高血压性脑出血患者血肿扩大影响因素及相关评估工具预测效果对比分析  

Comparative analysis of the influencing factors of hematoma enlargement and the prediction effect of related scales in patients with hypertensive cerebral hemorrhage

作　　者：李倩男 冯灵敏 周雪莲 苗晓 Li Qiannan;Feng Lingmin;Zhou Xuelian;Miao Xiao(Department of Neurosurgery,The First People's Hospital of Lianyungang,Lian Yungang 222000,China)

机构地区：[1]江苏省连云港市第一人民医院神经外科,连云港222000

出　　处：《中国综合临床》2025年第1期59-66,共8页Clinical Medicine of China

基　　金：江苏省连云港市科学技术协会软课题(Lkxyb24196)。

摘　　要：目的探讨高血压性脑出血患者血肿扩大的影响因素并构建对应的风险预测诺谟图,对所构建的模型以及不同血肿扩大风险评估工具筛查效果进行对比分析。方法选取2021年4月至2022年2月连云港市第一人民医院神经外科收治的232例高血压性脑出血患者作为研究对象。符合正分布的计量资料以xˉ±s表示,组间比较采用独立样本t检验;非正态分布以中位数(四分位数)[M(Q_(1),Q_(3))]表示,组间比较采用秩和检验。计数资料以百分比表示,组间比较采用χ^(2)检验或精确概率法。采用多因素Logistic回归分析高血压性脑出血患者血肿扩大的危险因素,并使用R软件构建诺谟图。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)和Hosmer-Lemeshow(H-L)拟合优度评价模型的区分度和校准度,应用决策曲线分析模型的临床有效性。采用构建的诺谟图、九分法以及基线脑出血量、复发性脑出血、使用华法林抗凝、脑室出血、从发病至基线CT时间(baseline amount of cerebral hemorrhage,recurrent hematencephalon,anticoagulation with warfarin,intraventricular hemorrhage,and time from onset to baseline CT,BRAIN)评分对纳入的患者进行血肿扩大风险评估并作为检验变量,以是否发生血肿扩大为状态变量,绘制ROC曲线对比分析构建的诺谟图、九分法以及BRAIN评分的ROC曲线下面积、灵敏度、特异度。采用Kappa检验分析构建的诺谟图、九分法以及BRAIN评分与血肿扩大结果的一致性。结果多因素Logistic回归分析结果显示,血压控制不良(OR=13.290,95%CI:3.676~48.049)、破入脑室(OR=4.825,95%CI:1.458~15.975)、早期神经功能恶化(OR=27.740,95%CI:8.713~88.314)、格拉斯哥昏迷评分(Glasgow coma scale,GCS)≤8分(OR=25.883,95%CI:6.542~102.404)是高血压性脑出血患者血肿扩大的主要影响因素(P值分别为<0.001、0.010、<0.001、<0.001)。诺谟图预测血肿扩大的H-L检验结果为χ^(2)=3ObjectiveTo explore the influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage and construct a corresponding risk prediction nomogram.The screening effects of the constructed model and different hematoma enlargement risk assessment tools were compared and analyzed.MethodsTwo hundred and thirty-two patients with hypertensive intracerebral hemorrhage from the Department of Neurosurgery,Lianyungang First People's Hospital from April 2021 to February 2022 were selected as the research subjects.Multivariate Logistic regression was used to analyze the risk factors of hematoma expansion in patients with hyperhemamic intracerebral hemorrhage,and R software was used to construct a nomo diagram.The receiver operating characteristic curve(ROC)and Hosmer-Lemeshow(H-L)goodness-of-fit were used to evaluate the discrimination and calibration of the model,and the decision curve was used to analyze the clinical validity of the model.The constructed Nomo diagram,nine-point method and BRAIN score were used to assess the risk of hematoma enlargement in the included patients and used them as test variables,and the ROC curve was plotted to compare and analyze the area under the ROC curve,sensitivity and specificity of the constructed Nomo diagram,nine-point method and BRAIN score.The Kappa test was used to analyze the consistency between the Nomo diagram,the nine-point method,and the BRAIN score and the hematoma expansion results.ResultsThe results of multivariate logistic regression analysis showed that blood pressure was poorly controlled(OR=13.290,95%CI:3.676-48.049),ventricular penetration(OR=4.825,95%CI:1.458-15.975),early neurological deterioration(OR=27.740,95%CI:8.713-88.314),Glasgow Coma Scale(GCS)≤8 points(OR=25.883,95%CI:6.542-102.404)was the main influencing factor for hematoma expansion in patients with hypertensive intracerebral hemorrhage(The P values were<0.001,0.010,<0.001,and<0.001,respectively).The H-L test results of Nomogram for predicting hematoma enlargement wereχ^(

关 键 词：脑出血 高血压性 血肿扩大 影响因素 诺谟图 评估工具对比 

分 类 号：R74[医药卫生—神经病学与精神病学]