自发性脑出血患者的血肿扩大CT预测征象与载脂蛋白E基因型的相关性探讨

Study on the correlation between the prediction of hematoma by expanded CT and apolipoprotein E genotype in patients with intracerebral hemorrhage

目的 探讨自发性脑出血(ICH)患者的血肿扩大预测中载脂蛋白E(ApoE)基因型与CT征象的相关性。方法 回顾性选取2019年2月至2021年5月西安西电集团医院收治的ICH患者300例,均在发病1 d内完成CT检查,均具有完整的ApoE基因型资料。分析300例患者的CT征象与ApoE基因型,单因素、多因素Logistic回归分析CT征象与ApoE基因型的相关性。结果 300例ICH患者中,在CT征象方面,旋涡征175例,血肿不规则形状154例,血肿不均质密度123例,卫星征60例,岛征58例,混杂征35例,黑洞征33例,液平7例。在ApoE基因型方面,ε3ε3 200例,ε3ε4 50例,ε2ε3 40例,ε4ε4 5例,ε2ε4 3例,ε2ε2 2例,换算为等位基因,ε2 20例,ε3 250例,ε4 30例。发病12、18 h内CT征象黑洞征与ApoE基因型ε2+相关(P<0.05),但CT征象旋涡征、血肿不规则形状、血肿不均质密度、卫星征、岛征、混杂征、液平与ApoE基因型ε2+无关(P>0.05);CT征象旋涡征、血肿不规则形状、血肿不均质密度、卫星征、岛征、混杂征、黑洞征、液平与ApoE基因型ε4+无关(P>0.05)。发病24 h内CT征象旋涡征、血肿不规则形状、血肿不均质密度、卫星征、岛征、混杂征、黑洞征、液平与ApoE基因型ε2+无关(P>0.05);CT征象血肿不均质密度与ApoE基因型ε4+相关(P<0.05),但CT征象旋涡征、血肿不规则形状、卫星征、岛征、混杂征、黑洞征、液平与ApoE基因型ε4+无关(P>0.05)。多因素Logistic回归分析显示,发病12、18 h内CT征象黑洞征的独立预测因素为ApoE基因型ε2(P<0.05),发病24 h内CT征象血肿不均质密度的独立预测因素为ApoE基因型ε3(P<0.05)。结论 ICH患者的血肿扩大预测中ApoE基因型ε2、ε3与CT征象相关,能够将有效依据提供给临床的诊断与治疗工作,从而有效改善患者预后。

Objective To investigate the correlation between Apolipoprotein E(ApoE) genotype and CT signs in the prediction of hematoma enlargement in patients with intracerebral hemorrhage(ICH). Methods Three hundred patients with spontaneous intracerebral hemorrhage from February 2019 to May 2021 in Xi’an XD Group Hospital were retrospectively selected, all of whom completed CT examination within one day of onset and had complete ApoE genotype data. CT signs and ApoE genotypes of 300 patients were analyzed. The correlation between CT signs and ApoE genotype was analyzed by univariate and multivariate Logistic regression.Results Among 300 patients, in terms of CT signs, there were 175 cases of vortex sign, 154 cases of irregular shape of hematoma, 123 cases of uneven density of hematoma, 60 cases of satellite sign, 58 cases of island sign, 35 cases of mixed sign, 33 cases of black hole sign and 7 cases of fluid level. In terms of ApoE genotypes, there were 200 cases of ε3ε3, 50 cases of ε3ε4, 40 cases of ε2ε3, 5 cases of ε4ε4, 3 cases of ε2ε4, and 2 cases of ε2ε2. CT black hole sign within 12 h and 18 h was correlated with ApoE genotype ε2+(P<0.05), but CT vortex sign, irregular shape of hematoma, uneven density of hematoma, satellite sign, island sign, mixed sign and fluid level were not correlated with ApoE genotype ε2+(P>0.05). CT vortex sign, irregular shape of hematoma, uneven density of hematoma, satellite sign, island sign, hybrid sign, black hole sign and fluid level were not correlated with ApoE genotype ε4+(P>0.05). CT signs such as vortex sign, irregular shape of hematoma, uneven density of hematoma, satellite sign, island sign, mixed sign, black hole sign and fluid level within 24 days of onset were not correlated with ApoE genotype ε2+(P>0.05). CT hematoma heterogeneity was correlated with ApoE genotype ε4+(P<0.05), but CT vortex sign, irregular shape of hematoma, satellite sign, island sign, hybrid sign, black hole sign and fluid level were not correlated with ApoE genotype ε4+(P>0.05). Multivariate Logistic regression analysis showed that ApoE genotype ε2 was the independent predictor of CT black hole sign within 12 and 18 h of onset(P<0.05), and ApoE genotype ε3 was the independent predictor of CT hematoma heterogeneity density within 24 h of onset(P<0.05). Conclusion ApoE genotype ε2, ε3 are associated with CT findings in the prediction of ICH in patients, which can provide effective evidence for clinical diagnosis and treatment, thereby effectively improving the prognosis of patients.