摘要
目的分析影响脑出血患者继发脑水肿的危险因素并构建其列线图模型。方法回顾2022年7月至2024年6月如皋市人民医院收治的210例脑出血患者的临床资料,根据是否继发脑水肿分为脑水肿组(n=89)和非脑水肿组(n=121)。采用多因素Logistic回归分析探讨脑出血患者继发脑水肿的影响因素,并以此构建列线图模型;采用受试者工作特性(ROC)曲线评估列线图模型对脑出血患者继发脑水肿的预测价值。结果脑水肿组年龄≥60岁、入院时格拉斯哥昏迷量表(GCS)评分<9分所占比例均大于非脑水肿组,发病至入院时间长于非脑水肿组,血肿量大于非脑水肿组,白细胞计数、中性粒细胞、中性粒细胞/淋巴细胞比值(NLR)、纤维蛋白原水平高于非脑水肿组,淋巴细胞水平低于非脑水肿组(P<0.05)。多因素分析结果显示,年龄≥60岁(OR=1.891,95%CI:1.374~2.603)、入院时GCS评分低(OR=0.433,95%CI:0.298~0.631)、血肿量大(OR=2.158,95%CI:1.493~3.119)、NLR高(OR=2.575,95%CI:1.686~3.933)、纤维蛋白原水平升高(OR=2.737,95%CI:1.775~4.221)是脑出血患者继发脑水肿的独立危险因素(P<0.05)。构建预测脑出血患者继发脑水肿的列线图模型,结果显示,一致性指数(C-index)为0.869(95%CI:0.816~0.922)。列线图模型预测脑出血患者继发脑水肿的曲线下面积(AUC)(95%CI)为0.873(0.820~0.926),特异度为67.92%,灵敏度为91.85%。结论脑出血患者继发脑水肿的危险因素包括年龄、入院时GCS评分、血肿量、NLR、纤维蛋白原,据此构建的列线图模型对脑出血患者继发脑水肿具有一定的预测价值。
Objective To analyze the risk factors for secondary cerebral edema in patients with cerebral hemorrhage and to construct its nomogram model.Methods The clinical data of 210 patients with cerebral hemorrhage admitted to Rugao People's Hospital from July 2022 to June 2024 were retrospectively analyzed.The patients were divided into cerebral edema group(n=89)and non-cerebral edema group(n=121)according to the secondary cerebral edema data.The influencing factors for secondary cerebral edema in patients with cerebral hemorrhage were explored by Multivariate Logistic regression analysis,and a nomogram model was constructed.The value of the nomogram model in predicting secondary cerebral edema in patients with cerebral hemorrhage was evaluated by ROC.Results The age≥60 years and the Glasgow Coma Scale(GCS)score<9 on admission in cerebral edema group were higher than those in non-cerebral edema group,the time from onset to admission was longer than that in noncerebral edema group,the amount of hematoma was greater than that in non-cerebral edema group,and the leukocyte count,neutrophil,neutrophil/lymphocyte ratio(NLR)and fibrinogen level were higher than those in non-cerebral edema group.The lymphocyte level was lower than that in non-cerebral edema group(P<0.05).Multivariate analysis showed that age≥60 years old(OR=1.891,95%CI:1.374-2.603),low GCS score at admission(OR=0.433,95%CI:0.298-0.631),large hematoma(OR=2.158,95%CI:1.493-3.119),high NLR(OR=2.575,95%CI:1.686-3.933)and elevated fibrinogen level(OR=2.737,95%CI:1.775-4.221)were independent risk factors for secondary cerebral edema in patients with cerebral hemorrhage(P<0.05).A nomogram model was constructed to predict secondary cerebral edema in patients with cerebral hemorrhage.The results showed that the consistency index(C-index)was 0.869(95%CI:0.816-0.922).The area under the curve(AUC)(95%CI)for predicting secondary cerebral edema in patients with cerebral hemorrhage was 0.873(0.820-0.926),the specificity was 67.92%and the sensitivity was 91.85%.Conclusions The risk factors for secondary cerebral edema in patients with cerebral hemorrhage include age,GCS score at admission,hematoma volume,NLR and fibrinogen.The nomogram model based on this analysis has certain predictive value for secondary cerebral edema in patients with cerebral hemorrhage.
作者
陈云云
周祎
吴婷婷
秦丹
薛刘媛
CHEN Yunyun;Zhou Yi;WU Tingting;QIN Dan;XUE Liuyuan(Department of Neurology,Rugao People's Hospital/Rugao Hospital Affiliated to Nantong University,Rugao,Jiangsu 226500,China)
出处
《中华神经外科疾病研究杂志》
2025年第3期64-68,共5页
Chinese Journal of Neurosurgical Disease Research
基金
江苏省自然科学基金项目(BK20201093)。
关键词
脑出血
脑水肿
危险因素
列线图
预测模型
Cerebral hemorrhage
Cerebral edema
Risk factors
Nomogram
Predictive model
