CT影像学特征及FM、FAR水平与颅脑外伤患者并发进展性出血性损伤的关系研究

A study on the relationship between CT imaging features,FM,FAR levels,and progressive hemorrhagic injury in patients with traumatic brain injury

目的探究CT影像学特征及纤维蛋白单体(FM)、纤维蛋白原-白蛋白比率(FAR)水平与颅脑外伤患者并发进展性出血性损伤(PHI)的关系。方法回顾性选取2021年6月至2023年6月康复大学青岛中心医院(青岛市中心医院)收治的106例颅脑外伤患者为研究对象,所有患者入院24 h内均行头颅CT复查,根据复查结果将35例并发PHI的颅脑外伤患者纳入进展组,71例未并发PHI患者纳入非进展组。对比两组患者临床基线资料、CT影像学特征、FM和FAR水平,采用多因素Logistic回归分析影响颅脑外伤患者发生PHI的独立危险因素。结果两组患者性别、年龄、体重指数、受伤至入院时间、饮酒史、高血压史、糖尿病史和致伤原因相比较,差异均无统计学意义(P>0.05)。进展组患者发生混杂征、岛征、颅骨骨折、硬膜外出血、硬膜内出血、脑实质内出血和蛛网膜下腔出血比例分别为25.71%、11.43%、34.29%、42.86%、51.43%、62.86%、71.43%,均高于非进展组(4.23%、1.41%、14.08%、22.54%、28.17%、36.62%、43.66%),差异均有统计学意义(P<0.05)。进展组患者FM和FAR水平分别为(182.72±45.27)mg/L、0.114±0.013,均高于非进展组[(113.77±46.73)mg/L、0.090±0.010],差异均有统计学意义(P<0.05)。经多因素Logistic回归分析,FM、FAR、混杂征、岛征、颅骨骨折、硬膜外出血、硬膜内出血、脑实质内出血和蛛网膜下腔出血均为影响颅脑外伤患者发生PHI的独立危险因素(P<0.05)。结论颅脑外伤后PHI患者CT特征明显,且FM和FAR表达水平越高,提示患者发生进展性出血风险越高。

Objective Exploring the relationship between CT imaging features,levels of fibrinogen monomer(FM),fibrinogen albumin ratio(FAR),and progressive hemorrhagic injury(PHI)in patients with traumatic brain injury.Methods A total of 106 traumatic brain injury patients admitted to Qingdao Central Hospital,University of Health and Rehabilitation Sciences(Qingdao Central Hospital)from June 2021 to June 2023 were retrospectively selected as the study subjects.All patients underwent head CT scans within 24 hours of admission.Based on the results of the scans,35 PHI patients were included in the progression group and 71 NPHI patients were included in the non progression group.The clinical baseline data,CT imaging features,FM and FAR levels between two groups of patients were compared.The independent risk factors of PHI in patients with craniocerebral trauma were analyzed by multivariate Logistic regression analysis.Results There were no statistically significant differences in gender,age,boby mass index,time from injury to hospital admission,drinking history,hypertension history,diabetes history and cause of injury between the two groups(P>0.05).The proportions of mixed signs,island signs,skull fractures,epidural hemorrhage,intradural hemorrhage,intracerebral hemorrhage,and subarachnoid hemorrhage in patients in the progression group were 25.71%,11.43%,34.29%,42.86%,51.43%,62.86%,71.43%,respectively,which were higher than those in the non progression group(4.23%,1.41%,14.08%,22.54%,28.17%,36.62%,43.66%),and the differences were statistically significant(P<0.05).The levels of FM and FAR in the progressive group were(182.72±45.27)mg/L and 0.114±0.013,respectively,which were higher than those in the non-progressive group[(113.77±46.73)mg/L,0.090±0.010],and the differences were statistically significant(P<0.05).Logistic regression analysis showed that FM,FAR,confounding sign,island sign,skull fracture,epidural hemorrhage,intradural hemorrhage,intracerebral hemorrhage,and subarachnoid hemorrhage were all independent risk factors affecting the occurrence of PHI in traumatic brain injury patients,all of which were negatively correlated with them(P<0.05).Conclusion The CT features of patients with progressive hemorrhagic injury after traumatic brain injury are obvious,and the higher the expression levels of FM and FAR,the higher the risk of progressive bleeding in patients.