平扫CT征象对高血压脑出血早期血肿扩大的预测价值

Predictive value of non-contrast CT signs for early hematoma expansion in patients with hypertensive intracerebral hemorrhage

目的:探讨平扫CT征象对高血压脑出血早期血肿扩大的预测价值。方法:纳入急性高血压脑出血患者189例,发病6 h内行CT平扫,根据24 h内复查CT是否出现血肿扩大分为扩大组和非扩大组,比较两组间差异,分析影响血肿扩大的因素及对早期血肿扩大有预测意义的因素。结果:血肿扩大组67例,非扩大组122例,两组平扫CT征象(漩涡征、混合征、岛征)间差异有统计学意义(χ2值分别约9.636、7.779、10.177,P值均<0.05)。多因素Logistic回归显示漩涡征、混合征、岛征均为早期血肿扩大的独立预测因素(P<0.05),OR值分别约0.301、0.390、3.319。经ROC曲线分析,漩涡征、混合征、岛征的AUC值分别约0.589、0.592、0.595,且两者联合的AUC值略高于单一征象(AUC值分别约0.602、0.613、0.616)。当三种征象同时出现时,预测血肿扩大的特异性达99.2%。结论:平扫CT征象是高血压脑出血早期血肿扩大的独立预测因素,且两者联合比单一征象的预测能力高。当所有征象同时出现时,具有高度特异性,提示发生早期血肿扩大的可能性极高。

Objective:To explore the predictive value of non-contrast computed tomography(CT)signs for early hematoma expansion in patients with hypertensive intracerebral hemorrhage.Methods:A total of 189 patients with acute hypertensive intracerebral hemorrhage were enrolled,who were examined by CT within six hours of onset.The patients were divided an early hematoma expansion group and a non-hematoma expansion group according to re-examined CT within 24 hours of onset whether hematoma expansion occurred.The differences between the two groups were compared.The factors influencing hematoma expansion and predicting early hematoma expansion were analyzed.Results:There were 67 cases in the expansion group and 122 cases in the non-expansion.The non-contrast CT signs,including swirl sign,blend sign,island sign,were significantly different between the two groups(all P<0.05).Multivariate logistic regression analysis showed that the swirl sign,blend sign,and island sign were independent risk factors for early hematoma expansion(all P<0.05),whose odds ratios were 0.301,0.390,and 0.319,respectively.After the ROC curve analysis,the area under curve(AUC)of the swirl sign,blend sign,and island sign were 0.589,0.592,and 0.595,and the AUC curve of any two signs combination was slightly larger than that of single sign,which were 0.602,0.613,and 0.616,respectively.The specificity of the three signs combination was 99.2%.Conclusion:The non-contrast CT was an independent predictive factor of early hematoma expansion in patients with hypertensive intracerebral hemorrhage.The predictive ability of any two signs combination was higher than that of a single sign.Our findings presented a high specificity of the three signs combination,and suggested a high probability of hematoma expansion.