脑出血血肿扩大的预测因素及预测评分系统

Predictive factors and prognostic scoring systems of hematoma expansion in cerebral hemorrhage

在中国,脑出血占所有卒中的18.8%~47.6%,其中部分患者出现血肿扩大。血肿扩大导致脑出血患者预后不良,因此准确预测血肿扩大可以为个体化治疗和试验设计提供依据,对血肿扩大高危患者提供最大可能的治疗效益。近年来,预测血肿扩大的影像学征象越来越多,如血肿内低密度灶、“岛征”“黑洞征”及CT血管成像(CTA)“点征”等。较多的临床预测评分也被提出,但仍需进行更多的外部队列验证。作者对血肿扩大的影像学预测因素、非影像学预测因素及预测评分系统进行综述。

In China,cerebral hemorrhage accounts for 18.8%- 47.6% of all stroke cases,and some of them have hematoma expansion.Hematoma expansion leads to poor outcomes in patients with intracerebral hemorrhage.Because of its influence on outcome,an ability to accurately predict hematoma expansion could open a path for individualized treatment and trial design aimed at patients at highest risk of hematoma expansion with maximum potential for therapeutic benefit.Recently,more and more imaging signs have been found to predict hematoma expansion such as hypodensities in hematoma,island sign,black hole sign and CT angiography spot sign.Although many prognostic scoring systems in clinics were recently developed, more external validation cohorts of patients with intracerebral hemorrhage are required.The imaging and non-imaging predictive factors of hematoma expansion,together with prognostic scoring systems,will be reviewed.