急性自发脑出血患者早期CT特征与病情进展的关系探讨

Relationship between early CT features and disease progression in patients with acute spontaneous cerebral hemorrhage

目的探讨急性自发脑出血患者早期CT征象中混杂征和岛屿征与患者病情进展的关系。方法回顾性分析2016年1月至2018年12月扬州大学附属医院收治的86例急性自发脑出血患者的临床资料与影像资料,根据48 h内患者转归情况分为进展组(37例)和未进展组(49例)。统计两组患者临床资料并进行单因素分析,将有统计学意义的变量采用多因素非条件Logistic回归分析筛选独立危险因素;分析CT岛屿征及CT混杂征对急性自发脑出血患者早期病情进展预判的阳性预测值、阴性预测值、灵敏度、特异度及约登指数。结果与未进展组比较,进展组平均血肿量、破入脑室患者比例、CT混杂征患者比例及CT岛屿征患者比例均增加(P <0.05);多因素非条件Logistic回归分析结果显示,CT混杂征及CT岛屿征均为预测急性自发脑出血患者早期病情进展的危险因素(OR=9.934,11.931,P <0.05);CT混杂征判断急性自发脑出血患者早期病情进展的灵敏度、特异度、阳性预测值、阴性预测值分别为59.5%、89.8%、81.5%、74.6%;CT岛屿征分别为51.4%、87.8%、76.0%、70.5%,CT混杂征与CT岛屿征的灵敏度、特异度、阳性预测值及阴性预测值比较差异均无统计学意义(P> 0.05)。结论 CT混杂征及CT岛屿征均为影响急性自发脑出血患者早期病情进展的独立危险因素,且两者均可独立预测早期血肿的增加,因此,临床工作者们需及时对急性自发脑出血患者颅脑出血量的增加情况进行预估和防范,进而有效帮助患者改善预后。

Objective To explore the relationship between the mixed sign and island sign in early CT plain scan and the patienfs disease progress in patients with acute cerebral hemorrhage.Methods The clinical and imaging data of 86 patients with acute spontaneous cerebral hemorrhage admitted to Affiliated Hospital of Yangzhou University from January 2016 to December 2018 were retrospectively reviewed.According to the results within 48 hours,the patients were divided into aggravation group(37 cases)and non-aggravation group(49 cases).The clinical data of two groups of patients were analyzed and univariate analysis was performed;then the statistically significant variables were screened for independent risk factors using multivariate non-conditional Logistic regression analysis;the positive predictive value,negative predictive value,sensitivity,specificity and Youden index of CT island sign and CT mixed sign in predicting the early progress of patients with acute spontaneous cerebral hemorrhage were analyzed.Results Compared with the non-progressive group,the average hematoma volume in the progressive group,the proportion of patients who broke into the ventricle,the proportion of patients with CT mixed sign,and the proportion of patients with CT island sign increased(P<0.05).Multivariate non-conditional Logistic regression analysis results showed that,CT confounding sign and CT island sign were both risk factors predicting disease early progression in patients with acute spontaneous cerebral hemorrhage(OZ?=9.934,11.931,P<0.05).Sensitivity,specificity,positive predictive value,negative predictive value for judging the progression of patients with acute spontaneous cerebral hemorrhage,the CT confounding signs were 59.5%,89.8%,81.5%,74.6%;CT island sign were 51.4%,87.8%,76.0%,70.5%,there was no significant difference in sensitivity,specificity,positive predictive value and negative predictive value between CT mixed sign and CT island sign(P>0.05).Conclusion CT confounding sign and CT island sign are independent risk factors that affect the disease early progression of patients with acute spontaneous cerebral hemorrhage,and both can independently predict the increase of early hematoma,therefore,clinical workers need to forecast and prevent the inorease of cerebral haemorrhage amount in patients with acute spontantous cerebral hemorrhage in a timely manner,effectively help patients improve their prognosis.