脑梗死占比对大面积脑梗死患者脑疝形成的预判价值

Predictive value of the ratio of cerebral infarction on cerebral hernia formation in patients with large area cerebral infarction

目的探讨脑梗死占比对大面积脑梗死患者脑疝形成的预判价值。方法回顾性分析2017年1月~2019年1月于重庆医科大学附属永川医院住院治疗的71例大面积脑梗死患者的临床资料。根据脑疝形成与否分为脑疝组(17例)和非脑疝组(54例)。对临床资料与影像学资料进行单因素和二元逻辑回归分析,采用ROC曲线评价诊断效果,寻找最佳预测值。结果两组临床资料比较,差异无统计学意义(P>0.05)。脑疝组的脑梗死体积、脑梗死占比、缓冲体积均大于非脑疝组,差异有统计学意义(P<0.05);两组的脑组织体积、颅腔体积比较,差异无统计学意义(P>0.05)。脑梗死占比为大面积脑梗死患者脑疝形成的独立危险因素(OR=7.749,95%CI:1.539~38.284,P<0.05)。脑梗死占比、脑梗死体积曲线下面积分别为0.818、0.808,当脑梗死占比为21%时为最佳拐点,敏感度为77%,特异度为76%。结论脑梗死占比为大面积脑梗死患者脑疝形成的独立危险因素,对判断大面积脑梗死患者脑疝形成有一定预测价值。

Objective To assess predictive value of the ratio of cerebral infarction on cerebral hernia formation in patients with large area cerebral infarction.Methods The clinical data of 71 patients with massive cerebral infarction hospitalized in Yongchuan Hospital Affiliated to Chongqing Medical University from January 2017 to January 2019 were retrospectively analyzed.They were divided into brain hernia group(17 cases)and non brain hernia group(54 cases)according to the formation of brain hernia.Single factor and binary logistic regression analysis were carried out for clinical data and imaging data.ROC curve was used to evaluate the diagnosis effect and find the best predictive value.Results Clinical data between two groups was not statistically significant(P>0.05).The volume of cerebral infarction,the proportion of cerebral infarction and the buffer volume of cerebral hernia group were larger than those of non cerebral hernia group,the differences were statistically significant(P<0.05).There were no significant differences in volume of brain tissue and cranial cavity between two groups(P>0.05).The proportion of cerebral infarction was an independent risk factor for the formation of cerebral hernia in patients with massive cerebral infarction(OR=7.749,95%CI:1.539-38.284,P<0.05).The proportion of cerebral infarction and the area under the volume curve of cerebral infarction was 0.818 and 0.808 respectively.When the proportion of cerebral infarction was 21%,it was the best turning point,the sensitivity was 77%,and the specificity was 76%.Conclusion The cerebral infarction proportion is an independent risk factor for the formation of cerebral hernia in patients with massive cerebral infarction,which provides a certain predictive value for judging the formation of cerebral hernia.