头颅CT血管成像点征对立体定向微创术治疗自发性脑出血术后再出血的预测价值

The Predictive Value of Cranial CTA Spot Signs in Predicting Postoperative Rebleeding after Stereotactic Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage

目的:探讨CT血管成像(CTA)点征对立体定向微创术治疗自发性脑出血术后再出血的预测价值。方法:回顾性分析2018年1月至2023年2月于贵州医科大学附属医院接受立体定向微创术联合尿激酶治疗的自发性脑出血患者。根据是否发生术后再出血分为再出血组和对照组,比较2组的临床特点、影像学特征等;根据基线CTA上是否存在点征,将患者分为点征阳性组和点征阴性组,比较2组的临床资料;应用多因素二元Logistics回归模型分析点征与术后再出血之间的关系,ROC曲线分析点征对术后再出血的预测价值。结果:本研究共纳入自发性脑出血患者221例,其中再出血64例(28.9%)。点征阳性组114例,有46例(40.4%)发生再出血;点征阴性组107例,有18例(16.8%)发生再出血,2组之间差异有统计学意义(P<0.01)。单因素分析中,男性、吸烟史、点征是脑出血术后再出血的危险因素。多因素二元Logistic回归分析分析表明,点征是术后再出血的独立预测指标(OR=3.177,95%CI 1.673~6.032,P=0.000)。ROC曲线分析显示,点征预测立体定向微创术后再出血的敏感性、特异性、阳性预测值、阴性预测值、约登指数分别为71.9%、56.7%、40.3%、83.2%和28.6%,曲线下面积(AUC)为0.643(95%CI 0.564~0.722,P=0.001)。结论:基线CTA上点征阳性可能是增加立体定向微创术治疗脑出血术后再出血风险的危险因素。

Objective:The purpose of this study was to investigate the predictive value of computed tomogra-phy angiography(CTA)spot signs in predicting postoperative rebleeding after stereotactic minimally invasive surgery for spontaneous intracerebral hemorrhage(sICH).Methods:A retrospective analysis was conducted on patients with sICH who received stereotactic minimally invasive surgery combined with urokinase therapy at the Affiliated Hospital of Guizhou Medical University from January 2018 to February 2023.According to whether there was postoperative rebleeding,the patients were divided into rebleeding group and control group,and their clinical characteristics and imaging features were compared.According to the presence or absence of spot signs on CTA,the patients were divided into spot sign positive group and spot sign negative group,and their clinical data were compared.Multivariate binary logistic regression model was applied to analyze the relationship be-tween spot signs and postoperative rebleeding,as well as the predictive value of spot signs for postoperative re-bleeding.Results:A total of 221 patients with sICH were included in this study,including 64 cases of rebleed-ing(28.9%).Among them,114 patients with spot sign positive had 46 cases of rebleeding(40.4%),while 107 pa-tients with spot sign negative had 18 cases of rebleeding(16.8%),and there was a significant difference between the two groups(P<0.01).In univariate analysis,male sex,smoking history,and spot sign were risk factors for postoperative rebleeding.Multivariate binary logistic regression analysis showed that spot sign was an indepen-dent predictor of postoperative rebleeding(OR=3.177,95%CI 1.673~6.032,P=0.000).The ROC curve analysis showed that the sensitivity,specificity,positive predicted value,negative predicted value and Youden index of the spot signs were 71.9%,56.7%,40.3%,83.2%and 28.6%,respectively,with an AUC of 0.643(95%CI 0.564~0.722,P=0.001).Conclusion:Baseline CTA spot signs positive may be a risk factor for increasing the risk of postoperative rebleeding after stereotactic minimally invasive surgery for sICH.