Scale for predicting early hematoma expansion in intracerebral hemorrhage based on CT-specific signs
-
摘要:
目的 探讨可能引发高血压脑出血早期血肿扩大的多种危险因素，建立脑出血早期血肿扩大的预测量表。 方法 回顾性分析107例自发性高血压脑出血患者的临床资料，采用单因素分析以及多元Logistic回归分析多种危险因素与早期血肿增大之间的关系。 结果 经单因素分析和多元Logistic回归分析显示，服用抗凝或抗血小板药物、急性期收缩压、发病到第一次CT时间、脑出血病史、第一次CT血肿量、CT特异征象6项指标具有统计学意义（P < 0.05），根据以上数据建立评分表，其中评分≥16分为极高风险组，11~15分为高危组，6~10分为中危组，≤5分为低危组。 结论 该预测量表可较准确地预测脑出血早期血肿是否扩大，可作为正确制定临床治疗方案的可靠参考依据。 Abstract:Objective To explore multiple risk factors which may trigger early hematoma expansion and to establish a predictive scale of early hematoma expansion for intracerebral hemorrhage. Methods The clinical data of 107 patients with spontaneous cerebral hemorrhage were analyzed retrospectively. The relationship between multiple risk factors and early haematoma enlargement was analysed by univariate analysis and multivariate logistic regression. Results Univariate analysis and multiple Logistic regression analysis showed that six indicators were statistically significant (P < 0.05): use of anticoagulant or antiplatelet drugs, baseline intracerebral hemorrhage volume, time to initial CT, acute blood pressure, CT special signs, recurrent intracerebral hemorrhage were independent risk factors for early hematoma expansion (P < 0.05). According to the above data, a scoring table was established, in which scores ≥16 points at extremely high- risk group, 11-15 at high-risk group, 6-10 at medium risk group and ≤5 at low-risk group. Conclusion The prediction scale can accurately predict the enlargement of haematoma in the early stage of intracerebral hemorrhage, which is independent of other clinical and imaging predictors, and can be used as a reliable reference basis for correct clinical treatment plan. -
Key words:
- cerebral hemorrhage /
- early hematoma enlargement /
- predictive score /
- CT special signs
-
表 1 入组患者基本数据统计
Table 1. Characteristics of Included patients [n (%)]
变量 总人数（n=107） 无血肿扩大（n=57） 血肿扩大（n=50） 年龄(岁, Mean±SD) 63.8±14.7 62.7±15.0 65.1±14.3 高龄 69(64.0) 35(61.4) 34（68.0） 女性 45(42.0) 22(38.6) 23（46.0） 患有糖尿病 12(11.2) 10（17.5） 2（4.0） 患有高血压 77(72.0) 40（70.1） 37（74.0） 服用抗凝药 6(5.6) 2（3.5） 4（8.0） 出、凝血指标化验异常 27(25.2) 16（28.1） 11（22.0） 合并肝硬化、肾透析、血液系统疾病等 22(20.5) 9（15.8） 13（26.0） 急性期收缩压（mmHg） ≤160 40(37.4) 21（36.8） 19（38.0） 160~200 44(41.1) 24（42.1） 20（40.0） > 200 19(17.8) 12（21.1） 7（14.0） 发病至第一次CT的时间（min） ≤60 24(22.4) 11（19.3） 13(26.0) 61~120 30(28.0) 13（22.8） 17(34.0) 121~180 27(25.2) 12（21.1） 15(30.0) 181~240 4(3.7) 3（5.3） 1(2.0) 241~300 5(4.6) 4（7.0） 1(2.0) > 300 17(15.9) 14（24.6） 3(6.0) 第一次CT时的血肿体积（mL） ≤10 55(51.4) 37（64.9） 18(36.0) 10~20 25(23.4) 10（17.5） 15(30.0) > 20 26(24.3) 10（17.5） 16(32.0) CT特异征象 29(27.1) 5（8.8） 24(48.0) 
下载: 导出CSV
表 2 单因素非条件Logistic回归分析结果
Table 2. Univariate Logistic regression analysis
危险因素 回归系数 标准误 Wald 相对危险度 95% CI P 年龄 -0.132 0.231 0.421 0.984 0.326~1.856 0.852 高龄(> 60岁) -0.325 0.126 0.532 1.253 0.425~0.736 0.120 性别 -0.523 0.235 0.456 0.865 0.457~1.924 0.954 糖尿病史 0.487 0.368 1.587 1.436 0.526~0.864 0.152 高血压史 0.561 0.223 1.214 1.312 0.532~1.617 0.148 服用抗凝药 2.256 0.363 27.326 5.523 0.053~0.361 < 0.001 出、凝血指标异常 1.624 0.253 6.258 3.239 0.138~0.524 0.032 合并肝硬化、肾透析、血液系统疾病等 1.848 0.364 6.932 3.985 0.089~0.476 0.013 急性期收缩压（mmHg） -1.968 0.297 8.398 4.856 0.069~0.453 0.009 发病至第一次CT的时间（min） 1.942 0.213 4.258 4.793 0.082~0.345 0.006 第一次CT时的血肿体积（mL） 2.489 0.446 24.328 1.652 0.064~0.267 < 0.001 CT特异征象 -1.653 0.685 18.392 6.592 0.047~0.369 < 0.001
下载: 导出CSV
表 3 多因素非条件Logistic回归分析结果
Table 3. Multivariable Logistic regression analysis
危险因素 95% CI P 从发病到第一次CT时间（h） < 1 2.63(1.68~6.45) < 0.001 1~2 2.54(1.43~4.27) 0.003 2~3 2.06(1.76~3.12) 0.012 3~4 1.55(1.24~2.36) 0.036 4~5 1.23(0.98~1.98) 0.045 > 5 1 1 抗凝或抗血小板药物应用 抗凝药物（华法令、利伐他班） 3.38(2.18~5.96) < 0.001 抗血小板药物（阿斯匹林、氯吡格雷） 2.52(1.67~4.34) 0.002 无 1 1 CT特异征象（岛征、混合征、漩涡征、黑洞征） 两个以上特异征象 2.46(1.34~3.15) 0.002 一个特异征象 1.95(1.32~2.97) 0.027 无 1 1 初次CT血肿量（mL） ≥20 2.24(1.56~3.27) 0.003 10~20 1.86(1.43~2.21) 0.024 ≤10 1 1 脑出血病史 2.09(1.18~2.77) 0.005 入院时血压（mmHg） ≥200 2.69(1.79~3.45) 0.002 160~200 1.77(1.35~2.47) 0.024 ≤160 1 1
下载: 导出CSV
表 4 高血压脑出血早期血肿扩大的预测量表
Table 4. Predictive scale of early hematoma expansion for intracerebral hemorrhage
危险因素 分值（分） 从发病到第一次CT时间（h） < 1 5 1~2 4 2~3 3 3~4 2 4~5 1 > 5 0 抗凝或抗血小板药物应用 抗凝药物（华法令、利伐他班） 6 抗血小板药物（阿斯匹林、氯吡格雷） 4 无 0 CT特异征象（岛征、混合征、漩涡征、黑洞征） 两个以上特异征象 4 一个特异征象 2 无 0 初次CT血肿量（mL） ≥20 5 10~20 3 ≤10 0 脑出血病史 有 4 无 0 入院时血压（mmHg） ≥200 4 160~200 2 ≤160 0 合计 0~28
下载: 导出CSV
表 5 不同风险组血肿扩大结果分析
Table 5. Analysis of different risk groups
组别 总人数 血肿扩大人数 比率（%） 低风险组（0~5） 36 6 16.6 中风险组（6~10）* 40 21 52.5 高风险组（11~15）* 26 19 73.1 极高风险组（16以上）* 5 4 80.0 合计 107 50 46.7 *INR > 1.5时风险级别上升一级.
下载: 导出CSV
-
[1] Ziai WC, Carhuapoma JR. Intracerebral hemorrhage[J]. Continuum (Minneap Minn), 2018, 24(6): 1603-22. [2] Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage[J]. N Engl J Med, 2001, 344(19): 1450-60. doi: 10.1056/NEJM200105103441907 [3] Kannel WB, Wolf PA, Verter J, et al. Epidemiologic assessment of the role of blood pressure in stroke. The Framingham study[J]. JAMA, 1970, 214(2): 301-10. doi: 10.1001/jama.1970.03180020021004 [4] Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the american heart association/american stroke association stroke council, high blood pressure research council, and the quality of care and outcomes in research interdisciplinary working group[J]. Stroke, 2007, 38(6): 2001-23. doi: 10.1161/STROKEAHA.107.183689 [5] Hong KS, Bang OY, Kang DW, et al. Stroke statistics in Korea: part Ⅰ. Epidemiology and risk factors: a report from the Korean stroke society and clinical research center for stroke[J]. J Stroke, 2013, 15 (1): 2-20. doi: 10.5853/jos.2013.15.1.2 [6] Toyoda K. Epidemiology and registry studies of stroke in Japan[J]. J Stroke, 2013, 15(1): 21-6. doi: 10.5853/jos.2013.15.1.21 [7] Delcourt C, Huang Y, ARIMA H, et al. Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study[J]. Neurology, 2012, 79(4): 314-9. doi: 10.1212/WNL.0b013e318260cbba [8] Chen S, Zhao BJ, Wang W, et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J]. Oncotarget, 2017, 8 (51): 89348-63. doi: 10.18632/oncotarget.19366 [9] Cheung RTF, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage[J]. Stroke, 2003, 34(7): 1717-22. doi: 10.1161/01.STR.0000078657.22835.B9 [10] Huynh TJ, Aviv RI, Dowlatshahi D, et al. Validation of the 9-point and 24- point hematoma expansion prediction scores and derivation of the PREDICT A/B scores[J]. Stroke, 2015, 46(11): 3105-10. doi: 10.1161/STROKEAHA.115.009893 [11] Brouwers HB, Chang Y, Falcone GJ, et al. Predicting hematoma expansion after primary intracerebral hemorrhage[J]. JAMA Neurol, 2014, 71(2): 158-64. doi: 10.1001/jamaneurol.2013.5433 [12] Wang X, ARIMA H, Al-Shahi Salman R, et al. Clinical prediction algorithm (BRAIN) to determine risk of hematoma growth in acute intracerebral hemorrhage[J]. Stroke, 2015, 46(2): 376-81. doi: 10.1161/STROKEAHA.114.006910 [13] Brouwers HB, Goldstein JN, Romero JM, et al. Clinical applications of the computed tomography angiography spot sign in acute intracerebral hemorrhage: a review[J]. Stroke, 2012, 43(12): 3427-32. doi: 10.1161/STROKEAHA.112.664003 [14] Magaki SD, Williams CK, Vinters HV. Glial function (and dysfunction) in the normal & ischemic brain[J]. Neuropharmacology, 2018, 134(Pt B): 218-25. [15] Li Q, Liu QJ, Yang WS, et al. Island sign: an imaging predictor for early hematoma expansion and poor outcome in patients with intracerebral hemorrhage[J]. Stroke, 2017, 48(11): 3019-25. doi: 10.1161/STROKEAHA.117.017985 [16] Boulouis G, Morotti A, Brouwers HB, et al. Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage[J]. JAMA Neurol, 2016, 73(8): 961-8. doi: 10.1001/jamaneurol.2016.1218 [17] Morotti A, Boulouis G, Dowlatshahi D, et al. Standards for detecting, interpreting, and reporting noncontrast computed tomographic markers of intracerebral hemorrhage expansion[J]. Ann Neurol, 2019, 86(4): 480-92. doi: 10.1002/ana.25563 [18] Kong XY, Qian W, Dong J, et al. Proposal of a prediction score for hematoma expansion after intracerebral hemorrhage[J]. Med Intensiva (Engl Ed), 2021, 45(3): 147-55. doi: 10.1016/j.medin.2019.08.004 [19] Al-Khaled M, Awwad S, Brüning T. Nontraumatic spontaneous intracerebral hemorrhage: baseline characteristics and early outcomes[J]. Brain Behav, 2020, 10(1): e01512. [20] Yu ZY, Zheng J, Guo R, et al. Performance of blend sign in predicting hematoma expansion in intracerebral hemorrhage: a meta-analysis[J]. Clin Neurol Neurosurg, 2017, 163: 84-9. doi: 10.1016/j.clineuro.2017.10.017 [21] Zheng J, Yu ZY, Guo R, et al. Meta-analysis of predictive significance of the black hole sign for hematoma expansion in intracerebral hemorrhage[J]. World Neurosurg, 2018, 115: e711-e716. doi: 10.1016/j.wneu.2018.04.140 [22] Law ZK, Ali A, Krishnan K, et al. Noncontrast computed tomo-graphy signs as predictors of hematoma expansion, clinical outcome, and response to tranexamic acid in acute intracerebral hemorrhage[J]. Stroke, 2020, 51(1): 121-8. doi: 10.1161/STROKEAHA.119.026128 [23] Li Q, Zhang G, Xiong X, et al. Black hole sign: novel imaging marker that predicts hematoma growth in patients with intracerebral hemorrhage[J]. Stroke, 2016, 47(7): 1777-81. doi: 10.1161/STROKEAHA.116.013186 [24] Xiong X, Li Q, Yang WS, et al. Comparison of swirl sign and black hole sign in predicting early hematoma growth in patients with spontaneous intracerebral hemorrhage[J]. Med Sci Monit, 2018, 24: 567-73. doi: 10.12659/MSM.906708 [25] Anderson CS, Huang YN, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial[J]. Lancet Neurol, 2008, 7(5): 391-9. doi: 10.1016/S1474-4422(08)70069-3 [26] Qureshi AI, Majidi S, Gilani WI, et al. Increased brain volume among good grade patients with intracerebral hemorrhage. Results from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) study[J]. Neurocrit Care, 2014, 20(3): 470-5. doi: 10.1007/s12028-013-9842-1 [27] Anderson CS, Heeley E, Huang YN, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage[J]. N Engl J Med, 2013, 368(25): 2355-65. doi: 10.1056/NEJMoa1214609 [28] Leasure AC, Qureshi AI, Murthy SB, et al. Association of intensive blood pressure reduction with risk of hematoma expansion in patients with deep intracerebral hemorrhage[J]. JAMA Neurol, 2019, 76(8): 949-55. doi: 10.1001/jamaneurol.2019.1141 [29] Flaherty ML, Woo D, Haverbusch M, et al. Potential applicability of recombinant factor Ⅶa for intracerebral hemorrhage[J]. Stroke, 2005, 36(12): 2660-4. doi: 10.1161/01.STR.0000189634.08400.82 [30] Eikelboom J, Merli G. Bleeding with direct oral anticoagulants vs warfarin: clinical experience[J]. Am J Emerg Med, 2016, 34(11S): 3-8. [31] Huynh TJ, Aviv RI, Dowlatshahi D, et al. Validation of the 9-point and 24-point hematoma expansion prediction scores and derivation of the PREDICT A/B scores[J]. Stroke, 2015, 46(11): 3105-10. doi: 10.1161/STROKEAHA.115.009893 [32] Fujii Y, Takeuchi S, Tanaka R, et al. Liver dysfunction in spontaneous intracerebral hemorrhage[J]. Neurosurgery, 1994, 35(4): 592-6. doi: 10.1227/00006123-199410000-00003 -
点击查看大图
表(5)
计量
- 文章访问数: 174
- HTML全文浏览量: 102
- PDF下载量: 13
- 被引次数: 0
