幕上深部自发性脑出血患者出血量临界值与临床预后的关系

The relationship between the critical bleeding volume and clinical prognosis in the patients with supratentorial deep spontaneous intracerebral hemorrhage

目的探讨幕上深部自发性脑出血(sICH)患者出血量临界值与临床预后的关系。方法回顾性分析2021年9月至2023年9月开封市中心医院神经科数据库登记的300例幕上深部sICH患者的临床资料。根据神经内科治疗后30 d的改良Rankin量表(mRS)评分将其分为预后良好组(n=135)与预后不良组(n=165),评估患者预后情况。基于脑出血部位进行亚分组,观察幕上深部sICH患者出血部位与临床预后的关系,并通过绘制受试者工作特征(ROC)曲线明确幕上深部不同出血部位的出血量,预测临床不良结局的最佳临界值;用10折交叉验证法对预测性能进行验证;使用最佳出血量临界值验证其与预后的关系。结果经Logistic回归分析,无论是否存在混杂因素情况下,sICH位置与幕上深部sICH患者预后有关(P<0.05);经ROC分析显示,基底节出血量为18.5 mL、丘脑出血量为8.5 mL时预测患者预后不良的敏感度、特异度较高,幕上深部sICH不同部位的出血量10折交叉检验法的平均曲线下面积(AUC)分别为0.872和0.885,进一步证实出血量预测的稳健性良好。根据出血量临界值划分为高出血量与低出血量,经Logistic回归分析显示,无论是否调整相关混杂因素,不同部位出血量临界值仍与幕上深部sICH患者预后有关(P<0.05)。结论幕上深部sICH患者的出血位置与临床预后具有一定相关性。本研究通过分析不同位置基底核团出血量,可以为临床预后评估、积极干预、精准治疗提供参考。

Objective To explore the relationship between the critical value of bleeding volume and clinical prognosis in the patients with supratentorial deep spontaneous intracerebral hemorrhage(sICH).Methods A retrospective analysis was conducted on the clinical data of 300 patients with supratentorial deep sICH registered in the neurology database of Kaifeng Central Hospital from September 2021 to September 2023.The prognosis of the patients was evaluated according to the modified Rankin Scale(mRS)score at 30 days after neurological treatment,and the patients were divided into good prognosis group(n=135)and poor prognosis group(n=165).The patients were further divided into the subgroups based on the site of cerebral hemorrhage,and the relationship between the site of hemorrhage and clinical prognosis in supratentorial deep sICH patients was observed.Receiver operating characteristic(ROC)curve was drawn to determine the optimal critical value for predicting clinical adverse outcomes of different supratentorial deep bleeding sites.The prediction performance was verified by 10-fold cross-validation method.The optimal critical value of bleeding volume was used to verify its relationship with the prognosis.Results Logistic regression analysis indicated the location of sICH was associated with the prognosis of patients with supratentorial deep sICH(P<0.05).ROC analysis showed that the sensitivity and specificity of predicting poor prognosis were higher when the basal ganglia hemorrhage volume was 18.5 mL and the thalamus hemorrhage volume was 8.5 mL.The average AUC of 10-fold cross-validation of hemorrhage volume in different sICH sites of the supratentorial deep region were 0.872 and 0.885,respectively,which further confirmed that the robustness of hemorrhage volume prediction was good.According to the critical value of bleeding volume,bleeding volume was divided into high bleeding volume and low bleeding volume.Logistic regression analysis showed that regardless of adjusting for related confounding factors,the critical values of bleeding volume in different sites were still related to the prognosis of patients with supratentorial deep sICH(P<0.05).Conclusions There is a certain relationship between the location of bleeding and clinical prognosis in the patients with supratentorial deep sICH.The article provided the references for the evaluation of clinical prognosis,active intervention,and precise treatment by analyzing the bleeding volume of basal ganglia at different sites.