脑白质疏松与自发性脑出血早期血肿扩大的相关性研究

Correlation between leukoaraiosis and hematoma expansion in early stage of spontaneous intracerebral hemorrhage

目的探讨脑白质疏松与自发性幕上脑出血早期血肿扩大的关系。方法回顾性连续入组2015年10月-2017年10月于中国医科大学附属第一医院神经内科住院治疗的自发性幕上脑出血患者,全部患者需在发病12 h之内完成首次头部CT且48 h内复查头部CT。应用Image J软件计算两次的血肿体积,采用Van Swieten量表评价脑白质疏松严重程度。比较早期血肿扩大组与未扩大组在血肿部位、血肿形态、脑白质疏松程度等临床、影像、实验室资料等的差异;判断脑白质疏松是否为早期血肿扩大的独立危险因素。结果94例(33.3%)发生早期血肿扩大,多因素Logistic回归分析显示VSS评分(OR=1.358,95%CI 1.139~1.619,P=0.001)、吸烟程度(OR=1.286,95%CI 1.029~1.606,P=0.027)是自发性幕上脑出血早期血肿扩大的独立危险因素。结论脑白质疏松与自发性幕上脑出血早期血肿扩大密切相关,即脑白质疏松程度越严重,早期血肿扩大发生率越高。

Objective To investigate the relationship between leukoaraiosis in spontaneous supratentorial intracerebral hemorrhage.Methods Patients with spontaneous supratentorial intracerebral hemorrhage who were admitted to the Department of Neurology,the First Affiliated Hospital of China Medical University from October 2015 to October 2017 were enrolled retrospectively.The patients were required to complete the cranial CT within 12 hours after ICH symptoms onset and the follow-up cranial CT within 48 hours.Hematoma volume and the volume of perihematoma edema were measured with Image J.The Van Swieten scale was used to evaluate the severity of leukoaraiosis.The differences in clinical,imaging and laboratory data such as hematoma location,hematoma shape,and degree of leukoaraiosis between early hematoma expansion group and nonexpantion group were compared to determine whether leukoaraiosis is an independent risk factor for early hematoma expansion.Results 94 cases(33.3%)developed early hematoma expansion.Multivariate logistic regression analysis showed that VSS score(OR=1.358,95%CI 1.139~1.619,P=0.001)and smoking degree(OR=1.286,95%CI 1.029~1.606,P=0.027)are independent risk factors for early hematoma expansion in spontaneous supratentorial intracerebral hemorrhage.Conclusion Leukoaraiosis is closely related to the early expansion of hematoma in spontaneous supratentorial intracerebral hemorrhage,that is,the more serious the degree of leukoarais,the higher the incidence of early hematoma expansion.