脑白质疏松对幕上自发性脑出血预后及血肿扩大的影响

Effect of leukoaraiosis on prognoses and enlarged hematoma in patients with spontaneous supratentorial intracerebral hemorrhage

目的探讨脑白质疏松对幕上自发性脑出血90d预后及血肿扩大的影响。方法对自2018年1月至2019年2月在南京医科大学附属淮安第一医院神经内科就诊的345例幕上自发性脑出血患者.采用vanSwieten量表(VSS)对入院时头颅CT影像行脑白质疏松严重程度评分,并依据评分分为无到中度脑白质疏松组(VSS评分0~2分)(n=288)与重度脑白质疏松组(VSS评分3~4分)(n=57),比较2组患者间90d预后良好(改良Rankin量表评分≤2分)比例及血肿扩大(血肿体积较入院时增加>12.5 mL或>原有体积的33%)发生率的差异;进-一步依据预后及有无血肿扩大分别将患者分为预后良好组(n=161)与预后不良组(n=184)、无血肿扩大组(n=303)和有血肿扩大组(n=42),采用单因素分析、多因素Logistics回归分析以及有序多分类Logistic回归分析明确脑白质疏松对患者预后,90dmRS评分及血肿扩大有无影响。结果与无到中度脑白质疏松组患者相比,重度脑白质疏松组患者90d预后良好比例明显较低(50.0%vs.29.8%),血肿扩大发生率明显较高(9.4%vs.26.3%),差异均有统计学意义(P<0.05)。多因素Logistics回归分析显示重度脑白质疏松是患者预后不良的独立危险因素(OR=0.390.95%CI:0.163-0.933.P=0.034)。有序多分类Logistic回归分析显示重度脑白质疏松患者有较高的90dmRS评分(OR=3.243.95%CI:1.775-5.923.P=0.000)。多因素Logistics回归分析显示重度脑白质疏松不是患者血肿扩大的独立危险囚素(P>0.05)。结论重度脑白质疏松可影响幕上自发性脑出血患者90d预后但不增加血肿扩大的风险。

Objeetive To explore the effect of leukoaraiosis(LA)severity on prognoses and enlarged hematoma in patients with spontaneous supratentorial intracerebral hemorrhage.Methods Three hundred and forty-five patients with spontaneous supratentorial intracerebral hemorrhage admitted to our hospital from January 2018 to February 2019 were chosen in our study.The van Swieten scale(vSS)was performed on baseline brain CT images to evaluate the LA severity;and according to the vSS scores,these patients were divided into absent-to-moderate LA group(0-2,n=288)and severe LA group(3-4,n=57);the percentage of patients with good prognosis(modified Rankin scale scoress290 d afier discharge)and incidence of enlarged hematoma(hematoma volume inereased by 12.5 mL or>33%of original volume as compared with that at admission)were compared between the two groups 90 d after discharge.According to the prognoses and enlarged hematoma,these patients were further divided into good prognosis group(n=161)and poor prognosis group(n=184),and non-hematoma expansion group(n=303)and hematoma expansion group(17=42),respectively;univariate analysis,multivariate Logistics regression analysis,and multi-classification Logistic regression analysis were used to evaluate the influence of LA severity in prognoses,mRS scores,and enlarged hematoma.Results As compared with the absent-to-moderate LA group,the severe LA group had significantly lower percentage of patients having good prognosis(50.0%vs.29.8%)and significantly higher incidence of enlarged hematoma(9.4%vs.26.3%,P<0.05).Multivariate Logistic regression analysis showed that severe LA was an independent risk factor for poor prognosis(OR=0.390,95%CI:0.163-0.933,P=0.034).Multi-classification Logistie regression analysis showed that patients with severe LA had high mRS scores(OR=3.243,95%CI:1.775-5.923,P=0.000).Multivariate L ogistic regression analysis showed that severe LA was not an independent risk factor for enlarged hematoma(P>0.05).Conclusion The severity of LA affects the prognoses 90d after discharge,but not increase the risk of enlarged hematoma in patients with spontaneous supratentorial intracere bral hemorrhage.