自发性脑出血后血肿增大的危险因素分析及预测效能评价  

作　　者：蔡莉新 陈美琴[1] 郑芳彬 尹睿[1] 

机构地区：[1]浙江省湖州市中心医院(湖州师范学院附属中心医院),313000

出　　处：《浙江临床医学》2024年第9期1319-1321,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省卫生科技计划项目(2023KY1168)。

摘　　要：目的分析自发性脑出血(SICH)后血肿增大(HE)的危险因素,评价危险因素预测效能。方法回顾性分析2021年2月至2023年3月210例SICH患者临床资料,依据24 h内CT复查结果分为HE组(n=61)、无HE组(n=149)。通过单因素分析SICH后HE的可能影响因素,Logistic回归分析筛选出SICH后HE的独立影响因素,并采用受试者操作特征(ROC)曲线评价独立影响因素对SICH后HE的预测价值。结果两组患者入院时收缩压、格拉斯哥昏迷量表(GCS)评分、中性粒细胞/淋巴细胞(NLR)、葡萄糖(GLU)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平及血肿密度是否均匀比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,入院时收缩压(OR=1.055)、NLR(OR=1.304)、GLU水平(OR=1.309)为SICH后HE的独立危险因素,GCS评分(OR=0.606)、LDL-C水平(OR=0.330)、血肿密度是否均匀(OR=0.314)为独立保护因素(P<0.05)。绘制ROC曲线发现,入院时收缩压、GCS评分、NLR、GLU、LDL-C水平、血肿密度是否均匀诊断SICH后HE的AUC分别为0.754、0.748、0.722、0.667、0.767、0.593。结论入院时高收缩压、高NLR、高GLU、血肿密度不均匀及低GCS评分、低LDL-C的SICH患者出现HE的风险高,对上述患者应加强动态观察,及时复查头颅CT,必要时立即行手术治疗。Objective To analyze the risk factors of hematoma enlargement(HE)after spontaneous intracerebral hemorrhage(SICH)and evaluate the predictive efficacy of risk factors.Methods The clinical data of 210 patients with SICH admitted to the hospital from February 2021 to March 2023 were retrospectively analyzed.According to the results of CT reexamination within 24 hours,they were divided into the HE group(n=61)and the non-HE group(n=149).The possible influencing factors of HE after SICH were analyzed by univariate analysis.Logistic regression analysis was used to screen out the independent influencing factors of HE after SICH,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of independent influencing factors for HE after SICH.Results Systolic blood pressure,Glasgow Coma Scale(GCS)score,neutrophils/lymphocytes(NLR),glucose(GLU),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),and hematoma density were compared as statistically significant differences(P<0.05).Logistic regression analysis showed that systolic blood pressure(OR=1.055),NLR(OR=1.304)and GLU level(OR=1.309)were independent risk factors for HE after SICH,while GCS score(OR=0.606),LDL-C level(OR=0.330)and whether the hematoma density was uniform(OR=0.314)were independent protective factors(P<0.05).ROC curve showed that systolic blood pressure,GCS score,NLR,GLU,LDL-C level and whether the hematoma density was uniform on admission had certain predictive effect on HE after SICH,with AUC of 0.754,0.748,0.722,0.667,0.767 and 0.593,respectively.Conclusion SICH patients with high systolic blood pressure,high NLR,high GLU,uneven hematoma density,low GCS score and low LDL-C are at high risk of HE,including dynamic observation,timely review of head CT,and immediately undergo surgical treatment if necessary.

关 键 词：自发性脑出血 血肿增大 危险因素 预测效能 

分 类 号：R743.34[医药卫生—神经病学与精神病学]