血液病相关颅内出血的临床和影像学特点分析

 目的　分析血液病相关颅内出血（ICH）的临床和影像学特点，提高临床医师的认识。方法　1998年1月至2010年5月发生的与原发血液病相关的ICH病例31例，回顾性分析其基础疾病、临床和影像学表现以及导致死亡的危险因素。结果　发生ICH的血液病以急性髓细胞白血病（AML）、特发性血小板减少性紫癜（ITP）多见，分别为13例和6例，多表现为头痛、烦躁、恶性呕吐和意识障碍，缺乏定位体征，影像学表现以渗血为主，CT与MRI诊断的符合率为60 %（3／5），头颅MRI的ICH检出率高于CT。总病死率为71 %（22／31），发热、白细胞＞5×109／L、血小板＜50×109／L、免疫球蛋白增高、凝血功能异常、全身多部位出血等是ICH的危险因素，具备≥2个危险因素者病死率为86.4 %（19／22），显著高于有≤1个危险因素的患者病死率33.3 %（3／9）]（χ2＝8.718，P＝0.003）。结论　血液病相关ICH是威胁患者生命的严重并发症，头颅MRI有助于提高血液病相关ICH诊断率，发热、白细胞＞5×109／L、血小板＜50×109／L、免疫球蛋白增高、凝血功能异常等多种危险因素并存可导致血液病ICH患者死亡率增加。

Analysis of clinical and radiological characteristics of intracranial hemorrhage in hematological diseases

Objective To analyze clinical and radiological characteristics of intracranial hemorrhage in hematological diseases to improve the recognition of them. Methods Thirty-one clinical data of intracranial hemorrhage cases with hematological diseases were reviewed. The basic diseases, clinical and radiological manifestations, and risk factors of mortality were analyzed. Results Intracranial hemorrhage usually occurred in patients with acute myeloid leukemia （AML） or idiopathic thromboeytopenic purpura （ITP）, and 13 and 6 cases, respectively, in this group. Most patients presented with headache, restlessness, nausea, vomiting, conscious disturbance and no localization sign by physical examination. CT or MRI images often revealed focus of errlysis. Compared with CT scan, a higher detection rate of ICH could be realized by MRI scan. The total mortality in this group of ICH patients was 71% （22/31）. Fever, white blood cell 〉5×10^9/L, platelet 〈50×10^9/L, hyperimmunoglobulinemia and disturbance of blood coagulation were risk factors for ICH of this group of patients. The mortality was higher in patients with no less than 2 risk factors86.4 % （19/22） vs 33.3 % （3/9）] （Х^2 = 8.718, P = 0.003）. Conclusion ICH is a serious complication for hematological patients. MRI scan is good at improving the diagnosis of ICH. It is of high risk of death in patients with no less than 2 risk factors such as fever, white blood cell higher than 5×10^9/L, platelet less than 50×10^9/L, hyperimmunoglobulinemia and disturbance of blood coagulation.