4884例轻型颅脑损伤CT结果阳性患者危险因素的Logistic回归分析

The Logistic regression identification of risk factors for 4 884 cases of mild head injury （MHI） with abnormal computerized tomography （CT）

目的探讨轻型颅脑损伤（MHI）患者的危险因素，为临床判断MHI程度提供参考依据。方法回顾性分析4884例MHI患者的临床各因素和颅脑CT检查结果，对患者的性别、年龄（≥65岁、〈65岁）、意识丧失、逆行性健忘、呕吐、脑脊液漏、癫痫、头皮外伤、神经病学阳性体征和格拉斯哥昏迷评分（GCS）进行非条件Logistic回归分析。结果Logistic回归分析显示，性别优势比（OR）=0．703，95％可信区间（95％CI）0．53～0．94，P=0．02；年龄≥65岁OR=3．74，95％CI2．38～5．88，P=0．00；意识丧失0R=18．17，95％CI12．66～26．07，P=0．00；逆行性健忘OR=4．19，95％CI2．17～8．07，P=0．00；呕吐OR=27．01，95％CI18．45～39．55，P=0．00；脑脊液漏OR=63．80，95％CI33．01～123．30，P=0．00；癫痫OR=1．61，95％CI0．30～8．58，P=0．58；头皮外伤OR=0．95，95％C10．75～1．22，P=0．69；神经病学阳性体征OR=9．87，95％CI2．03～47．95，P=0．05；GCS评分OR=1．10，95％CI0．85～1．42，P=0．47，其中男性、高龄（≥65岁）、意识丧失、逆行性健忘、呕吐、脑脊液漏、神经病学阳性体征是MHI的危险因素。结论性别、年龄、意识丧失、逆行性健忘、呕吐、脑脊液漏、神经病学阳性体征对判断MHI程度有一定意义，可为临床处理这类损伤提供有益的参考依据。

Objective To identify the risk factors in patients with MHI for the evaluation of the severity of the damage. Methods The clinical data and brain CT findings from 4 884 MHI patients were analyzed retrospectively using non-conditional Logistic regression for their relation to gender, age （≥65 years, 〈65 years）, loss of consciousness, retrograde amnesia, vomiting, cerebrospinal fluidotorrhea/rhinorrhea, epilepsy, scalp trauma, positive neurological signs and glasgow coma scale （GCS）. Results The odds ratio （OR）, 95% confidence interval （95% CI）, and confidence coefficient （P） for all the factors were demonstrated as follows, repectively, gender： （0. 703, 0.53 - 0.94, 0. 02）; age ≥ 65 years： （3.74, 2.38 - 5.88, 0.00）; loss of consciousness： （18.17, 12.66 - 26.07, 0. 00）; retrograde amnesia： （4.19, 2.17 - 8. 07, 0.00）; vomiting： （27.01, 18.45-39.55, 0.00）; cerebrospinal fluid-otorrhea/ rhinorrhea： （63.80, 33.01 123.30, 0.00）; epilepsy： （1.61, 0.30-8.58, 0.58）; scalp trauma： （0.95, 0.75 - 1.22, 0.69）; positive neurological signs： （9.87, 2.03 -47.95, 0. 05）; and GCS score： （1.10, 0. 85 - 1.42, 0. 47）. The factor male, age≥65 years, loss of consciousness, retrograde forgetfulness, vomiting, cerebrospina[ fluid-otorrhea/rhinorrhea, and positive neurological signs were found to be risk factors for MHI. Conclusion The risk factors as listed above may serve as indexes in the severity evaluation for MHI, and the design of treatment-plan for the patients.