原发性脑出血超急性期血肿增长速度与临床预后的关系研究

Analysis of Association between Ultraearly Hematoma Growth and Outcome after Acute Spontaneous Intracerebral Hemorrhage

目的探讨超急性期血肿增长速度(ultraearly hematoma growth,UHG)与急性原发性脑出血(intracerebral hemorrhage,ICH)血肿扩大及临床预后的关系。方法连续收集发病6 h内就诊的ICH患者。患者完成基线及(24±2)h颅脑计算机断层扫描(computed tomography,CT),记录临床信息及结局信息。UHG定义为基线血肿体积除以发病至头CT扫描时间。血肿扩大定义为发病24 h血肿体积较基线血肿体积增加>33%或者>6 ml。90 d及1年预后不良定义为改良Rankin量表评分>2分。多元Logistic回归分析UHG与血肿扩大及ICH临床预后的关系。结果研究共纳入148例发病6h内到院的ICH患者。所有ICH患者的UHG为5.3(2.3,12.9)ml/h。UHG在完成头CT较早(P<0.001)、血肿扩大(P=0.019)、90 d预后不良(P<0.001)及1年预后不良(P<0.001)的患者中数值较大。UHG>4.7 ml/h是1年不良预后的独立危险因素,比值比为17.5,95%可信区间为1.44～21.23(P=0.025)。其预测1年不良预后的灵敏度为61.5%,特异度为65.1%,阳性预测率为68.4%,阴性预测率为58%。结论 UHG是ICH患者1年不良预后的独立危险因素。

Objective To investigate the association of ultraearly hematoma growth （UHG） with the hematoma growth （HG） and clinical outcomes in patients with acute spontaneous intracerebral hemorrhage （ICH）.Methods Acute ICH patients who went for consultation within 6 hours after onset were enrolled into study consecutively. Patients underwent baseline and 24-hour computed tomography （CT） scans. The clinical data and outcome were recorded. UHG was defined as the relation between baseline ICH volume/onset-to-imaging time （OIT）. Hematoma enlargement was defined as HG volume 〉33% or 〉6 ml at 24 hours after onset. And poor outcome was defined as modified Rankin Scale score 〉2 at 90 days and l year after onset. The multivariable logistic regression analysis was used to investigate the association of UHG with HG and clinical outcomes after ICH.Results A total of 148 patients with acute （〈6 h） ICH were enrolled. The median speed of UHG was 5.3 （interquartile range 2.3-12.9） ml/h. The UHG was significantly faster in patients who scanned earlier （P〈0.001）, as well as in patients who experienced HG （P=0.019）, 90-day poor outcome （P〈0.001） and l-year poor outcome （P〈0.001）. UHG〉4.7 ml/h was an independent risk factor for 1-year poor outcome （odds ratio 17.5; 95% confidence interval 1.44-21.23, P=0.025）. For UHG to predict 1-year poor outcome, the sensitivity, specificity, positive predictive value and negative predictive value were 61.5%, 65.1%, 68.4% and 58%, respectively. Conclusion UHG was an independent risk factor for 1-year poor outcome after acute ICH.