原发性脑出血患者早期血肿扩大的头颅CT征象及联合检查的预测价值分析

The head CT signs of early hematoma enlargement and the predictive value of sign combinations in patients with primary cerebral hemorrhage

目的探究原发性脑出血患者早期血肿扩大(HE)的头颅CT征象及联合检查的预测价值。方法114例原发性脑出血患者,于首次检查后24 h内复查头颅CT,根据血肿扩大情况将患者分为HE组(血肿体积增大≥6 ml或血肿量增加>33%)及非HE组,比较两组首次头颅CT征象,分析其对原发性脑出血患者出现HE的预测价值及与HE发生的关系;根据发病6个月后的格拉斯哥结局评分(GOS)将HE组分为预后较好组及预后不良组,分析首次头颅CT征象对患者预后的预测价值。结果HE组血肿形态不规则、存在混合密度征、岛征、黑洞征、血肿内低密度征、卫星征的人数比例高于非HE组(P<0.05);血肿形态不规则、存在岛征、黑洞征、血肿内低密度征是原发性脑出血患者出现HE的危险因素(P<0.05);联合检测预测原发性脑出血患者出现HE的AUC大于各征象单独检测(P<0.05);预后不良组中血肿形态不规则、存在血肿内低密度征的人数比例高于预后较好组(P<0.05);血肿形态、血肿内低密度征联合检测预测原发性脑出血HE患者预后的AUC大于各征象单独检测(P<0.05)。结论血肿形态不规则、存在岛征等征象联合检测对原发性脑出血患者出现HE具有预测价值,且血肿形态、血肿内低密度征对HE患者预后具有预测价值。

Objective Toinvestigate the head CT signs of early hematoma enlargement(HE)and the predictive value ofsign combinations in patients with primarycerebral hemorrhage.Methods A total of 114 patients with primary cerebral hemorrhage were enrolled.Head CT was re-examined within 24h after the first examination.According to HE,the patients were divided into a HE group(hematoma volume increment≥6 ml or hematoma increment>33%)and a non-HE group.The first head CT signs between the two groups were compared.Their predictive value for HEin patients with primary cerebral hemorrhage and the relationship betweenCT signs and HE were analyzed.According to Glasgow Outcome Score(GOS)after 6 months of onset,the HE group was divided into a better prognostic group and a poor prognostic group.The predictivevalue of the first head CT signs for prognosis was also analyzed.Results The proportion of cases with irregular hematoma shape,mixed density sign,island sign,black hole sign,low density sign in hematoma and satellite sign in the HE group was higher than that inthe non-HE group(P<0.05).The irregular hematoma shape,island sign,black hole sign and low density sign in hematoma were risk factors of HE in patients with primary cerebral hemorrhage(P<0.05).The area under curve(AUC)of combinations of the above four signs for predicting HE was greater than that of single sign(P<0.05).The proportion of cases with irregular hematoma shape and intra-hematoma low density sign in the poor prognosis group was higher than that in the better prognosis group(P<0.05).The AUC of combinations of the two signs was greater than that of each sign alone(P<0.05).Conclusion The combined detection of irregular hematoma shape,island sign,black hole sign and low density sign in hematoma has a predictive value for HE in patients with primary cerebral hemorrhage.Hematoma shape and low density sign in hematoma have apredictivevalue for prognosis of HE patients.