自发性脑出血患者术后短期预后的影响因素及预测模型的构建  

Influencing factors and prediction model construction of short-term prognosis after surgery in patients with spontaneous cerebral hemorrhage

作　　者：张啸虎 肖耀东 梁子怡 胡宏伟 程宇 路洋 梁君 ZHANG Xiaohu;XIAO Yaodong;LIANG Ziyi;HU Hongwei;CHENG Yu;LU Yang;LIANG Jun(Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院神经外科,徐州221002

出　　处：《临床神经外科杂志》2025年第1期55-60,68,共7页Journal of Clinical Neurosurgery

基　　金：徐州医科大学附属医院院级科研项目(2023ZL12)。

摘　　要：目的探索自发性脑出血(sICH)患者近期转归的关键影响因素,并建立相应的预测模型。方法回顾性分析2021年1月—2024年4月在徐州医科大学附属医院神经外科就诊的250例sICH患者,通过改良Rankin量表(mRS)评分系统进行评估,将患者分成预后良好组103例和预后不良组147例。本研究拟采用单因素分析、多因素Logistic回归分析等方法,建立脑出血患者的Nomogram模型,并采用受试者工作特征(ROC)曲线、校准曲线等方法对模型进行评估。结果两组患者的格拉斯哥昏迷指数(GCS)评分、白蛋白、血肿体积、收缩压、中性粒细胞(NBC)、中性粒细胞/淋巴细胞比值(NLR)、D-二聚体(D-D)、D-二聚体/白蛋白比值(DAR)均有显著性差异(P<0.05),多因素Logistic回归分析显示sICH患者的NLR高、GCS评分低、D-D高、DAR高是其短期预后不良的重要独立危险因素(P<0.05)。以此建立Nomogram模型,ROC曲线表明预测sICH患者预后不良的曲线下面积(AUC)为0.912(95%CI=0.864~0.976),ROC曲线和校准曲线表明该Nomogram模型性能较高。结论NLR、GCS评分、D-D、DAR是sICH患者预后的独立危险因素,基于这些指标建立的Nomogram预测模型在判断sICH患者预后方面具有更好的价值。Objective To explore the key influencing factors on the short-term outcomes of patients with spontaneous intracerebral hemorrhage(sICH)and establish a corresponding predictive model.Methods A total of 250 patients with spontaneous intracerebral hemorrhage who were admitted to the Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University from January 2021 to April 2024 were analyzed retrospectively.Evaluations were performed using the modified Rankin scale(mRS)score system,categorizing patients into a good prognosis group(103 cases)and a poor prognosis group(147 cases).The study intended to use univariate analysis,multivariate logistic regression analysis,and other methods to establish a Nomogram model for patients with intracerebral hemorrhage.The model was evaluated using receiver operating characteristic(ROC)curves and calibration curves.Results There were significant differences between the two groups in GCS score,albumin,hematoma volume,systolic blood pressure,neutrophils(NBC),lymphocytes(LY),neutrophil-to-lymphocyte ratio(NLR),D-dimer(D-D),and the D-dimer/albumin ratio(DAR)(P<0.05).Multivariate logistic regression analysis showed that high NLR,low GCS score,high D-D,and high DAR were important independent risk factors for poor short-term prognosis in sICH patients(P<0.05).A Nomogram model was established based on these factors.The ROC curve indicated that the area under curve(AUC)for predicting poor prognosis in patients with spontaneous intracerebral hemorrhage was 0.861(95%CI=0.804-0.917).The ROC curve and calibration curve showed that this Nomogram model has high performance.Conclusions NLR,GCS score,D-D and DAR are independent risk factors for the prognosis of patients with spontaneous intracerebral hemorrhage.The Nomogram prediction model based on these indicators has better value in judging the prognosis of sICH patients.

关 键 词：D-二聚体 D-二聚体/白蛋白比值 脑出血 预后 预测模型 

分 类 号：R743[医药卫生—神经病学与精神病学]