摘要
目的评价CT灌注成像(CTPI)参数联合格拉斯哥昏迷评分(GCS)评分对颅脑损伤(TBI)患者损伤程度及近期预后的预测效能。方法回顾性分析2019年1月至2022年12月于衡水市第四人民医院收治的220例颅脑损伤患者资料。所有患者入院时均行头颅CT及CTPI检查,根据GCS评分分为轻中度组(9~15分)与重度组(≤8分),根据出院后3个月格拉斯哥结局扩展量表(GOSE)评分分为预后不良组(1~4分)和预后良好组(5~8分)。比较不同组间CTPI参数差异,采用多因素Logistic回归构建颅脑损伤程度和预后预测模型,并通过受试者工作特征(ROC)曲线评估模型预测效能。结果重度组脑血容量(CBV)、脑血流量(CBF)及GCS评分均低于轻中度组;平均通过时间(MTT)长于轻中度组(均P<0.05)。Logistic回归分析结果显示,高CBV(OR=0.592,95%CI:0.429~0.783)、CBF(OR=0.616,0.427~0.806)、GCS(OR=0.748,0.586~0.963)评分与TBI程度轻有关,长MTT与TBI程度重有关(OR=2.007;95%CI:1.615~3.790)。预后不良组CBV、CBF、GCS评分均低于预后良好组,MTT长于预后良好组(P<0.05);高CBV(OR=0.541,95%CI:0.384~0.826)、CBF(OR=0.493,0.350~0.792)、GCS(OR=0.706,0.589~0.942)评分与预后良好有关,较长MTT与预后不良有关(OR=1.934;95%CI:1.480~2.657)。ROC曲线分析显示,CTPI联合GCS评分预测TBI严重程度的AUC为0.772(95%CI:0.690~0.853),敏感度81.42%,特异度61.07%;预测近期预后的AUC为0.851(95%CI:0.784~0.917),敏感度74.68%,特异度78.60%。该联合模型对不同TBI病理类型亦具较好预测效能,其中弥漫性轴索损伤AUC最高(0.975,95%CI:0.954~0.996),其次分别为硬膜下血肿(0.824)、脑挫伤(0.842)和硬膜外血肿(0.783)。结论CTPI参数联合GCS评分对TBI患者损伤程度及近期预后具有较高的预测价值。
Objective To evaluate the predictive efficacy of CT perfusion imaging(CTPI)parameters combined with GCS score for the severity and short-term prognosis of patients with traumatic brain injury(TBI).Methods A retrospective analysis was conducted on the data of 220 patients with craniocerebral injury who were admitted to the Fourth People's Hospital of Hengshui from January 2019 to December 2022.All patients underwent CT and CTPI examinations upon admission.They were divided into the mild-to-moderate group and the severe group based on the GCS score at admission,and into the poor prognosis group and the good prognosis group based on the Glasgow Outcome Scale Extended(GOSE)score at 3 months after discharge.The CTPI parameters of different severity groups and different prognosis groups were compared.Multivariate logistic regression was used to construct the prediction models for the severity and prognosis of TBI,and the receiver operating characteristic(ROC)curve was established to analyze the predictive efficacy.Results CBV,CBF,and GCS scores in the severe group were lower than those in the mild-to-moderate group,and the MTT in the severe group was longer than that in the mild-to-moderate group,with statistically significant differences(P<0.05).Logistic regression analysis showed that Higher CBV(OR=0.592,95%CI:0.429–0.783),CBF(OR=0.616,95%CI:0.427–0.806),and GCS(OR=0.748,95%CI:0.586–0.963)scores were independent protective factors for reduced severity of TBI,while prolonged MTT(OR=2.007,95%CI:1.615–3.790)was an independent risk factor for increased severity of TBI(all P<0.05).CBV,CBF,and GCS scores in the poor prognosis group were lower than those in the good prognosis group,and the MTT in the poor prognosis group was longer than that in the good prognosis group,with statistically significant differences(P<0.05).Logistic regression analysis showed that higher CBV(OR=0.541,95%CI:0.384–0.826),CBF(OR=0.493,95%CI:0.350–0.792),and GCS(OR=0.706,95%CI:0.589–0.942)scores were independent protective factors for favorable prognosis;prolonged MTT(OR=1.934,95%CI:1.480–2.657)was an independent risk factor for unfavorable prognosis(all P<0.05).The ROC curve was established,and the AUC(95%CI)of the model for predicting the severity of TBI using CTPI parameters combined with GCS score was 0.772(0.690-0.853),with a sensitivity of 81.42%and a specificity of 61.07%;the AUC(95%CI)for predicting the prognosis of TBI patients was 0.851(0.784-0.917),with a sensitivity of 74.68%and a specificity of 78.60%;both had high predictive efficacy.The AUC(95%CI)of CTPI parameters combined with GCS score for predicting diffuse axonal injury was 0.975(0.954-0.996),0.824(0.752-0.896)for subdural hematoma,and 0.842(0.776-0.910)for cerebral contusion.The incidence of epidural hematoma was 0.783(0.702-0.863),all of which had relatively high predictive efficacy.Conclusions CTPI parameters combined with GCS score have high predictive efficacy for the severity and short-term prognosis of TBI patients.
作者
王芬
周立霞
吴婷
史佩佩
张静
WANG Fen;ZHOU Lixia;WU Ting;SHI Peipei;ZHANG Jing(CT Room,Hengshui Fourth People's Hospital,Hengshui,Hebei 053000,China;Department of Imaging,The Second Hospitalof Hebei Medical University,Shijiazhuang 050000,China)
出处
《中华神经外科疾病研究杂志》
2026年第4期70-76,共7页
Chinese Journal of Neurosurgical Disease Research
基金
衡水市科技计划项目(2022014002Z)。
关键词
CT灌注成像
GCS评分
颅脑损伤
损伤程度
近期预后
CT perfusion imaging
GCS score
traumatic brain injury
severity
Short-term prognosis
