CT增强扫描结合凝血功能检测对急性脑出血患者预后的预测价值

Prognostic value of enhanced CT scan combined with coagulation function detection in patients with acute intracerebral hemorrhage

目的分析CT增强扫描结合凝血功能检测对急性脑出血(ICH)患者预后的预测价值。方法回顾性分析2021-01—2022-12四川大学华西医院治疗的110例急性ICH患者,根据发病30 d的格拉斯哥预后量表(GOS)评分评估预后,GOS<4分为预后不良组(n=31),GOS≥4分为预后良好组(n=79)。分析2组患者一般情况、入院后6 h内的CT检查资料及凝血功能指标[D-二聚体(D-D)、纤维蛋白原(FIB)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)],采用受试者工作特征(ROC)曲线分析CT增强扫描结合凝血功能检测对AICH的预测价值。结果CT平扫显示2组患者混合征、岛征阳性比例比较差异无统计学意义(P>0.05),CT增强扫描显示预后不良组患者渗漏征阳性比例高于预后良好组(P<0.001),ROC曲线显示渗漏征预测急性ICH患者预后的曲线下面积(AUC)为0.834(P<0.001)。预后不良组患者D-D、FIB、TT、PT、APTT指标均高于预后良好组(P<0.001),ROC曲线显示D-D、FIB、TT、PT、APTT预测急性ICH患者预后的AUC分别为0.784、0.707、0.758、0.745、0.768(P<0.001),联合预测急性ICH患者预后的AUC为0.759(P<0.001)。CT增强扫描结合凝血功能预测急性ICH患者预后的AUC为0.898(P<0.001),高于两种方式单独预测的AUC(Z=2.108、3.312,P=0.035、0.001)。结论CT增强扫描结合凝血功能对急性脑ICH患者预后有较高的预测价值。

Objective To analyze the prognostic value of enhanced CT scan combined with coagulation function detection in patients with acute intracerebral hemorrhage(ICH).Methods A total of 110 patients with acute ICH treated in the West China Hospital were retrospectively analyzed between January 2021 and December 2022.The prognosis was evaluated according to the Glasgow outcome scale(GOS)within 30 days after onset,GOS<4 were divided into poor prognosis group(n=31)and GOS≥4 were divided into the good prognosis group(n=79).The general situations,CT scan data within 6 hours after admission and coagulation function indexes(D-dimer(D-D),fibrinogen(FIB),thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT))in the two groups were analyzed.The predictive value of enhanced CT scan combined with coagu⁃lation function detection for AICH was analyzed by receiver operating characteristic(ROC)curves.Results The results of CT plain scan showed that there was no significant difference in proportions of mixed sign and island sign between the two groups(P>0.05).The results of enhanced CT scan showed that the proportion of leakage sign in poor prognosis group was higher than that in good prognosis group(P<0.001).The area under the curve(AUC)of leakage sign for predicting the prognosis of patients with acute ICH was 0.834(P<0.001).D-D,FIB,TT,PT and APTT in poor prognosis group were higher than those in good prognosis group(P<0.001).The results of ROC curves analysis showed that AUC values of D-D,FIB,TT,PT and APTT for predicting the prognosis of patients with acute ICH were 0.784,0.707,0.758,0.745 and 0.768,respectively(P<0.001).AUC of combined detection with the above indexes was 0.759(P<0.001).AUC of enhanced CT scan combined with coagulation function detection was 0.898(P<0.001),which was greater than that of the two methods alone(Z=2.108,3.312;P=0.035,0.001).Conclusion Enhanced CT scan combined with coagulation function detection has higher prog⁃nostic value in patients with acute ICH.