Predictive value of CT mixed sign, island sign combined with NPR for the hematoma enlargement of spontaneous basal ganglia hemorrhage
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摘要:
目的 分析CT混合征、岛征结合中性粒细胞与血小板比值（NPR）对自发性基底节脑出血（sBGICH）血肿增大的预测价值。 方法 回顾性分析本院急诊科及神经外科2020年2月~2022年11月收治的200例sBGICH患者的资料。根据其发病24 h内出血是否血肿增大，将患者分为出血血肿增大组（n=43）和出血无血肿增大组（n=157）。比较两组的CT混合征、岛征、卫星征、漩涡征、黑洞征、NPR和预后评分。 结果 两组的性别、年龄、发病时间、CT漩涡征、破入脑室的差异均无统计学意义(P > 0.05)；出血血肿增大组的CT混合征、岛征、卫星征、黑洞征和NPR均高于出血无血肿增大组，预后评分低于出血无血肿增大组(P < 0.05)。经多因素Logistic回归性分析，CT混合征、岛征、卫星征、黑洞征、NPR > 5均是sBGICH发病24 h内出血血肿增大的危险因素(P < 0.05)。以sBGICH发病24 h内是否出血血肿增大进行分组，绘制ROC曲线，CT混合征、岛征、卫星征、黑洞征、NPR联合诊断预测的AUC为0.873，敏感度、特异性分别为72.30%、91.50%。 结论 CT混合征、岛征等结合NPR对sBGICH血肿增大有较高的预测价值，可根据临床实际情况灵活运用。 -
关键词:
- 混合征 /
- 岛征 /
- 中性粒细胞与血小板比值 /
- 自发性基底节脑出血 /
- 血肿增大
Abstract:Objective To analyze the predictive value of CT mixed sign, island sign combined with neutrophil to platelet ratio (NPR) for the hematoma enlargement of spontaneous basal ganglia hemorrhage (sBGICH). Methods We retrospectively reviewed the data of 200 patients with sBGICH admitted to the Department of Emergency and Department of Neurosurgery of our hospital from February 2020 to November 2022. The patients were grouped as bleeding hematoma enlargement group (n=43) and no bleeding hematoma enlargement group (n=157) according to whether the bleeding had enlarged within 24 hours of onset. The CT mixed sign, island sign, satellite sign, swirl sign, black hole sign, NPR and prognosis scores were compared between the two groups. Results There were no statistically significant differences in gender, age, onset time, CT swirl sign, and intraventricular rupture between the two groups (P > 0.05). The CT mixed sign, island sign, satellite sign, black hole sign, and NPR were significantly higher in the bleeding hematoma enlargement group than in the no bleeding hematoma enlargement group, while the prognosis score was significantly lower (P < 0.05). Multivariate logistic regression analysis showed that CT mixed sign, island sign, satellite sign, black hole sign, and NPR > 5 were risk factors for bleeding hematoma enlargement within 24 hours of sBGICH onset (P < 0.05). The ROC curve was drawn according to whether bleeding hematoma enlargement occurred within 24 h of sBGICH onset, and the area under the curve of the joint diagnosis and prediction of CT mixed sign, island sign, satellite sign, black hole sign and NPR was 0.873, with a sensitivity and specificity of 72.30% and 91.50%, respectively. Conclusion CT mixed sign, island sign combined with NPR have a high predictive value for the hematoma enlargement of sBGICH and it can be flexibly used according to the actual clinical situation. -
图 1 脑出血血肿增大各类CT影像
Figure 1. Various CT images with enlarged hematoma of cerebral hemorrhage.
A: CT mixed sign; B: CT island sign/black hole sign/CT swirl sign; C: CT island sign/CT swirl sign; D: CT mixed sign; E: CT satellite sign; F: CT swirl sign.
图 2 CT征象与NPR预测sBGICH发病24 h内出血血肿增大的ROC曲线
Figure 2. ROC curve of CT signs and NPR prediction of hematoma enlargement within 24 h of onset of sBGICH.
表 1 两组临床资料比较
Table 1. Comparison of general data between the two groups (n)
Index HE group (n=43) Non-HE group (n=157) t/χ2 P Gender 0.021 0.884 Male 26 93 Female 17 64 Age (years, Mean±SD) 56.29±5.94 57.53±6.81 1.086 0.279 Onset time (h, Mean±SD) 3.22±0.65 3.31±0.58 0.878 0.381 Mixed sign 27.692 < 0.001 Yes 17 12 No 26 145 Island sign 18.887 < 0.001 Yes 13 10 No 30 147 Satellite sign 16.477 < 0.001 Yes 11 8 No 32 149 Swirl sign 2.928 0.087 Yes 7 12 No 36 145 Black hole sign 21.923 < 0.001 Yes 14 10 No 29 147 Break into encephalocoele 2.370 0.124 Yes 5 8 No 38 149 NPR (Mean±SD) 5.68±1.07 4.89±0.87 5.010 < 0.001 Prognostic score (point, Mean±SD) 2.74±0.55 3.85±0.63 10.505 < 0.001 NPR: Neutrophil-to-platelets ratio; HE: Hematoma enlargement. 
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表 2 变量赋值表
Table 2. Variable assignment table
Variable Assignment Mixed sign 0：No；1：Yes Island sign 0：No；1：Yes Satellite sign 0：No；1：Yes Black hole sign 0：No；1：Yes NPR 0：≤5；1： > 5
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表 3 sBGICH发病24 h内出血血肿增大的多因素Logistic回归性分析
Table 3. Logistic regression analysis of the increase of haemorrhagic hematoma within 24 hours after the onset of sBGICH
Factor β SE Wald χ2 OR P 95% CI Mixed sign 2.131 0.533 7.501 8.420 < 0.001 3.124-17.274 Island sign 1.463 0.464 6.795 4.321 0.001 1.772-12.913 Satellite sign 1.296 0.619 3.382 3.655 0.026 1.154-8.322 Black hole sign 1.599 0.509 6.172 4.947 0.021 1.189-10.744 NPR > 5 1.479 0.256 22.568 4.389 < 0.001 2.681-27.321
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表 4 各指标敏感度、特异性及AUC
Table 4. Sensitivity, specificity and AUC of each index.
Index Sensitivity(%) Specificity(%) AUC AUC 95% CI Mixed sign 34.90 89.70 0.632 0.559-0.688 Island sign 39.80 86.30 0.630 0.566-0.695 Satellite sign 18.10 92.30 0.552 0.485-0.619 Black hole sign 27.70 81.50 0.596 0.530-0.661 NPR 73.50 70.10 0.784 0.730-0.837 Combined index 72.30 91.50 0.873 0.832-0.914
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