目的:脑出血（intracerebral hemorrhage,ICH）是一种危害最严重的卒中亚型,具有较高的发病率和死亡率,而血肿早期增大是神经功能恶化和不良预后的最关键因素之一,因此寻找预测血肿增大的指标具有重大意义。本文通过对深圳市南山区人民医院的脑出血患者进行分析,探讨高血压性脑出血24h内血肿是否扩大与不同CT征象之间的相关性。方法:回顾性分析185例高血压性脑出血患者的临床资料与CT图像,比较血肿扩大组及未扩大组CT参数间的差异,对两组差异有统计学意义的指标进行组间二元Logistic回归分析,明确CT指标与血肿扩大与否之间的相关性,再以混杂征、分叶征、黑洞征为检验变量评估其对脑出血早期血肿扩大的预测能力.结果:血肿扩大组及血肿未扩大组的CT定量资料:初始体积、最大径、最小径、最大CT值、平均CT值、最大径与最小径差值的差异均无统计学意义（P>0.05）。CT定性资料:混杂征、分叶征及黑洞征间差异有统计学意义（P<0.05）,血肿破入脑室差异无统计学意义。通过二元Logistic回归分析显示患者入院时收缩压及CT征象中混杂征、分叶征、黑洞征为血肿早期增大的独立危险因素。使用诊断试验四格表法计算出混杂征、黑洞征和/或分叶征联合征象与早期血肿扩大的相关性敏感度、特异度、阳性预测值和阴性预测值分别为78.4%、59.0%、42.1%和87.8%,约登指数为0.374,其约登指数比混杂征、黑洞征和分叶征更接近1。结论:平扫CT中混杂征、分叶征、黑洞征对24 h内高血压性脑出血血肿增大有较好的预测价值。

Objective: Intracerebral hemorrhage , the most devastating form of stroke,has high morbidity and mortality. Hematoma expansion is the most critical factors for the deterioration of neurological function and poor prognosis. Therefore,it is of great significance to look for indicators to predict HE.This paper analyzed cerebral hemorrhage patients in Nanshan people's hospital to explore the correlation between hematoma expansion within 24 hours ofhypertensive intracerebral hemorrhage and signs of nonenhanced computed tomography(NECT).
Methods:The clinical data and CT images of 185 patients with hypertensive intracerebral hemorrhage were retrospectively analyzed. The difference in CT parameters were Compared between the expansion group and the unexpanded group. Binary Logistic regression analysis was performed on the indicators with statistical significallce between the two groups to identify the potentiaI correlation between CT parameters and hematoma expansion. The roles of blend sign, lobulation sign, and black hole sign in predicting early hematoma expansion was assessed.
Results: The CT quantitative data including initial volume, maximum diameter, minimum diameter, maximum CT value, mean CT value, maximum diameter and minimum diameter difference showed no significant difference between these two group ( all P >0.05 ) ; CT qualitative data including the blend sign, LobuLated sign, and black hole sign were significant difference ( p <0.05 ), but the differences became not significant after the hematoma break into the ventricles. Binary Logistic regression analysis showed that blend signs, lobulation signs, and black hole signs were independent risk factors for early hematoma expansion, with sensitivity, specificity, positive predictive value and negative predictive value of the combined signs and the early hematoma expansion calculated by the fourfold -table method were 78.4%, 59.0%, 42.1% and 87.8%, respectively, and the Youden index was 0.374, Its Youden index was closer to 1 than the blend sign,the black hole sign, and the lobulation sign.
Conclusion: The blend sign, the lobulation sign, and the black hole sign in NECT can be used to predict hematoma expansion within 24 hours after hypertensive cerebral hemorrhage.