ICH指數(shù)對急性腦出血患者預(yù)后的簡易評估
發(fā)布時間：2018-10-05 19:28
【摘要】：目的急性腦出血是一種嚴重危害人類健康的常見病。目前的多項研究關(guān)于腦出血預(yù)后估測模型已經(jīng)很多,腦出血預(yù)后模型的測評對于腦出血患者積極采取各種治療手段、病情的交代上及醫(yī)療資源的合理利用上有著至關(guān)重要的作用,但目前預(yù)測腦出血(I CH)患者死亡率和功能預(yù)后的模型都必須結(jié)合高端設(shè)備儀器檢查,費用比較貴,程序比較復(fù)雜,時效性比較慢。本研究建立并評估了一個簡單、可靠、易行的、合理的、適用于各種大小醫(yī)院快速預(yù)測腦出血預(yù)后的模型,即腦出血指數(shù)(I CHI),探討其臨床應(yīng)用價值。 方法自2007年1月至2011年12月住院的急性腦出血病例。收集了共780例腦出血患者,分為腦出血存活組590例和腦出血死亡組190例(院內(nèi)死亡的)。所有入選患者均記錄臨床基本資料,包括Age、Male.BP、Gu、ALT、高密度脂蛋白膽固醇、血細胞分析等)。運用SPSSl5.0統(tǒng)計軟件處理分析,定性變量用率表示,基線特征比較采用t檢驗,以P0.05為差異有統(tǒng)計學(xué)意義。觀察年齡、血糖、白細胞及GCS評分對腦出血預(yù)后的測評價值,進行Logi stic回歸分析,評估各變量對腦出血住院死亡率的貢獻大小 結(jié)果兩組患者之間的性別比較,組間差異無統(tǒng)計學(xué)意義(P0.05)；兩組患者之間的血壓、血糖、ALT、高密度脂蛋白膽固醇、血細胞分析等基本資料比較,組間差異有統(tǒng)計學(xué)意義(P0.05)；而且年齡、血糖、白血細胞計數(shù)(WBC)、格拉斯哥昏迷評分(GCS)與腦出血的死亡率有極大的相關(guān)性。建立腦出血指數(shù)(I CH)的公式[I CHI=年齡(歲)/10+血清葡萄糖(mmol/L)+白細胞計數(shù)(109、L)—GCS評分]。并繪制受試者工作特征(ROC)曲線,評估I CHI的預(yù)測價值。結(jié)果顯示ROC曲線面積(AURC)為0.797(95%可信區(qū)間為：0.762-0.832,P0.001)。腦出血指數(shù)對死亡率的最適值為18,腦出血指數(shù)對死亡率的敏感性、對死亡率的特異性、約登指數(shù)(Youden's i ndex)依次為0.637,0.800和0.437。與總體死亡率(24.39明相比,18I CHI27(死亡率45.56%)和I CHI27(死亡率62.86%)時住院死亡率明顯增加。 結(jié)論院內(nèi)死亡患者較存活患者Age偏大,G u、VBC計數(shù)偏高,腦出血后存活組患者的GCS評分比腦出血后死亡組偏高；并且經(jīng)過Logi st i c回歸分析后發(fā)現(xiàn),這四項指標與腦出血預(yù)后有更為密切的關(guān)系。這符合臨床上實際現(xiàn)象,即隨著年齡的增大,體內(nèi)各種應(yīng)急反應(yīng)的加重及危險評分偏低,腦出血患者的預(yù)后越差。檢測以上指標,相比腦出血體積量的計算,有助于從更實際的角度出發(fā)評估腦出血患者的病情及預(yù)后程度,可能為臨床合理有效診斷腦出血患者及其預(yù)后測評提供更為及時快速的簡易預(yù)測手段。腦出血指數(shù)(1CHI)是一個簡單的預(yù)測模型,對其他預(yù)測模型是一個補充。
[Abstract]:Objective Acute intracerebral hemorrhage (AICH) is a common disease that seriously endangers human health. There have been many models for estimating the prognosis of intracerebral hemorrhage in recent studies. The evaluation of prognosis models of cerebral hemorrhage has taken various treatment measures for patients with intracerebral hemorrhage. It is very important to account for the condition of the disease and to utilize the medical resources reasonably. However, the models for predicting the mortality and functional prognosis of (I CH) patients with intracerebral hemorrhage must be combined with high-end equipment, the cost is expensive and the procedure is more complicated. Timeliness is slow. This study established and evaluated a simple, reliable, feasible and reasonable model for predicting the prognosis of intracerebral hemorrhage (ICH) in various hospitals, I. e., intracerebral hemorrhage index (I CHI),). Methods from January 2007 to December 2011, patients with acute cerebral hemorrhage were hospitalized. A total of 780 patients with intracerebral hemorrhage were divided into two groups: intracerebral hemorrhage survival group (590 cases) and intracerebral hemorrhage death group (190 cases). All patients were enrolled to record basic clinical data, including Age,Male.BP,Gu,ALT, high density lipoprotein cholesterol, blood cell analysis, etc. SPSSl5.0 statistical software was used to process the analysis, the qualitative variable rate was expressed, and the baseline characteristics were compared with t test, with P0.05 as the difference. The value of age, blood glucose, white blood cell and GCS score on prognosis of intracerebral hemorrhage was observed. Logi stic regression analysis was performed to evaluate the contribution of various variables to the mortality rate of patients with intracerebral hemorrhage. There was no significant difference between the two groups (P0.05); there were significant differences in blood pressure, alt, HDL cholesterol, blood cell analysis between the two groups (P0.05); and age, blood sugar, White blood cell count (WBC), Glasgow coma score (GCS) was significantly correlated with ICH mortality. The formula of intracerebral hemorrhage index (I CH) was established [I CHI= age (years old) / 10 serum glucose (mmol/L) leukocyte count (109 L) GCS score]. The predictive value of I CHI was evaluated by drawing the (ROC) curve of the operating characteristics of the subjects. The results showed that the area of ROC curve (AURC) was 0.797 (95% CI = 0.762-0.832). The most suitable value of ICH index for mortality was 18. The sensitivity of ICH index to mortality and the specificity of ICH index to mortality were 0.6370.800 and 0.43770.800, respectively. Compared with the total mortality rate (24.39 Ming), the hospital mortality at 18 I CHI27 (mortality rate 45.56%) and I CHI27 (mortality rate 62.86%) increased significantly. Conclusion the number of Age in patients with death in hospital is higher than that in patients with survival. The GCS score of patients with intracerebral hemorrhage is higher than that of patients who die after intracerebral hemorrhage, and it is found by Logi st i c regression analysis. These four indexes were closely related to the prognosis of intracerebral hemorrhage. This is in line with the actual clinical phenomenon, that is, with the increase of age, the aggravation of various emergency responses and the lower the risk score, the worse the prognosis of patients with intracerebral hemorrhage. Comparing with the calculation of the volume of intracerebral hemorrhage (ICH), the above indexes can be used to evaluate the degree of illness and prognosis of ICH patients from a more practical point of view. It may provide a more timely and rapid method for the diagnosis of ICH and its prognosis evaluation. Cerebral hemorrhage index (1CHI) is a simple prediction model, which is a supplement to other prediction models.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R743.34
[Abstract]:Objective Acute intracerebral hemorrhage (AICH) is a common disease that seriously endangers human health. There have been many models for estimating the prognosis of intracerebral hemorrhage in recent studies. The evaluation of prognosis models of cerebral hemorrhage has taken various treatment measures for patients with intracerebral hemorrhage. It is very important to account for the condition of the disease and to utilize the medical resources reasonably. However, the models for predicting the mortality and functional prognosis of (I CH) patients with intracerebral hemorrhage must be combined with high-end equipment, the cost is expensive and the procedure is more complicated. Timeliness is slow. This study established and evaluated a simple, reliable, feasible and reasonable model for predicting the prognosis of intracerebral hemorrhage (ICH) in various hospitals, I. e., intracerebral hemorrhage index (I CHI),). Methods from January 2007 to December 2011, patients with acute cerebral hemorrhage were hospitalized. A total of 780 patients with intracerebral hemorrhage were divided into two groups: intracerebral hemorrhage survival group (590 cases) and intracerebral hemorrhage death group (190 cases). All patients were enrolled to record basic clinical data, including Age,Male.BP,Gu,ALT, high density lipoprotein cholesterol, blood cell analysis, etc. SPSSl5.0 statistical software was used to process the analysis, the qualitative variable rate was expressed, and the baseline characteristics were compared with t test, with P0.05 as the difference. The value of age, blood glucose, white blood cell and GCS score on prognosis of intracerebral hemorrhage was observed. Logi stic regression analysis was performed to evaluate the contribution of various variables to the mortality rate of patients with intracerebral hemorrhage. There was no significant difference between the two groups (P0.05); there were significant differences in blood pressure, alt, HDL cholesterol, blood cell analysis between the two groups (P0.05); and age, blood sugar, White blood cell count (WBC), Glasgow coma score (GCS) was significantly correlated with ICH mortality. The formula of intracerebral hemorrhage index (I CH) was established [I CHI= age (years old) / 10 serum glucose (mmol/L) leukocyte count (109 L) GCS score]. The predictive value of I CHI was evaluated by drawing the (ROC) curve of the operating characteristics of the subjects. The results showed that the area of ROC curve (AURC) was 0.797 (95% CI = 0.762-0.832). The most suitable value of ICH index for mortality was 18. The sensitivity of ICH index to mortality and the specificity of ICH index to mortality were 0.6370.800 and 0.43770.800, respectively. Compared with the total mortality rate (24.39 Ming), the hospital mortality at 18 I CHI27 (mortality rate 45.56%) and I CHI27 (mortality rate 62.86%) increased significantly. Conclusion the number of Age in patients with death in hospital is higher than that in patients with survival. The GCS score of patients with intracerebral hemorrhage is higher than that of patients who die after intracerebral hemorrhage, and it is found by Logi st i c regression analysis. These four indexes were closely related to the prognosis of intracerebral hemorrhage. This is in line with the actual clinical phenomenon, that is, with the increase of age, the aggravation of various emergency responses and the lower the risk score, the worse the prognosis of patients with intracerebral hemorrhage. Comparing with the calculation of the volume of intracerebral hemorrhage (ICH), the above indexes can be used to evaluate the degree of illness and prognosis of ICH patients from a more practical point of view. It may provide a more timely and rapid method for the diagnosis of ICH and its prognosis evaluation. Cerebral hemorrhage index (1CHI) is a simple prediction model, which is a supplement to other prediction models.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R743.34
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