原发性脑出血患者血肿成熟度不良的临床特点及影响因素分析  

Clinical characteristics and risk factors of immature hematomas in patients with primary intracerebral hemorrhage

作　　者：蒋雯琪 李勇军[2] 李昕阳 朱燏燚 王德任[1] 张世洪[1] 吴波[1] 徐芒芒[1] JIANG Wenqi;LI Yongjun;LI Xinyang;ZHU Yuyi;WANG Deren;ZHANG Shihong;WU Bo;XU Mangmang(Department of Neurology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;West China School of Medicine,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院神经内科,成都610041 [2]四川大学华西临床医学院,成都610041

出　　处：《华西医学》2024年第12期1880-1886,共7页West China Medical Journal

基　　金：四川省科学技术厅自然科学基金项目(2023NSFSC1561);成都市科学技术局技术创新研发项目(2024-YF05-00628-SN)。

摘　　要：目的探讨原发性脑出血患者中血肿成熟度不良的临床特征及其影响因素分析。方法回顾性选择2012年3月—2021年1月在四川大学华西医院就诊的原发性脑出血患者。采用CT平扫评估是否存在血肿成熟度不良、血肿体积以及血肿突起或卫星灶的数量及血肿是否有指状突起等形态学特征;采用MRI评估脑小血管病影像标志物如腔隙、微出血、脑白质病变(white matter hyperintensities,WMH)、扩大的血管周围间隙等。将纳入患者分为血肿成熟度不良组与血肿成熟度良好组。采用多因素logistic回归分析血肿成熟度不良的影响因素。结果共纳入患者170例。其中,男性121例(71.2%);平均年龄(60.9±13.3)岁;血肿成熟度不良129例(75.9%)。血肿成熟度不良组与血肿成熟度良好组比较结果显示,较高的入院美国国立卫生研究院卒中量表评分、较大的血肿体积、血肿体积>30 mL、较多的血肿突起或卫星灶数量、较低的圆形或椭圆形血肿发生率、脑小血管病评分、较低的WMH负荷及较低的脑小血管病总负荷与血肿成熟度不良的发生相关。多因素logistic回归分析结果显示,调整年龄、性别、高血压、糖尿病、吸烟、饮酒、入院美国国立卫生研究院卒中量表评分、血肿体积后,较低的圆形或椭圆形血肿的发生率、WMH发生率、侧脑室周围WMH评分与血肿成熟度不良的发生相关。结论血肿为圆形或椭圆形的发生率越低、侧脑室周围WMH越轻,血肿成熟度不良的发生率可能越高。Objective To investigate the clinical characteristics and risk factors of immature hematomas in patients with primary intracerebral hemorrhage.Methods Patients with primary intracerebral hemorrhage who admitted in West China Hospital of Sichuan University between March 2012 and January 2021 were retrospectively analyzed.Brain CT scan was used to evaluate the presence of immature hematomas,as well as hematoma volume and the morphological features such as the number of hematoma projections or satellite foci,and finger-like projections.Imaging markers of cerebral small vessel disease such as lacunes,microbleeds,white matter hyperintensities(WMH),and enlarged perivascular space were evaluated on MRI.Mature hematomas were defined when the hematomas were completely homogeneous,without any irregularity or hypodensity,otherwise the hematomas were regarded as immature.Patients were divided into two groups:mature hematomas and immature hematomas.Multivariate Logistic regression was used to analyze the risk factors of immature hematomas.Results A total of 170 patients were included.Among them,there were 121 males(71.2%).The average age was(60.9±13.3)years old,and 129 cases(75.9%)had immature hematomas.The comparison between the mature hematomas group and the immature hematomas group showed that higher admission National Institutes of Health Stroke Scale score,larger hematoma volume,hematoma volume>30 mL,more hematoma projections or satellite foci,lower incidence of round or oval hematomas,cerebral small vessel disease score,lower WMH burden,and lower burden of cerebral small vessel disease were associated with the occurrence of immature hematomas.The results of multiple logistic regression analysis showed that lower incidence of round or oval hematomas,lower incidence of WMH,and lower periventricular WMH scores were associated with the occurrence of immature hematomas after adjusting for age,gender,hypertension,diabetes,smoking,alcohol consumption,admission National Institutes of Health Stroke Scale score,and hematoma volu

关 键 词：原发性脑出血 血肿形态 血肿成熟度 脑小血管病 

分 类 号：R743.34[医药卫生—神经病学与精神病学]