不同部位脑出血血肿容积的影响因素分析

doi:10.16138/j.1673-6087.2021.05.009

摘要/Abstract

摘要：

目的：分析不同部位脑出血血肿容积与相关危险因素的关系。方法：收集2013至2017年间我院收治的373例脑出血患者的临床资料,按出血部位分为基底节区出血组和脑叶出血组,对临床资料进行回顾性分析研究。结果：基底节区出血组入院时平均收缩压（P=0.034）及舒张压（P=0.001）、血尿酸（P=0.001）较脑叶出血组高,且既往有高血压病史者比例更高（P<0.001）,既往有饮酒史者比例更高（P=0.034）。脑叶出血组平均年龄（P<0.001）、血纤维蛋白降解产物（fibrin degradation product, FDP）（P=0.001）、血D-二聚体（P=0.003）、血肿容积（P<0.001）较基底节区出血更高,且既往有脑出血史比例更高（P=0.02）。二元Logistics回归分析发现,年龄每增加1岁,发生脑叶出血的风险增加4.9%（P<0.001）,既往有脑出血病史患者再发脑叶出血的风险是再发基底节区出血风险的3.08倍（P=0.025）,既往有高血压病史的脑出血患者再发脑叶出血的风险是再发基底节出血的0.477倍（P=0.031）。对2组脑出血血肿容积分别进行多重线性回归分析,结果提示年龄（β=-1.04,P=0.002）、国际标准化比值（international normalized ratio,INR）（β=14.219,P=0.008）、血尿酸（β=-0.008,P=0.046）、血高密度脂蛋白胆固醇（β=5.393,P=0.003）及既往有无抗血小板服药史（β=4.706,P=0.002）是基底节区脑出血血肿容积的预测因素;血尿酸（β=-0.041,P=0.015）、饮酒史（β=-15.189,P=0.010）、吸烟史（β=12.579,P=0.005）、既往缺血性卒中史（β=12.899,P=0.031）是脑叶出血血肿容积的预测因素。结论：基底节出血与脑叶出血的发生危险因素存在差异,2组脑出血血肿容积的预测因素仅部分重叠,提示不同部位脑出血病理生理学机制不同,导致不同部位的血肿容积不同。

关键词: 脑出血, 危险因素, 血肿容积

Abstract:

Objective To analyze risk factors of hematoma volume of cerebral hemorrhage in different location. Methods A total of 373 patients with cerebral hemorrhage from 2013 to 2017 years in our hospital were enrolled. According to the hemorrhage location, the patients were divided into basal ganglia hemorrhage group and lobar hemorrhage group, and the clinical data were analyzed retrospectively. Results Compared with lobar hemorrhage group, the average systolic blood pressure (P=0.034) and diastolic blood pressure (P=0.001), the content of serum uric acid (P=0.001) were higher in basal ganglia hemorrhage group, in which the patient had a higher proportion of the history of hypertension (P<0.001) and alcohol drinking (P=0.034). The average age (P<0.001), the levels of fibrin degradation product(FDP)(P=0.001) and D-dimers (P=0.003), the hematoma volume(P<0.001) in lobar hemorrhage group were higher than ganglia hemorrhage group, and the patients in lobar group had a higher proportion of the history of cerebral hemorrhage (P=0.02). Binary Logistics regression analysis showed that the risk of lobar hemorrhage increased 5.7%(P<0.001) when age increased one additional year. The risk of recurrent lobar hemorrhage was 3.27 times than that of basal ganglia hemorrhage (P=0.025) as the patients had a history of cerebral hemorrhage, and the risk of recurrent lobar hemorrhage was 0.477 times (P=0.031) than that of basal ganglia hemorrhage as the patients had a history of hypertension. Using multivariable linear regression to analyze hematoma volume change, we found that age （β=-1.04, P=0.002）, international normalized ratio(INR)（β=14.219, P=0.008）, the content of uric acid （β=-0.008, P=0.046）, high density lipoprotein cholesterol (β=5.393, P=0.003), antiplatelet therapy (β=4.706, P=0.002) were independent predictive factors of basal ganglia cerebral hemorrhage. While the content of uric acid (β=-0.041, P=0.015), prior drinking history (β=-15.189, P=0.010), prior smoking history (β=12.579, P=0.005) and history of ischemic stroke (β=12.899, P=0.031) were independent predictive factors of lobar hemorrhage. Conclusions The risk factors of basal ganglia and lobar hematoma volume were different, and their independent predictive factors of hematoma volume were only partially overlapped. It suggests that the pathophysiological mechanisms determining the hematoma volume are not same in different locations.

Key words: Cerebral hemorrhage, Risk factors, Haematoma volume

中图分类号:

R743.34

邓伟平, 杨钊, 刘建荣. 不同部位脑出血血肿容积的影响因素分析[J]. 内科理论与实践, 2021, 16(05): 331-336.

DENG Weiping, YANG Zhao, LIU Jianrong. Risk factor analysis of hematoma volume of cerebral hemorrhage in different location[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(05): 331-336.

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项目	基底节区出血组（n=242）	脑叶出血组（n=131）	P
男性[n/（%）]	168（69.4）	84（64.1）	0.297
年龄（岁）	65.25±13.26	71.37±12.82	<0.001
有高血压病史[n/（%）]	178（73.6）	66（50.4）	<0.001
收缩压(mmHg)	157.59±20.47	152.19±24.75	0.034
舒张压(mmHg)	87.87±13.42	82.70±14.55	0.001
BMI（kg/m²）	24.79±4.02	24.17±5.21	0.201
HbA_1c(%)	5.97±1.11	5.84±0.95	0.272
PT（s)	11.74±6.56	12.06±19.35	0.589
APTT（s）	28.81±3.64	29.51±4.50	0.110
FDP（mg/L）	5.78±10.78	12.00±19.35	0.001
Fg(g/L)	3.11±0.85	3.23±0.92	0.212
TT(s)	18.43±1.85	18.38±1.81	0.834
INR	1.04±1.18	1.02±0.19	0.864
D-二聚体（mg/L）	1.47±3.64	3.66±7.60	0.003
尿酸(mmol/L)	274.86±101.38	239.43±94.71	0.001
TG(mmol/L)	1.86±1.09	1.74±1.21	0.354
TC(mmol/L)	4.82±1.07	4.65±0.91	0.108
LDL-C(mmol/L)	2.95±0.91	2.84±0.73	0.219
HDL-C(mmol/L)	1.17±0.35	1.19±0.37	0.540
Hcy(μmol/L)	14.62±8.05	14.83±12.47	0.859
ApoE(g/L)	4.26±1.23	4.38±1.52	0.440
HV(mL)	6.03±4.89	16.44±13.66	<0.001
有吸烟史[n/（%）]	70（28.9）	35（26.7）	0.651
有饮酒史[n/（%）]	44（18.2）	13（9.9）	0.034
有糖尿病史[n/（%）]	48（19.8）	22（16.8）	0.473
有脑出血病史[n/（%）]	17（7.0）	19（14.5）	0.020
有缺血性卒中史[n/（%）]	42（17.4）	16（12.2）	0.191
有抗血小板服药史[n/（%）]	36（14.9）	19（14.5）	0.923

项目	OR	95% CI	P
年龄	1.049	1.02~1.078	<0.001
高血压病史	0.477	0.243~0.933	0.031
收缩压	0.989	0.972~1.007	0.242
舒张压	0.998	0.968~1.028	0.875
BMI	1.01	0.947~1.077	0.758
HbA_1c	0.828	0.596~1.151	0.263
尿酸	1.001	0.998~1.004	0.509
HV	1.159	1.108~1.211	<0.001
性别	1.205	0.589~2.467	0.61
饮酒史	0.871	0.325~2.332	0.783
吸烟史	0.848	0.384~1.875	0.684
糖尿病史	0.751	0.31~1.824	0.528
脑出血病史	3.083	1.123~8.461	0.029
TG	1.009	0.74~1.377	0.952
TC	0.671	0.288~1.561	0.354
LDL-C	1.552	0.602~4.002	0.363
HDL-C	0.845	0.303~2.355	0.747
PT	1.005	0.955~1.057	0.859
APTT	1.018	0.932~1.111	0.691
FDP	1.012	0.993~1.031	0.21
FIB	0.838	0.581~1.209	0.344
TT	0.991	0.824~1.192	0.926
INR	0.857	0.544~1.35	0.857

项目	β	95%CI	P
年龄	-1.04	-1.70~-0.39	0.002
收缩压	0.02	-0.025~0.066	0.383
舒张压	0.003	-0.070~0.075	0.941
BMI	0.147	-0.026~0.319	0.095
HbA_1c	0.079	-0.680~0.838	0.837
PT	-0.005	-0.260~0.326	0.917
APTT	0.033	-0.260~0.326	0.825
FDP	0.062	-0.084~0.207	0.402
Fg	0.277	-0.637~1.192	0.550
TT	0.266	-0.220~0.753	0.282
INR	14.219	3.693~24.745	0.008
D-二聚体	-0.129	-0.542~0.285	0.540
尿酸	-0.008	-0.015~0.000	0.046
TG	0.97	0.002~1.938	0.050
TC	-1.608	-4.415~1.199	0.260
LDL-C	2.267	-0.717~5.252	0.136
HDL-C	5.393	1.817~8.969	0.003
Hcy	-0.034	-0.121~0.054	0.448
ApoE	-0.355	-1.044~0.335	0.311
性别	0.341	-1.486~2.168	0.713
饮酒史	0.341	-1.763~2.445	0.749
吸烟史	0.788	-1.041~2.617	0.396
糖尿病史	0.308	-1.714~2.331	0.764
脑出血病史	-0.194	-3.234~2.846	0.900
缺血性卒中史	-1.274	-4.045~1.496	0.365
抗血小板服药史	4.706	1.700~7.713	0.002

项目	β	95%CI	P
年龄	-0.052	-0.308~0.204	0.687
收缩压	0.021	-0.142~0.185	0.794
舒张压	0.015	-0.258~0.288	0.914
BMI	-0.139	-0.667~0.388	0.600
HbA_1c	3.254	-0.318~6.825	0.074
PT	-7.304	-51.033~36.425	0.740
APTT	0.094	-1.046~1.234	0.870
FDP	0.455	-0.323~1.232	0.248
Fg	2.593	-1.070~6.256	0.162
TT	-1.249	-3.258~0.760	0.219
INR	97.981	-440.335~636.297	0.718
D-二聚体	-1.217	-3.072~0.639	0.195
尿酸	-0.041	-0.073~-0.008	0.015
TG	3.155	-0.614~6.924	0.099
TC	1.554	-6.108~9.216	0.687
LDL-C	-0.384	-8.388~7.619	0.924
HDL-C	1.389	-10.166~12.943	0.811
Hcy	-0.007	-0.227~0.214	0.951
ApoE	-1.403	-3.787~0.981	0.245
性别	0.705	-5.716~7.127	0.827
饮酒史	-15.189	-26.654~-3.724	0.010
吸烟史	12.579	3.923~21.236	0.005
糖尿病	-1.292	-10.930~8.347	0.790
脑出血病史	1.151	-7.123~9.426	0.782
缺血性卒中	12.899	1.190~24.607	0.031
抗血小板服药史	-7.092	-16.864~2.681	0.152