血清镁离子浓度对自发性脑出血患者急性期发生再出血的预测价值  

Predictive value of serum magnesium ion concentration for rebleeding in the acute phase of spontaneous intracerebral hemorrhage

作　　者：颜晓彤 沈正奎 任思颖 王丽琨 伍国锋 YAN Xiaotong;SHEN Zhengkui;REN Siying;WANG Likun;WU Guofeng(Department of Emergency,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China;Department of Emergency,Mingguang People's Hospital,Mingguang 239400,Anhui,China)

机构地区：[1]贵州医科大学附属医院急诊科,贵州贵阳550004 [2]明光市人民医院急诊科,安徽明光239400

出　　处：《贵州医科大学学报》2024年第12期1794-1799,共6页Journal of Guizhou Medical University

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);贵州省优秀青年科技人才项目(黔科合平台人才[2021]5612)。

摘　　要：目的探讨血清镁离子浓度对自发性脑出血(sICH)患者急性期发生再出血的临床意义。方法选取确诊的sICH住院患者382例,据住院期间再出血情况分为再出血组(n=63)和无再出血组(n=319),收集2组患者的一般临床资料(年龄、性别、既往史、入院时收缩压和舒张压、住院时间及手术治疗)、入院时实验室检查资料(血清镁离子、血清钙离子、血清钾离子、白细胞计数、中性粒细胞计数、淋巴细胞计数、单核细胞计数、嗜酸性粒细胞百分比、嗜碱性粒细胞百分比、血小板计数、纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间、国际标准化比值、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总蛋白及白蛋白)及神经功能评分[格拉斯哥昏迷评分(GCS)],采用改良Rink量表(mRS)评价2组患者发病第14天的预后,采用单因素和二元logistic回归分析sICH患者急性期发生再出血的影响因素,采用受试者工作特征(ROC)曲线分析血清镁离子浓度对sICH患者急性期发生再出血的预测价值。结果再出血组sICH患者血清钾、镁、氯、活化部分凝血活酶时间、纤维蛋白原水平及嗜酸性粒细胞百分比均低于无再出血组(P<0.05);二元logistic回归显示,血清镁离子是预测sICH患者再出血的独立危险因素(P<0.05);ROC曲线分析显示,血清镁离子预测sICH患者急性期发生再出血的曲线下面积(AUC)为0.647,最大截断值为0.819 mmol/L。结论血清镁离子浓度可预测sICH患者急性期发生再出血,低于0.819 mmol/L提示再出血发生风险增高。Objective To evaluate the predictive significance of serum magnesium ion concentration for rebleeding during the acute phase in patients with spontaneous intracerebral hemorrhage(sICH).Methods This study included 382 inpatients diagnosed with sICH,classified into a rebleeding group(n=63)and a non-rebleeding group(n=319)based on the occurrence of rebleeding during hospitalization.Data were collected on demographics,medical history,blood pressure,length of hospitalization,and surgical treatment.Laboratory findings at admission included serum electrolyte levels(magnesium,calcium,potassium),complete blood counts,coagulation parameters,and liver function tests.Neurological function was assessed with the Glasgow Coma Scale(GCS),and prognosis was measured using the modified Rankin scale(mRS)on day 14.logistic regression identified risk factors for rebleeding,while ROC curve analysis assessed the predictive utility of serum magnesium levels.Results Serum magnesium,potassium,chloride,APTT,fibrinogen,and eosinophil percentages were significantly lower in the rebleeding group(P<0.05).logistic regression analysis identified serum magnesium concentration as an independent risk factor for rebleeding(P<0.05).ROC analysis demonstrated an AUC of 0.647,with 0.819 mmol/L as the optimal threshold for predicting rebleeding risk.Conclusion Serum magnesium ion concentration is a valuable biomarker for predicting acute-phase rebleeding in sICH patients,with levels below 0.819 mmol/L indicating elevated risk.

关 键 词：脑出血 预后 ROC曲线 自发性脑出血 血清镁离子 再出血 风险 

分 类 号：R74[医药卫生—神经病学与精神病学]