维持性血液透析合并脑出血患者血肿扩大的相关因素分析

The related factors of hematoma expansion in patients with maintenance hemodialysis complicated with intracerebral hemorrhage

目的探讨影响维持性血液透析(maintenance hemodialysis,MHD)合并脑出血(Intracerebral hemorrhage,ICH)患者发生血肿扩大(hematoma expansion,HE)的危险因素。方法回顾性分析2015-2019年就诊于徐州医科大学附属医院MHD合并ICH的临床资料。根据72 h内复查头颅CT的结果将患者分为HE组以及非血肿扩大(non-hematoma expansion,NHE)组。单因素分析出影响HE发生的危险因素,再次基础上行多因素Logistic回归分析明确HE发生的危险因素及保护因素,最后运用受试者工作特征曲线(receiver operating characteristic,ROC)判断所得因素的预测效能。结果与NHE组相比,HE组在中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、入院收缩压(systolic blood pressure,SBP)及舒张压(diastolic blood pressure,DBP)、钙磷乘积水平显著增高,血红蛋白(hemoglobin)、入院格拉斯哥昏迷评分(glasgow coma score,GCS)水平显著降低,差异具有统计学意义(P <0.05)。多因素Logistic回归分析显示SBP、NLR为影响HE发生的危险因素,HB是其保护因素。由ROC曲线分析可知,SBP、NLR、HB对应的曲线下面积分别为0.738(95%CI:0.597~0.879,P=0.005)、0.792(95%CI:0.663~0.921,P=0.001)、0.698(95%CI:0.550~0.846,P=0.016),最佳截断值分别为191.0、9.90和80.0。结论 MHD合并ICH发生HE的危险因素为炎症指标高(NLR、PLR)、入院SBP及DBP高、钙磷乘积高、入院GCS评分低、血红蛋白低,其中SBP、NLR为影响患者发生HE的危险因素,HB是保护因素。

Objective To investigate the risk factors of hematoma expansion(HE)in patients with main-tenance hemodialysis(MHD)complicated with intracerebral hemorrhage(ICH).Methods The clinical data ofMHD patients complicated with ICH in the Affiliated Hospital of Xuzhou Medical University from 2015 to 2019 were analyzed retrospectively. All the patients were divided into HE group and NHE group according to CT examina-tion within 72 hours after onset to conclude the related factors affecting HE. Univariate analysis was used to analyzethe risk factor of HE and logistic regression to identify independent risk and protective factors. The receiver operat-ing curve(ROC)was used to determine the predictive power of the risk factors.Results Compared with those inNHE group,the neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),systolic blood pres-sure and diastolic blood pressure at admission,calcium and phosphorus product in HE group were significantlyincreased,but hemoglobin and Glasgow coma score were significantly decreased,and the difference was statisticallysignificant(P < 0.05). Multivariate logistic analysis showed systolic blood pressure at admission and NLR wereindependent risk factors for HE. HB was a protective factor affecting the occurrence of HE. The area under the re-ceiver operating characteristic analysis of SBP,NLR and HB for hematoma expansion risk were 0.738(95%CI:0.597 ~ 0.879,P = 0.005),0.792(95%CI:0.663 ~ 0.921,P = 0.001),0.698(95%CI:0.550 ~ 0.846,P = 0.016)respectively and the cut-off points of them were 191.0,9.90 and 80.0 respectively.Conclusion Higher inflamma-tory index,higher systolic pressure and diastolic blood pressure count on admission,higher calcium and phosphorus products,lower hemoglobin and GCS scores are risk factors for HE in MHD patients combined with ICH. Mean-while,systolic blood pressure and NLR are independent risk factors while HB is a protective factor.