超声测得视神经鞘直径及其与眼球横径比值对急性出血性脑卒中患者预后的预测价值  

Predictive value of ultrasonic optic nerve sheath diameter and its ratio to eyeball transverse diameter in patients with acute hemorrhagic stroke

作　　者：王祥卫 李勋[1] 赵峰[1] 徐佳 曹嘉雯 Wang Xiangwei;Li Xun;Zhao Feng;Xu Jia;Cao Jiawen(Department of Critical Care Medicine,Taixing People'Hospital,Taizhou 225400,China)

机构地区：[1]泰兴市人民医院重症医学科,江苏泰州225400

出　　处：《中华脑血管病杂志(电子版)》2024年第6期580-585,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：南京医科大学康达学院2023年度发展基金课题重点项目自然科学类(KD2023KYJJ188)。

摘　　要：目的探讨超声视神经鞘直径(ONSD)和ONSD/眼球横径(ETD)与急性出血性脑卒中患者预后的关系。方法将泰兴市人民医院2021年10月至2023年3月收治的急性出血性脑卒中患者97例以住院结局分组,将改良Rankin量表评分≤3分的患者纳入预后良好组(61例),评分>3分的患者纳入预后不良组(36例)。应用床旁超声测量ONSD和ETD,采用独立样本t检验比较2组患者超声测量ONSD、ONSD/ETD及其他临床资料的差异,将单因素分析中差异有统计学意义的指标纳入多因素Logistic回归,分析ONSD、ONSD/ETD与急性出血性脑卒中患者预后的关系,绘制受试者操作特征(ROC)曲线,分析ONSD、ONSD/ETD对其预后的预测价值。结果预后不良组ONSD、ONSD/ETD、中线移位值分别为(5.54±0.48)mm、(0.25±0.02)、(5.77±3.27)mm,显著高于预后良好组[(4.33±0.46)mm、(0.20±0.02)、(2.52±0.97)mm],差异具有统计学意义(t=12.323、10.811、7.262,P均<0.001);预后不良组格拉斯哥昏迷量表(GCS)评分为(5.01±1.98)分,显著低于预后良好组[(10.85±2.67)分],差异具有统计学意义(t=11.394,P<0.001)。多因素Logistic回归分析显示,ONSD、ONSD/ETD、GCS评分均是急性出血性脑卒中患者预后的影响因素(OR=3.688、2.654、0.282,P=0.013、<0.001、<0.001);ROC曲线分析显示ONSD、ONSD/ETD预测急性出血性脑卒中预后的曲线下面积(AUC)为0.970、0.953,以4.96 mm为ONSD临界值,其预测急性出血性脑卒中预后的敏感度、特异度分别为91.67%、95.08%,以0.22为ONSD/ETD临界值,其预测急性出血性脑卒中预后的敏感度、特异度分别为88.89%、90.16%;并联试验、串联试验的AUC分别为0.901、0.928,敏感度为91.67%、88.89%,特异度为88.52%、96.72%。结论基于超声测量所得ONSD、ONSD/ETD均可作为急性出血性脑卒中患者预后的特异度预测指标,尤其ONSD在预测效能上更具优势,联合预测的临床获益仍值得探究。Objective To explore the relationship between ultrasonic optic nerve sheath diameter(ONSD),the ratio of ONSD to eyeball transverse diameter(ETD)and the prognosis of acute hemorrhagic stroke patients.Methods Acute hemorrhagic stroke patients(n=97)admitted to Taixing People&apos;Hospital from October 2021 to March 2023 were categorized into groups according to hospitalization outcomes.Patients with modified Rankin scale(mRS)≤3 points were categorized as the good prognosis group(n=61),while those with an mRS score>3 points were included in the poor prognosis group(n=36);The beside ultrasonic measurements of ONSD,ONSD/ETD,and other clinical data of patients in the two groups were compared by t-test.Significant indicators were included in the multivariate Logistic analysis to assess their association with patient prognosis following acute hemorrhagic stroke.Receiver operating characteristic(ROC)curve was plotted to evaluate the prognostic value of ultrasonic measurement of ONSD and ONSD/ETD.Results The poor prognosis group exhibited significantly higher values for ONSD,ONSD/ETD,and midline displacement[(5.54±0.48)mm,(0.25±0.02),(5.77±3.27)mm]compared to the good prognosis group[(4.33±0.46)mm,(0.20±0.02),(2.52±0.97)mm;t=12.323,10.811,7.262,all P<0.001].The Glasgow coma score(GCS)were also significantly lower in the poor prognosis group[5.01±1.98 vs 10.85±2.67;t=11.394,P<0.001).Multivariate Logistic regression analysis identified ONSD,ONSD/ETD,and GCS scores as prognostic factors for acute hemorrhagic stroke(OR=3.688,2.654,0.282;P=0.013,<0.001,<0.001).ROC curve analysis showed that the area under the curve(AUC)for ONSD and ONSD/ETD in predicting the prognosis of acute hemorrhagic stroke were 0.970 and 0.953,respectively.With a critical value of 4.96 mm for ONSD,the sensitivity and specificity to predict the prognosis of acute hemorrhagic stroke were 91.67%and 95.08%,respectively.For ONSD/ETD,with a critical value of 0.22,the sensitivity and specificity to predict the prognosis of acute hemorrhagic stroke were

关 键 词：急性出血性脑卒中 超声 视神经鞘直径 眼球横径 

分 类 号：R743.34[医药卫生—神经病学与精神病学]