早期弥漫性轴索损伤患者CT影像特点与预后危险因素分析

CT Imaging Features and Prognostic Risk Factors in Patients with Early Diffuse Axonal Injury

目的研究早期弥漫性轴索损伤(DAI)患者CT影像特点与预后危险因素分析。方法将我院2012年5月至2014年6月收治的79例早期DAI患者纳入研究对象行回顾性分析,其中2例随访过程中失联脱落研究。分析患者一般资料与CT影像特点,并于入院后6个月随访预后情况,按照预后效果分为预后良好组(37例)、预后不良组(40例),对两组病例资料行单因素与多因素Logistic回归分析,探究影响DAI预后的独立高危因素。结果 CT影像分析显示,77例患者中58例患者有病灶检出,19例患者未检出病灶;其中27例出现微出血病灶,24例检出水肿灶,另7例为非出血性病灶;11例出现中间微出血低信号、外围水肿高信号影像。24例患者的出血灶位于大脑皮质、白质、灰白质交界处、胼胝体、脑干、小脑、基底节等组织界面,直径均在2mm以下。18例患者急性期合并脑肿胀、脑室出血、蛛网膜下腔出血、弥散性脑萎缩等非典型表现。因素分析显示瞳孔变化、入院格拉斯哥昏迷指数(GCS)评分、CT病灶个数、昏迷时间为影响DAI预后的独立危险因素(P<0.05)。结论微出血灶、水肿灶的形成为DAI患者的典型CT影像特征,瞳孔变化、入院GCS评分、CT病灶个数、昏迷时间为影响预后的独立高危因素,可为DAI的早期诊断与治疗提供重要依据。

Objective To study the CT imaging features and prognostic risk factors in patients with diffuse axonal injury （DAI）. Methods 79 cases of patients with early DAI treated in our hospital from May 2012 to June 2014 were enrolled in this study and were made of the retrospective analysis, among which 2 cases were lost in follow-up. The general data and CT imaging features of the patients were analyzed, and the prognosis was followed up at 6 months after admission. According to the prognosis effects, the patients were divided into the good prognosis group （37 cases） and the poor prognosis group （41） cases）. The data of two groups were analyzed by single factor and multi-factor Logistic regression, and the independent risk factors influencing the prognosis of DAI were explored..Results CT imaging analysis showed that there were 58 cases of patients with lesions and 19 cases of patients without lesions in the 77 patients, and there were 27 cases with microbleeds, 24 cases with edema and 7 cases with non-hemorrhagic lesions. And there were 11 eases of low signal in the middle of micro-bleeding and high signal in the peripheral edema images. There were24 cases of bleeding in the cerebral cortex, white matter, the junction of gray matter, the corpus callosum, brain stein, cerebellum, basal ganglia and other tissue interfaces with the diameter below 2mm. There were 18 patients in the acute phase complicated with brain swelling, ventricular hemorrhage, subarachnoid hemorrhage, diffuse brain atrophy and other atypical performance. Factor analysis showed that pupil changes, admission Glasgow Coma Index （GCS） score, number of CT lesions and coma time were independent risk factors for DAI prognosis （P〈0.05）. Coliclusion The formations of micro-hemorrhage and edema lesions are typical CT imaging features of DAI patients. And the pupil changes, admission GCS score, number of CT lesions and coma time are independent risk factors for prognosis, which can provide important basis for early diagnosis and treatment of DAI.