新疆医科大学学报

目的自发性脑出血早期血肿扩大影响因素及预测研究。方法选取2017年5月-2020年5月中国人民解放军北部战区空军医院神经内科收治的经头颅CT检查确诊为自发性脑出血(SICH)患者106例为研究对象,根据患者早期有无血肿扩大(HE)分为HE组42例,无HE组64例。采用单因素方差分析比较影响SICH患者早期有无HE的一般情况、脑出血情况、血肿情况、出血后处理情况及患者机体反应情况等因素,具有统计意义的因素建立Logistic回归模型分析HE的独立影响因素。以受试者工作特征曲线(ROC曲线)评估中性粒细胞与淋巴细胞比值(NLR)和高敏C-反应蛋白(hsCRP)对HE的预测价值。结果多因素Logistic回归分析显示,脑血管淀粉样变、血肿不规则、6 h内使用甘露醇、hs-CRP、WBC_T1、NE_T1、LY_T1、NLR_T1均为SICH患者早期HE发生的相关影响因素(P<0.05)。ROC曲线分析显示,NLR_T1和hs-CRP对SICH患者早期发生HE预测的AUC为0.982、0.940,具有较高准确性。以ROC曲线靠左上方约登指数的最大切点作为最佳临界值,该点预测NLR_T1和hs-CRP敏感度、特异度分别为92.9%/90.5%、100%/89.1%。两项联合预测AUC为0.979,敏感度、特异度为92.9%、100.0%。结论 SICH患者早期HE发生的影响因素包括出血后药物使用、血肿情况、出血后机体反应情况等,在临床护理中需要加强监测,及早预防HE发生,NLR_T1和hs-CRP对其具有一定的预测评估价值,联合预测价值更高。

Objective To predictively study on the influencing factors on hematoma enlargement in early stage of spontaneous cerebral hemorrhage. Methods A total of 106 patients with spontaneous intracerebral hemorrhage(SICH) admitted to Department of Neurology, Air Force Hospital of Northern Theater of PLA from May 2017 to May 2020 were selected. According to whether the patients had hematoma en1 argement(HE) or not at the early stage, they were divided into the HE group(42 cases) and the none-HE group(64 cases). One-way analysis of variance(ANOVA) was used to compare the factors affecting the SICH individuals' general condition, cerebral hemorrhage, hematoma, post-bleeding treatment, and body reaction between two groups. The logistic regression model was established for statistically significant factors to analyze the independent risk factors of HE. Receiver operating characteristic(ROC) curve was performed to evaluate the predictive value of neutrophil-to-lymphocyte ratio(NLR) and high-sensitivity C-reactive protein(hs-CRP) for HE. Results The multivariate logistic regression analysis showed that, cerebral vascular amyloidosis, irregular hematoma, mannitol use within 6 h, hs-CRP, WBC_T1, NE_T1, LY_T1, NLR_T1 were all related factors of early HE in SICH patients(P<0.05). ROC curve analysis displayed that, the area under curve(AUC) predicted by NLR_T1 and hs-CRP for early HE in patients with SICH was 0.982, 0.940 respectively, which indicated a high accuracy. Based on the optimum critical value which was the maximum tangent point of the Jordan index at the upper left of the ROC curve, the predicted sensitivity and specificity of NLR_T1 and hs-CRP were 92.9%/90.5% and 100%/89.1%. The combined prediction of AUC was 0.979, sensitivity was 92.9%, and specificity was 100.0%. Conclusion There are many factors influencing the occurrence of early HE in SICH patients, including post-bleeding drug use, hematoma, body reaction, etc. Further, it is necessary to strengthen monitoring in clinical care to prevent the occurrence of HE in the early time. NLR_T1 and hs-CRP have a certain value of predictive evaluation for it, as well as a higher value for their combined predictive effect.