青年自发性脑出血预后的相关因素分析(1)
DOI：10.3760/cma.j.issn.1671-0282.2013.09.019
作者单位：225001 江苏省扬州，苏北人民医院神经内科(陈兰兰、陈蓓蕾、张娴娴、叶青、张扬威、李晓波)；江苏省人民医院神经内科(万琪)
通信作者：李晓波，Email： lxbljy@163.com
【摘要】目的 探索青年自发性脑出血预后的相关因素及其预测价值。方法 回顾性收集2008年至2011年所有入住苏北人民医院的首次急性自发性脑出血青年患者。使用逐步logistic回归法分析30 d的死亡及预后良好(mRS评分为0～2)的因素，使用受试者工作特征曲线分析各因素的预测价值。结果 青年自发性脑出血30 d死亡的危险因素有：合并高血压病(P=0.023)或糖尿病(P=0.007)、幕下血肿(P=0.000)、血肿体积大(P=0.008)、GCS评分低(P=0.000)、外周血白细胞高(P=0.000)、血糖高(P=0.039)、凝血酶原时间长(P=0.001)。预后良好的独立因素有：年纪轻(P=0.001)、无高血压病(P=0.010)或糖尿病(P=0.028)、血肿体积小(P=0.000)、NIHSS评分低(P=0.000)、外周血白细胞低(P=0.000)、血糖低(P=0.012)、收缩压水平低(P=0.000)。其中NIHSS评分及GCS评分对预后判断具有很高的价值，收缩压、外周血白细胞及血肿体积对预后也有较好的预测作用。结论 青年自发性脑出血短期预后判断时应综合考虑各因素及其预测价值。
, http://www.100md.com
【关键词】自发性脑出血；青年；预后；病死率；预后良好
Analysis of relevant factors to the outcomes of spontaneous intracerebral hemorrhage in young adults CHEN Lan-lan*， WAN Qi， CHEN Bei-lei， ZHANG Xian-xian， YE Qing， ZHANG Yang-wei， LI Xiao-bo. *Department of Neurology， Northern Jiangsu People’s Hospital， Yangzhou 225001， China
Corresponding author：LI Xiao-bo，Email： lxbljy@163.com
【Abstract】Objective To study factors used to predict 30-day mortality and favorable outcomes to intracerebral hemorrhage (ICH) in young adult subjects and to estimate the reliability of these predictors. Methods Data of 175 acute ICH patients selected from 201 patients admitted to our hospital from 2008 to 2011 were reviewed retrospectively. Patients were assessed with Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) and routine laboratory examinations after admission. Independent predictors of 30-day mortality or good outcome (modified Rankin score， 0-2) were identified by stepwise logistic regression. Results There were 90 male and 85 female， and 142 survivals and 33 deaths. The modified Rankin score (mRS) of survival group was <6 and mRS=6 in death group， and mRS<3 in good outcome group and mRS>or=3 in poor outcome group. Independent factors for 30-day mortality were hypertension (P=0.023) or hyperglycemia (P=0.007)， infra-tentorial ICH (P=0.000)， large ICH volume (P=0.008)， low Glasgow Coma Scale (GCS) scores (P=0.000)， high white blood cell count (P=0.000)， higher blood glucose level (P=0.039) and prothrombin time (PT) (P=0.001) after admission. Independent factors for 30-day good outcome were younger age (P=0.001)， normal blood pressure (P=0.010) or absence of hyperglycemia (P=0.028)， lower NIHSS scores (P=0.000)， small ICH volume (P=0.000)， low white blood cell (WBC) count (P=0.000)， lower blood glucose level (P=0.012) or lower systolic blood pressure (SBP) level (P=0.000) at admission. The NIHSS score and GCS score were excellent predictors， while the SBP level， WBC count and ICH volume were fine predictors. Conclusions Overall prognostic factors should be integrated to get high reliabilities for predicting the outcomes of ICH in young people., 百拇医药(陈兰兰 万琪 陈蓓蕾 张娴娴 叶青 张扬威 李晓波)
作者单位：225001 江苏省扬州，苏北人民医院神经内科(陈兰兰、陈蓓蕾、张娴娴、叶青、张扬威、李晓波)；江苏省人民医院神经内科(万琪)
通信作者：李晓波，Email： lxbljy@163.com
【摘要】目的 探索青年自发性脑出血预后的相关因素及其预测价值。方法 回顾性收集2008年至2011年所有入住苏北人民医院的首次急性自发性脑出血青年患者。使用逐步logistic回归法分析30 d的死亡及预后良好(mRS评分为0～2)的因素，使用受试者工作特征曲线分析各因素的预测价值。结果 青年自发性脑出血30 d死亡的危险因素有：合并高血压病(P=0.023)或糖尿病(P=0.007)、幕下血肿(P=0.000)、血肿体积大(P=0.008)、GCS评分低(P=0.000)、外周血白细胞高(P=0.000)、血糖高(P=0.039)、凝血酶原时间长(P=0.001)。预后良好的独立因素有：年纪轻(P=0.001)、无高血压病(P=0.010)或糖尿病(P=0.028)、血肿体积小(P=0.000)、NIHSS评分低(P=0.000)、外周血白细胞低(P=0.000)、血糖低(P=0.012)、收缩压水平低(P=0.000)。其中NIHSS评分及GCS评分对预后判断具有很高的价值，收缩压、外周血白细胞及血肿体积对预后也有较好的预测作用。结论 青年自发性脑出血短期预后判断时应综合考虑各因素及其预测价值。
, http://www.100md.com
【关键词】自发性脑出血；青年；预后；病死率；预后良好
Analysis of relevant factors to the outcomes of spontaneous intracerebral hemorrhage in young adults CHEN Lan-lan*， WAN Qi， CHEN Bei-lei， ZHANG Xian-xian， YE Qing， ZHANG Yang-wei， LI Xiao-bo. *Department of Neurology， Northern Jiangsu People’s Hospital， Yangzhou 225001， China
Corresponding author：LI Xiao-bo，Email： lxbljy@163.com
【Abstract】Objective To study factors used to predict 30-day mortality and favorable outcomes to intracerebral hemorrhage (ICH) in young adult subjects and to estimate the reliability of these predictors. Methods Data of 175 acute ICH patients selected from 201 patients admitted to our hospital from 2008 to 2011 were reviewed retrospectively. Patients were assessed with Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) and routine laboratory examinations after admission. Independent predictors of 30-day mortality or good outcome (modified Rankin score， 0-2) were identified by stepwise logistic regression. Results There were 90 male and 85 female， and 142 survivals and 33 deaths. The modified Rankin score (mRS) of survival group was <6 and mRS=6 in death group， and mRS<3 in good outcome group and mRS>or=3 in poor outcome group. Independent factors for 30-day mortality were hypertension (P=0.023) or hyperglycemia (P=0.007)， infra-tentorial ICH (P=0.000)， large ICH volume (P=0.008)， low Glasgow Coma Scale (GCS) scores (P=0.000)， high white blood cell count (P=0.000)， higher blood glucose level (P=0.039) and prothrombin time (PT) (P=0.001) after admission. Independent factors for 30-day good outcome were younger age (P=0.001)， normal blood pressure (P=0.010) or absence of hyperglycemia (P=0.028)， lower NIHSS scores (P=0.000)， small ICH volume (P=0.000)， low white blood cell (WBC) count (P=0.000)， lower blood glucose level (P=0.012) or lower systolic blood pressure (SBP) level (P=0.000) at admission. The NIHSS score and GCS score were excellent predictors， while the SBP level， WBC count and ICH volume were fine predictors. Conclusions Overall prognostic factors should be integrated to get high reliabilities for predicting the outcomes of ICH in young people., 百拇医药(陈兰兰 万琪 陈蓓蕾 张娴娴 叶青 张扬威 李晓波)