恶性小脑出血对少量自发性小脑出血患者预后的影响  

Impact of malignant cerebellar hemorrhage on prognosis of patients with small amount of spontaneous cerebellar hemorrhage

作　　者：杨朝朕 任思颖 伍国锋 林世奇 张芝源 王丽琨 Yang Chaozhen;Ren Siying;Wu Guofeng;Lin Shiqi;Zhang Zhiyuan;Wang Likun(Clinical Medical College,Guizhou Medical University,Guiyang550004,Guizhou Province,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科 [3]贵州医科大学附属金阳医院神经外科 [4]贵州医科大学第二附属医院急诊科

出　　处：《中华老年心脑血管病杂志》2024年第5期535-538,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(82260244);贵州省科技计划项目[黔科合支撑(2021)一般071,黔科合平台人才(2021)5612号]

摘　　要：目的探讨恶性小脑出血对少量自发性小脑出血3个月预后的影响。方法回顾性连续纳入2014年4月至2023年3月在贵州医科大学附属医院急诊科、贵州医科大学附属金阳医院神经外科、贵州医科大学第二附属医院神经外科的自发性小脑出血患者380例,符合少量自发性小脑出血及相关临床资料的患者共70例被纳入本研究;分为良性小脑出血组43例,恶性小脑出血组27例;又将少量自发性小脑出血患者分为预后良好组51例和预后不良组19例。收集2组患者一般临床资料、影像资料、并发症、炎性指标及预后进行分析比较,通过共线性诊断排除具有共线性影响的因素后,采用二元logistic回归分析预后良好与预后不良的独立相关性,最终采用ROC曲线对有意义的资料进行分析。结果恶性小脑出血组血肿最大直径显著高于良性小脑出血组(P=0.021)。预后不良组恶性小脑出血、中性粒细胞、白细胞计数、中性粒细胞/淋巴细胞比值显著高于预后良好组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,恶性小脑出血是3个月预后不良的独立预测因素(OR=6.218,95%CI:1.140~17.623,P=0.013);恶性小脑出血预测患者3个月预后的敏感性、特异性,阳性预测值、阴性预测值及约登指数分别为63.2%、70.6%、44.4%、83.7%、0.338,曲线下面积为0.669。结论恶性小脑出血是少量自发性小脑出血患者3个月预后的独立预测因子;恶性小脑出血比良性小脑出血预后差。Objective To investigate the effect of malignant cerebellar hemorrhage on 3-month prognosis of small spontaneous cerebellar hemorrhage.Methods Clinical data of 380consecutive patients with spontaneous cerebellar hemorrhage admitted in Emergency Department of the Affiliated Hospital of Guizhou Medical University,Neurosurgery Department of Jinyang Hospital Affiliated to Guizhou Medical University,and Neurosurgery Department of the Second Affiliated Hospital of Guizhou Medical University from April 2014to March 2023were collected and retrospectively analyzed,and finally,70patients who met the requirements of small amount of spontaneous cerebellar hemorrhage were enrolled in this study.They were assigned into benign cerebellar hemorrhage group(43cases)and malignant cerebellar hemorrhage group(27cases).According to their clinical outcomes in 3months after onset,they were divided into a good prognosis group(51cases)and a poor prognosis group(19cases).General clinical data,imaging data,complications,inflammatory indicators and prognosis were collected.After collinear diagnosis was used to exclude factors with collinear influence,the independent correlation between good prognosis and poor prognosis was analyzed by binary logistic regression model.Finally,ROC curve was plotted to analyze the significant data.Results The maximum diameter of hematoma was significantly larger in the malignant cerebellar hemorrhage group than the benign group(P=0.021).The patients of the poor prognosis group had larger proportion of malignant cerebellar hemorrhage,and higher neutrophil percentage,WBC count and NLR than those of the good prognosis group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that malignant cerebellar hemorrhage was an independent predictor of poor prognosis in 3months(OR=6.218,95%CI:1.140-17.623,P=0.013).The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of malignant cerebellar hemorrhage in predicting the 3-month prognosis of patients were 63.2%,70.6%,44.4

关 键 词：脑出血 创伤性 预测 预后 恶性小脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]