弥漫性轴索损伤预后影响因素的Logistic回归分析

Logistic regression analysis of influential factors for prognosis of diffuse axonal injury

目的探讨影响弥漫性轴索损伤（DAI）患者长期预后的相关因素。方法采用定群病例的前瞻性研究,记录75例DAI患者的相关指标及伤后6个月随访结果,对其临床和影像相关指标与预后进行单因素和多因素分析,多因素分析采用Logistic逐步回归分析。结果 Logistic逐步回归分析显示入院格拉斯哥昏迷评分（GCS）（OR=0.021,95%CI0.0071.557）、双侧瞳孔变化（OR=27.532,95%CI8.97557.413）、MR I弥散加权成像脑中轴部位病灶数（OR=5.753,95%CI2.1369.392）及脑中轴部位平均表观弥散系数（OR=0.353,95%CI0.1340.964）是影响DAI患者预后的相关因素;上述相关因素结合后预测DAI患者预后的准确率达92.0%。结论入院GCS、双侧瞳孔变化、MR I弥散加权成像脑中轴部位病灶数及脑中轴部位平均表观弥散系数是影响DAI患者预后的独立相关因素;临床因素与影像学指标结合则能更准确地评估DAI患者预后。

Objective To explore the influential factors for long-term prognosis of diffuse axonal injury（DAI）. MethodsProspective cohort study was performed on 75 patients with DAI,and related data of DAI and follow-up findings 6 months after injury were recorded.Single and multiple factor analysis were carried out to analyze the relationship between related factors and prognosis of DAI.Logistic regression analysis was employed for multiple factor analysis. Results Logistic regression analysis revealed that Glasgow coma score（GCS） score on admission（OR=0.021,95% CI 0.007-1.557）,bilateral pupillary abnormality（OR=27.532,95% CI 8.975-57.413）,number of lesions of brain central areas on diffusion weighted imaging of MRI（OR=5.753,95% CI 2.136-9.392） and average apparent diffusion coefficient of brain central areas（OR=0.353,95% CI 0.134-0.964） were influential factors for prognosis of DAI.The combination of the above factors provided a predictive accuracy of 92.0% for prognosis of DAI. Conclusion GCS on admission,bilateral pupillary abnormality,number of lesions of brain central areas on diffusion weighted imaging of MRI and average apparent diffusion coefficient of brain central areas are independent factors for prognosis of DAI.Accurate prognosis prediction for DAI may be provided on the basis of clinical and imaging findings.