for PHI were constructed according to whether coagulation tests was included.Model 1 included standard variables such as general data and imaging data of mTBI patients;Model 2 added coagulation tests based on standard variable of model one;Model 3 included only coagulation indicators.Independent influencing factors for PHI in mTBI patients were revealed by univariate and multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve and area under curve(AUC)were used to evaluate the ability of different predictive models for PHI.Internal validation of the prediction models was used by bootstrap analysis.Results Among 270 mTBI patients,43 cases developed PHI,and the incidence of PHI was 15.9%.There was statistically significant difference in the first CT scan time,GCS score on admission,skull fracture,traumatic intracerebral hematoma,traumatic epidural hematoma,fibrinogen(FIB)and D-dimer between the two groups(P<0.05).Multivariate Logistic regression analysis showed that the first CT scan time,GCS score on admission,traumatic intracerebral hematoma,FIB,D-dimer were independent risk factors for PHI.Comparison of 3 prediction models showed that Model 2(AUC=0.908,95%CI:0.868-0.940)has better predictive ability than Model 1(AUC=0.848,95%CI:0.800-0.889)and Model 3(AUC=0.805,95%CI:0.752-0.850).Conclusion As an independent influencing factor for PHI in patients with mTBI,coagulation tests has a good ability to predict the occurrence of PHI.

关 键 词：凝血指标 中型创伤性脑损伤 进展性出血性损伤 预测能力 

分 类 号：R651.15[医药卫生—外科学]