目的: 分析头颅计算机断层扫描（computed tomography,CT）征象在自发性脑出血（spontaneous intracerebral hemorrhage,SICH）患者血肿扩大中的预测效能,以提高临床早期干预准确性和有效性。方法: 选取2021年1月—2024年6月于我院收治的282例SICH患者的临床资料。均在发病6 h内进行首次头颅CT检查,并在首次检查后24 h内复查头颅CT,依据是否出现血肿扩大分成扩大组（93例）和未扩大组（189例）。详细记录两组患者基线资料、头颅CT征象资料,采用单因素、多因素Logistic回归分析SICH患者血肿扩大的影响因素,绘制工作特征（receiver operating characteristic,ROC）曲线分析头颅CT征象在SICH患者血肿扩大预测中的效能。结果: 单因素分析结果显示,扩大组患者初始血肿量、破入脑室占比、既往脑出血史占比、入院收缩压（systolic blood pressure,SBP）、混杂征占比、漩涡征占比、黑洞征占比、卫星征占比、岛征占比均高于未扩大组。多因素Logistic回归分析结果显示,初始血肿量多、既往脑出血史占比高、混杂征占比高、漩涡征占比高、黑洞征占比高、卫星征占比高、岛征占比高为SICH患者出现血肿扩大独立危险因素。ROC曲线结果显示,头颅CT征象联合预测SICH患者血肿扩大的AUC显著高于头颅CT征象单独预测。结论: 初始血肿量、既往脑出血史及混杂征、漩涡征、黑洞征、卫星征等头颅CT征象均为SICH患者血肿扩大独立预测因素,针对SICH患者临床医师应早期筛查高风险患者,并及时采取干预措施,有助于降低血肿扩大风险,改善整体预后。
Abstract
Objective To analyze the predictive efficacy of computed tomography (CT) signs in patients with spontaneous intracerebral hemorrhage (SICH) to improve the accuracy and effectiveness of early clinical intervention. Methods The clinical data of 282 patients with SICH admitted to our hospital from January 2021 to June 2024 were selected. The first head CT examination was performed within 6h after the onset of the disease, and the head CT examination was re-examined within 24h after the first examination. The patients were divided into an expanded group (93 cases) and an unexpanded group (189 cases) according to whether hematoma enlargement occurred. The baseline data and skull CT signs of the two groups were recorded in detail. Univariate and multivariate logistic regression were used to analyze the influencing factors of hematoma enlargement in SICH patients. The receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of skull CT signs in the prediction of hematoma enlargement in SICH patients. Results The results of single factor analysis showed that: initial hematoma, ventricle rupture, history of cerebral hemorrhage, admission systolic blood pressure (SBP), hybrid, vortex, black hole, satellite and island in the expanded group were all higher than those in the non-expanded group. Multivariate logistic regression analysis showed that the initial hematoma volume was large, and the history of cerebral hemorrhage was high, high proportion of mixed, high proportion of whirlpool, the proportion of black holes was high, and the proportion of satellites was high and high island ratio were independent risk factors for hematoma enlargement in SICH patients. The ROC curve results showed that the AUC of the enlarged hematoma in SICH patients predicted by the combination of skull CT signs was significantly higher than that predicted by skull CT signs alone. Conclusion Initial hematoma volume, previous history of intracerebral hemorrhage, mixed signs, vortex signs, black hole signs, satellite signs and other skull CT signs are independent predictors of hematoma expansion in SICH patients. In the process of diagnosis and treatment of SICH patients, clinicians should screen high-risk patients early and take timely intervention measures, which can help reduce hematoma expansion and improve the overall prognosis.
关键词
头颅CT征象 /
自发性脑出血 /
血肿扩大 /
预测效能
Key words
skull computed tomography findings /
spontaneous cerebral hemorrhage /
enlargement of hematoma /
predictive effectiveness
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基金
沧州市重点研发计划指导项目“人工智能辅助诊断技术在脑出血患者临床诊疗中的应用价值”（222106012）
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