颅脑损伤远隔血肿部位迟发性脑梗死预后影响因素分析

Analysis of prognostic factors in patients with delayed cerebral infarction at distant hematoma sites with craniocerebral injury.

目的探讨颅脑损伤远隔血肿部位迟发性脑梗死患者的预后影响因素。方法回顾性分析2016年5月至2021年5月福建医科大学附属第二医院神经外科收治77例急性颅脑损伤远隔血肿部位迟发性脑梗死患者临床资料。采用改良Rankin评分(modified Rankin scale,mRS)量表,评价患者伤后3个月的神经功能状态,分为结局良好组(mRS评分为Ⅰ~Ⅱ级)和结局不良组(mRS评分Ⅲ~V级)。通过比较分析和多因素logistics回归分析,揭示预后危险因素;联合指标ROC曲线分析DIC评分和Wells评分预测急性颅脑损伤远隔血肿部位迟发性脑梗死的预后能力。结果与预后良好组相比,预后不良组的血小板减少、凝血酶原时间(prothrombin time,PT)延长、活化部分凝血激酶时间(activated partial thromboplastin time,APTT)延长、D二聚体升高、糖尿病、弥漫性血管内凝血(disseminated intravascular coagulation,DIC)评分高、Wells评分高,且差异具有统计学意义(P<0.05)。logistic回归分析显示,DIC评分(OR=10.067,95%CI:1.157~87.592,P=0.036)和Wells评分(OR=44.534,95%CI:3.715~533.935,P=0.003)是预后的影响因素。ROC曲线分析结果显示,DIC评分+Wells评分可预测神经功能恢复(AUC=0.923),取最佳分界点时敏感性97.3%,特异性75.0%。结论 Wells评分联合DIC评分具有较好预测颅脑损伤远隔血肿部位迟发性脑梗死患者预后不良的价值。

Objective hematoma sites of craniocerebral injury.MethodsA retrospective analysis of the clinical data of 77 patients with acute craniocerebral injury with delayed cerebral infarction at the remote hematoma site admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Fujian Medical University from May 2016 to May 2021. According to the Modified Rankin Scale(mRS) scale evaluated 3 months after injury, patients were divided into a good outcome group(mRS grade I-II) and a poor outcome group(mRS grade III-V). Univariate analysis and multivariate logistic regression analysis were used to evaluate the prognostic risk factors;Combined index ROC curve analysis of DIC score and Wells score was used to predict the prognosis of acute brain injury patients with remote hematoma delayed cerebral infarctionResults Compared with the good prognosis group, the poor prognosis group had thrombocytopenia, prolonged PT, prolonged APTT,increased D-dimer, high DIC score, and high Wells score, and the difference was statistically significant(P<0.05);Binary Logistic regression analysis showed that DIC score(OR=10.067, 95%CI: 1.157~87.592, P =0.036) and Wells score(OR=44.534, 95%CI: 3.715~533.953, P =0.003) were significant prognostic factors;ROC curve analysis results showed that: DIC score + Wells score(AUC=0.923,) was the key factor predicting the recovery of neurological function and the sensitivity was 97.3% and the specificity was 75.0% based on the best cut-off point.Conclusion combination of Wells score and DIC score has a better predictive value in predicting the poor prognosis of patients with delayed cerebral infarction with distal hematoma in craniocerebral injury.