自发性幕上大容积脑出血的影响因素

目的： 探讨自发性幕上大容积脑出血的保护和危险因素。方法： 回顾性分析2014 年1 月至2018 年12 月在中南大学湘雅医院住院的自发性幕上脑出血患者，根据脑出血量是否≥30 mL分为大容积脑出血组(255 例)和非大容积脑出血组(397 例)，对2 组患者的临床资料进行单因素及多因素logistic 回归分析。结果： 幕上大容积脑出血组与非大容积脑出血组患者的入院时收缩压、舒张压、白细胞计数、中性粒细胞计数、低密度脂蛋白胆固醇水平、高密度脂蛋白胆固醇水平、钙离子浓度、国际标准比值差异有统计学意义(均P<0.05)。多因素logistic 回归分析显示：低密度脂蛋白胆固醇水平增高(OR=0.709， 95% CI： 0.564~0.892，P=0.003)、钙离子浓度增高(OR=0.084， 95% CI：0.023~0.309，P<0.001)是幕上大容积脑出血的保护因素；而白细胞计数增多(OR=1.268，95% CI：1.194~1.347，P<0.001)、高密度脂蛋白胆固醇水平增高(OR=1.884，95% CI：1.199~2.961，P=0.006)、入院时收缩压升高(OR=1.022，95% CI：1.014~1.030，P<0.001)、国际标准比值增大(OR=26.209，95% CI：4.712~145.764，P<0.001)为其危险因素。结论： 幕上大容积脑出血的发生是多因素共同作用的结果，白细胞计数增多、入院时收缩压升高、高密度脂蛋白胆固醇水平增高、国际标准比值增大可能会增加其发生风险，而低密度脂蛋白胆固醇水平和钙离子浓度的增高可能降低其发生风险。

Influential factors for large volume of spontaneous supratentorial intracerebral hemorrhage

Objective: To explore the relevant protective and risk factors that affect spontaneoussupratentorial large volume intracerebral hemorrhage.Methods: Clinical data of hospitalized patients with spontaneous supratentorialintracerebral hemorrhage in Xiangya Hospital of Central South University from January2014 to December 2018 were retrospectively analyzed. According to the amount ofintracerebral hemorrhage (≥30 mL), the patients were divided into a large volume intracerebral hemorrhage group (255 cases) and a non-large volume intracerebralhemorrhage group (397 cases). Univariate and multivariate logistic regression analysis forthe clinical data from the two groups of patients were performed.Results: Systolic blood pressure, diastolic blood pressure, white blood cell count,neutrophil count, low-density lipoprotein (LDL) cholesterol, high-density lipoproteincholesterol, calcium ion concentration, and international standard ratio between the largevolume intracerebral hemorrhage group and the non-large volume intracerebral hemorrhagegroup were significantly different (all P<0.05). Multivariate logistic regression analysisshowed the increased LDL cholesterol (OR=0.709, 95% CI 0.564 to 0.892, P=0.003) andthe increased calcium concentration (OR=0.084, 95% CI 0.023 to 0.309, P<0.001) were theprotective factors for large volume intracerebral hemorrhage on the screen; while theincreased white blood cell count (OR=1.268, 95% CI 1.194 to 1.347, P<0.001), theincreased high-density lipoprotein cholesterol (OR=1.884, 95% CI 1.199 to 2.961, P=0.006), the increased systolic blood pressure at admission (OR=1.022, 95% CI 1.014 to1.030, P<0.001), and the increased international standard ratio (OR=26.209, 95% CI 4.712to 145.764, P<0.001) were the risk factors.Conclusion: The occurrence of spontaneous supratentorial large volume intracerebralhemorrhage is the result of combination of multiple factors. The increased white blood cellcount, the increased systolic blood pressure, the increased high-density lipoproteincholesterol, and the increased international standard ratio may increase its risk, while theincreased LDL cholesterol and calcium concentration may reduce its risk.