320排CT血管造影检查时间与自发性脑出血患者早期血肿扩大的相关性

Correlation between the time window of 320-row CT angiography and early hematoma expansion in patients with spontaneous intracerebral hemorrhage

摘要:

目的 探讨320排CT血管造影（CTA）检查时间与自发性脑出血（SICH）患者早期血肿扩大的相关性。方法 回顾性分析2022年1月—2024年12月贵州医科大学附属医院收治的210例SICH患者的临床资料。患者于首次CT平扫检查后6～18 h再次行CT平扫，根据血肿是否扩大分为扩大组（74例）和无扩大组（136例）。比较扩大组和无扩大组临床资料，影响因素的分析采用多因素一般Logistic回归模型；绘制受试者工作特征（ROC）曲线。将研究组患者按发病至接受CTA检查间隔时间分为<6 h组、6～12 h组和>12 h组。比较3组早期血肿扩大情况，相关性分析用Spearman法。结果 扩大组发病至入院时间、发病至首次CT平扫时间均长于无扩大组（P <0.05），初始血肿体积大于无扩大组（P <0.05），入院时NIHSS评分、漩涡征、黑洞征、分叶征、混杂征、血肿形态不规则占比及接受320排CTA检查占比均高于无扩大组（P <0.05），入院时GCS评分低于无扩大组（P <0.05）。多因素一般Logistic回归分析结果显示，初始血肿体积［O^R=1.293（95% CI：1.034，1.617）］、黑洞征［O^R=2.766，（95% CI：1.043，7.336）］、接受320排CTA检查［O^R=3.319（95% CI：1.633，6.745）］均为SICH患者早期血肿扩大的独立危险因素（P <0.05）。接受320排CTA检查预测SICH患者早期血肿扩大的诊断效能最好，其曲线下面积为0.796，敏感性为78.38%（95% CI：0.673，0.871），特异性为80.88%（95% CI：0.733，0.871）。6～12 h组早期血肿扩大发生率低于<6 h组（P <0.05），>12 h组早期血肿扩大发生率低于6～12 h组（P <0.05）。Spearman相关性分析结果显示，行320排CTA检查时间与早期血肿扩大发生率呈负相关（P <0.05）。结论 接受320排CTA检查可能增加SICH患者早期血肿扩大发生风险，320排CTA检查时间与SICH患者早期血肿扩大发生相关。

Abstract:

Objective To investigate the correlation between the time window of 320-row CT angiography (CTA) and early hematoma expansion in patients with spontaneous intracerebral hemorrhage (SICH).Methods A retrospective analysis was conducted on the clinical data of 210 patients with SICH who were admitted to the Affiliated Hospital of Guizhou Medical University from January 2022 to December 2024. All patients underwent a follow-up non-contrast CT scan 6-18 hours after the initial non-contrast CT scan. Based on the presence or absence of hematoma expansion, patients were divided into an expansion group (n = 74) and a non-expansion group (n = 136). Clinical data were compared between the expansion group and the non-expansion group. The influencing factors were analyzed using a logistic regression model, and a receiver operating characteristic (ROC) curve was plotted. Patients undergoing CTA examination were further divided into a < 6 h group, a 6-12 h group, and a > 12 h group according to the time interval from onset to CTA examination. The incidence of early hematoma expansion was compared among the three groups, and correlation analysis was performed using Spearman’s method.Results Compared with the non-expansion group, patients in the expansion group had longer onset-to-admission time, longer onset-to-initial non-contrast CT time, larger initial hematoma volume, higher National Institutes of Health Stroke Scale (NIHSS) scores at admission, and higher proportions of swirl sign, black hole sign, lobulation sign, mixed-density sign, irregular hematoma shape, and receipt of 320-row CTA examination (all P < 0.05). In contrast, Glasgow Coma Scale (GCS) scores at admission were significantly lower in the expansion group than in the non-expansion group (P < 0.05). Multivariable logistic regression analysis demonstrated that larger initial hematoma volume [O^R = 1.293 (95% CI: 1.034, 1.617], presence of the black hole sign [OR = 2.766 (95% CI: 1.043, 7.336], and receipt of 320-row CTA examination [O^R = 3.319 (95% CI: 1.633, 6.745] were independent risk factors for early hematoma expansion in patients with SICH (all P < 0.05). The 320-row CTA examination showed the best diagnostic performance for predicting early hematoma expansion in SICH patients, with an area under the curve (AUC) of 0.796, a sensitivity of 78.38% (95% CI: 0.673, 0.871), and a specificity of 80.88% (95% CI: 0.733, 0.871). The incidence of early hematoma expansion in the 6-12 h group was significantly lower than that in the < 6 h group (P < 0.05), while the incidence in the > 12 h group was significantly lower than that in the 6-12 h group (P < 0.05). Spearman correlation analysis further demonstrated that the timing of 320-row CTA examination was negatively correlated with the incidence of early hematoma expansion (P < 0.05).Conclusion Receiving 320-row CTA examination may increase the risk of early hematoma expansion in patients with SICH. The examination window of 320-row CTA is related to the occurrence of early hematoma expansion in SICH patients.