创伤性脑出血术后再出血危险因素的Logisitic回归分析

Logistic regression analysis of risk factors predicting postoperative intracerebral re-hemorrhageof patients with traumatic intracerebral hemorrhage

目的通过回顾性病例对照研究方法分析创伤性脑出血患者相关临床指标以筛选出术后再出血的危险因素。方法收集自2007年1月至2011年9月在苏州大学附属第一医院住院的237例创伤性脑出血患者病历资料，按是否发生出血分为术后再出血组84例和术后未出血组153例。对患者11个临床指标进行单因素、多因素Logistic回归分析，筛选出独立危险因素，并通过受试者工作特征曲线（ROC）分析其预测价值。结果单因素分析显示发病到手术时间、颅内血肿量、凝血酶时间、血清前白蛋白水平、血糖水平在术后再出血组和术后未出血组间比较差异有统计学意义（P〈0．05）；多因素分析血清前白蛋白水平（P=-O．016，OR=0．994，95％CI：O．988～0．999）、凝血酶时间f卢0．044，OR=1．114，95％CI：1．003～1．238）及血肿量（P=-0．003，OR=1．020，95％CI：1．007～1．033）是创伤性脑出血术后再出血的独立危险因素，且ROC曲线分析表明三者对其发生均有一定的预测价值。结论血清前白蛋白水平降低、凝血酶时间延长及血肿量大的创伤性脑出血患者术后再出血的发生风险大．需密切监护，及早进行临床干预。

Objective To investigate the risk factors of postoperative intracerebral re-hemorrhage of patients with traumatic intracerebral hemorrhage by analyzing the clinic factors through case control study. Methods Clinical data of 237 patients with traumatic intracerebral hemorrhage, admitted to our hospital from January 2007 to September, were collected; these patients were divided into postoperative intracerebral re-hemorrhage group （n=84） and non-postoperative intracerebral re-hemorrhage group （n=153） according to the re-hemorrhage; the 11 independent risk factors were proved by univariate and multivariate binary logistic regression analysis, of which predicting value was evaluated by receiver operating characteristic （ROC） curve. Results Univariate binary logistic regression analysis indicated that 5 factors as the time fi＇om injure to operation, volume of intracranial hematoma （VOL）, thrombin time （TT）, prealbumin （PAB） and blood sugar were significantly different between patients with postoperative intraeerebral re-hemorrhage and patients without postoperative intracerebral re-hemorrhage （P〈0.05）. Multivariate binary logistic regression analysis indicated that PAB （P=0.016, OR=0.994, 95%CI： 0.988-0.999）, TT （P=0.044, OR=l.l14, 95%CI： 1.003-1.238） and VOL （P=0.003, OR=l.020, 95% CI： 1.007-1.033） were the independent risk factors of postoperative intracerebral re-hemorrhage of patients with traumatic intracerebral hemorrhage, and ROC curve indicated that all these three factors had predictive value. Conclusion Patients with low PAB, prolonged TT or large VOL have higher risk of postoperative intracerebral re-hemorrhage; more attention should be paid on these patients to prevent intracerebral hemorrhage recurrence.