基线血肿平均CT值和血肿形状规则指数预测自发性脑出血患者血肿增大

Baseline hematoma mean CT value and shape regularity index predict hematoma enlargement in patients with spontaneous intracerebral hemorrhage

目的探讨基线血肿平均CT值和血肿形状规则指数(shape regularity,SR)对自发性脑出血(intracerebral hemorrhage,ICH)患者血肿增大(hemorrhage enlargement,HE)的预测价值。方法回顾性纳入2018年6月至2021年12月榆林市第一医院收治的ICH患者。在发病后24 h内进行首次头颅CT扫描,在首次扫描后72 h内复查头颅CT。HE定义为复查CT血肿体积较首次CT增加至少6 ml或33%。利用3D Slicer软件重建三维图像,并计算SR。应用多变量logistic回归分析确定HE的独立影响因素。应用受试者工作特征(receiver operator characteristic,ROC)曲线评价基线血肿平均CT值对HE的预测价值。结果共纳入249例ICH患者,男性134例(53.8%),年龄(62.2±12.1)岁,中位基线格拉斯哥昏迷量表评分为12分,中位发病至首次CT扫描时间为3.1 h,中位基线血肿体积为10.9 ml,58例(23.3%)出现HE。HE组基线血肿平均CT值[(58.5±3.2)HU对(60.3±3.3)HU;P<0.01]和基线SR(0.615±0.146对0.688±0.100;P<0.001)显著低于非HE组。多变量logistic回归分析表明,发病至首次CT时间[优势比(odds ratio,OR)0.867,95%置信区间(confidence interval,CI)0.786~0.957;P=0.004]、基线血肿体积(OR 1.050,95%CI 1.028~1.073;P<0.001)、基线血肿平均CT值(OR 0.809,95%CI 0.725~0.902;P<0.001)是HE的独立预测因素,而基线SR与HE无显著独立相关性。ROC曲线分析表明,基线血肿平均CT值预测HE的曲线下面积为0.652(95%CI 0.573~0.731;P<0.001),最佳截断值为57.97 HU,预测HE的敏感性和特异性分别为50%和75.9%。结论基线血肿平均CT值是ICH患者HE的独立影响因素,对HE具有一定的预测价值。

Objective To investigate the predictive values of baseline hematoma mean CT value and shape regularity(SR)for hematoma enlargement(HE)in patients with spontaneous intracerebral hemorrhage(ICH).Methods Patients with ICH admitted to Yulin First Hospital from June 2018 to December 2021 were retrospectively included.The first head CT scan was performed within 24 h of onset,and the second head CT scan was performed within 72 h of the first scan.HE was defined as an increase in hematoma volume of at least 6 ml or 33%from the first CT.3D Slicer software was used to reconstruct 3D images and SR was calculated.Multivariate logistic regression analysis was used to determine the independent factor for HE.Receiver operator characteristic(ROC)curve was used to evaluate the predictive value of baseline hematoma mean CT value for HE.Results A total of 249 patients with ICH were enrolled,including 134 males(53.8%),and aged 62.2±12.1 years.The median baseline Glasgow Coma Scale score was 12,and the median time from onset to first CT scan was 3.1 h.The median baseline hematoma volume was 10.9 ml,and 58 patients(23.3%)showed HE.The baseline hematoma mean CT value in the HE group(58.5±3.2 HU vs.60.3±3.3 HU;P<0.01)and baseline SR(0.615±0.146 vs.0.688±0.100;P<0.001)were significantly lower in the non-HE group.Multivariate logistic regression analysis showed that the time from onset to first CT scan(odds ratio[OR]0.867,95%confidence interval[CI]0.786-0.957;P=0.004),the baseline hematoma volume(OR 1.050,95%CI 1.028-1.073;P<0.001),and the baseline hematoma mean CT value(OR 0.809,95%CI 0.725-0.902;P<0.001)were the independent predictors of HE,while the baseline SR had no significant independent correlation with HE.ROC curve analysis showed that the area under the curve of baseline hematoma mean CT value for predicting HE was 0.652(95%CI 0.573-0.731;P<0.001),with an optimal cutoff value of 57.97 HU.The sensitivity and specificity for predicting HE were 50% and 75.9%,respectively.Conclusion The baseline hematoma mean CT value is an independent factor for HE in patients with ICH and has certain predictive value for HE.