脑出血指数对急性脑出血病人预后评估的临床价值

摘要

目的：探讨脑出血指数(ICHI)的临床应用价值。方法收集太原市中心医院神经内科2007年1月—2011年12月住院的急性脑出血病人780例,分为脑出血存活组(590例)和脑出血死亡组(190例；院内死亡)。记录入选病人的临床基本资料,包括年龄、性别、血压、血糖、丙氨酸氨基转移酶(ALT)、高密度脂蛋白胆固醇、血细胞分析及格拉斯哥昏迷(GCS)评分等。分析各指标对脑出血预后的测评价值,评估各指标对脑出血住院死亡率的影响。结果两组病人性别比较,差异无统计学意义(P>0.05)；两组病人血压、血糖、ALT、高密度脂蛋白胆固醇、白细胞计数等比较,差异有统计学意义(P<0.05)。建立脑出血指数(ICHI)公式[ICHI=年龄(岁)/10+血清葡萄糖(mmol/L)+白细胞计数(109/L)-GCS评分]。绘制受试者工作特征(ROC)曲线,评估 ICHI的预测价值。结果显示 ROC曲线面积(AURC)为0.797(95%可信区间为：0.762~0.832,P<0.001)。ICHI对死亡率的最适值为18；对死亡率敏感性、特异性及约登指数(Youden’s index)分别为0.637,0.800和0.437。与总体死亡率(24.39%)比较,1827(死亡率62.86%)时住院死亡率明显增加。结论随着年龄增大,体内各种应激反应加重及危险评分偏高,脑出血病人预后较差,ICHI作为一个简单预测模型,可用于脑出血病人的预后评估。%Objective To investigate the clinical value of intracerebral hemorrhage(ICH)index (ICHI)on the prognosis of acute cere-bral hemorrhage.Methods We col ected a total of 780 in patients with acute cerebral hemorrhage from 2007 January to 2011 De-cember in Taiyuan City Central Hospital and divided these patients into survival group (n=590)and death group (n=190,in hos-pital mortality).Basic clinical data of these patients were recorded in,including age,gender,blood pressure (BP), serum glucose (Glu), alanine aminstransferase (ALT), high density lipoprotein cholesterol (HDL), blood cel analysis, and Glasgow coma scale (GCS) scores etc.We analyzed the evaluation value of each index on the prognosis of cerebral hemorrhage,and evaluated the contribution of each index on hospital mortality of cerebral hemorrhage.Results There was significant differences in BP,Glu,ALT,HDL,white blood cel (WBC)and other basic data between two groups(P<0.05).Then we established the ICHI formula [ICHI= age (years)/10 +Glu (mmol/L)+WBC count (109/L) GCS scores].We draw the receiver operating characteristic (ROC)curve,to assess the predic-tive value of ICHI.Results showed that the ROC area under the curve (AURC )was 0.797 (95% confidence interval:0.762 to 0.832,P<0.001).The optimum ICHI value on mortality was 18,and the sensitivity on mortality,the specificity on mortality,and the Youden index (Youden’s index)respectively are 0.637,0.800 and 0.437.And when ICHI 18 to 27 (45.56% mortality)and ICHI more than 27 (mortality 62.86%),the hospitalization mortality increased obviously when compared to the overal mortality rate (24.39%). Conclusion The prognosis of patients with cerebral hemorrhage came to worse with the enhancement of emergency responses and high risk scores.ICHI is a simple prediction model which can be used for the evaluation of the prognosis in patients with cerebral hem-orrhage.