CT平扫混合征和黑洞征及其联合征象对脑出血患者早期血肿扩大的预测价值

Blend sign,black hole sign and its combined signs with CT scanning for the predictive value of early hematoma enlargement in patients with intracerebral hemorrhage

目的探讨CT平扫混合征和(或)黑洞征预测原发性脑出血患者早期血肿扩大的价值。方法前瞻性连续纳入2011年7月至2016年7月重庆医科大学附属第一医院原发性脑出血患者244例,发病至首次CT时间均≤6 h,根据是否存在早期血肿扩大分为血肿扩大组(82例)和未扩大组(162例)。收集患者一般资料进行组间比较,包括既往史、临床特点、入院格拉斯哥昏迷评分(GCS)、影像学特征[黑洞征、混合征及黑洞征和(或)混合征]等;对早期血肿扩大的影响征象进行多因素Logistic回归分析;采用受试者工作特征曲线计算约登指数,并对早期血肿扩大的影像学征象的预测值进行分析。结果 (1)早期血肿扩大者中,黑洞征27例(32.9%)、混合征33例(40.2%)、混合征和(或)黑洞征50例(61.0%)。(2)将血肿体积按1 ml、发病至入院首次CT时间按1 h、入院GCS按1分递增进行赋值,并将黑洞征、混合征分别纳入进行多因素Logistic回归分析,结果显示,混合征(OR=14.04,95%CI:5.16~38.18)、黑洞征(OR=5.69,95%CI:2.12~15.30)均为早期血肿扩大的独立危险因素(均P<0.01);经过进一步调整显示,混合征和(或)黑洞征也为早期血肿扩大的独立危险因素(OR=14.08,95%CI:5.99~33.08,P<0.01)。(3)经受试者工作特征曲线分析,混合征和(或)黑洞征预测早期血肿扩大的敏感度、特异度、阳性预测值、阴性预测值和约登指数分别为:61.0%、90.1%、76.0%、82.0%和0.511,其约登指数比黑洞征(约登指数:0.280)和混合征(约登指数:0.346)更接近1。结论与单一征象相比较,混合征联合黑洞征对脑出血早期血肿扩大的预测能力更好。

Objective To investigate the value of blend sign and/or black hole sign with CT scanning for predicting early hematoma enlargement in patients with primary intracerebral hemorrhage.Methods From July 2011 to July 2016,244 consecutive patients with primary intracerebral hemorrhage in the First Affiliated Hospital of Chongqing Medical University were enrolled prospectively. From the onset to the first CT time were all ≤6 h. They were randomly divided into either an early hematoma enlargement group（ n = 82） or a non-hematoma enlargement group（ n = 162） according to whether they had early hematoma enlargement or not. The general data of patients were collected and compared between the groups,including previous history,clinical features,Glasgow coma scale（ GCS） at admission,imaging features（ black hole sign,blend sign and black hole sign and/or blend sign）,etc. Multivariate logistic regression analysis was performed on the factors influencing early hematoma enlargement. The predictive value of imaging signs of early hematoma enlargement was analyzed. Results（ 1） In patients with early hematoma enlargement,there were 27（ 32. 9%） patients had black hole sign,33（ 40. 2%） had blend sign,and 50（ 61. 0%） had blend sign and/or black hole sign.（ 2） The volume of hematoma according to 1 ml,the first CT time from onset to admission according to 1 h,and GCS on admission according to 1,the black hole sign and blend sign were included in the multivariate logistic regression analysis. The results showed that both the blend sign（ OR,14. 04,95% CI 5. 16-38. 18） and the black hole sign（ OR,5. 69,95% CI 2. 12-15. 30） were the independent risk factors for early hematoma enlargement（ all P 0. 01）. After further adjustment,it showed that the blend sign and/or black hole sign were also the independent risk factors for early hematoma enlargement（ OR,14. 08,95% CI 5. 99-33. 08,P 0. 01）.（ 3） After the analysis of the receiver operating characteristic curve,the sensitivity,specificity,positive predictive value,negative predictive value,and Youden Index of the blend sign and/or black hole sign of predicting early hematoma enlargement were61. 0%,90. 1%,76. 0%,82. 0%,and 0. 511,respectively. Its Youden Index was closer to 1 than the black hole sign（ Youden Index： 0. 280） and the blend sign（ Youden Index： 0. 346）. Conclusion Compared with the single sign,the blend sign combined with black hole sign has better predictive ability for early hematoma enlargement after intracerebral hemorrhage.