基于倾向性评分评价漩涡征预测自发性脑出血血肿扩大的价值

目的 运用倾向性评分匹配（PSM）评价CT漩涡征预测自发性脑出血（sICH）病人早期血肿扩大（HE）价值。 方法 回顾性选取2015年1月—2020年2月首诊sICH病人271例,其中男162例,女109例,年龄17~92岁,平均（59.24±16.8）岁。所有病人均于发病后6 h内和24 h内完成初次和二次CT平扫检查。根据病人有无早期HE分为HE组（72例）和非HE组（199例）。由2名放射科医师各自独立分析横断面CT平扫漩涡征的表现。采用独立样本t检验或Mann-Whitney U检验比较2组间的计量资料,采用χ²检验比较2组间的计数资料,采用kappa一致性检验分析2名医生对漩涡征评估的一致性。采用Logistic回归分析预测早期HE发生的危险因素。使用PSM将2组病人配对,比较2组病人PSM匹配前后漩涡征对早期HE的预测价值。 结果 HE组高血压病史、入院收缩压、初始血肿体积及漩涡征阳性比例均高于非HE组,入院格拉斯哥昏迷评分（GCS）低于非HE组（均P<0.05）。2名医师对漩涡征的评估一致性较好（kappa=0.905）。Logistic回归分析显示,较高的入院收缩压和初始血肿体积、较低的入院GCS评分及漩涡征阳性是预测早期HE的独立危险因素（均P<0.05）。PSM匹配后单因素分析显示HE组病人漩涡征阳性比例高于非HE组（P<0.05）。 结论 使用PSM方法在均衡变量、减少偏倚后评估漩涡征预测sICH病人早期HE更为准确,临床医师可根据CT平扫漩涡征的出现对有早期HE风险的sICH病人采取及时有效的治疗措施,可减轻病人的不良预后。

Value of swirl sign in predicting the hematoma expansion based on propensity score matching

Objective To evaluate the value of CT swirl sign in predicting the early hematoma expansion (HE) in patients with spontaneous intracerebral hemorrhage (sICH) using propensity score matching (PSM). Methods A total of 271 patients with sICH diagnosed from January 2015 to February 2020 were retrospectively selected. There were 162 males and 109 females, aged from 17 to 92 years old, with an average age of 59.24±16.8 years. All patients underwent CT scan within 6 hours and 24 hours after the onset. Patients were divided into HE group (72 cases) and non-HE group (199 cases) according to the presence of early HE. Two radiologists independently analyzed the presence of swirl sign on the cross-sectional CT images. The independent sample t test or Mann-Whitney U test was used to compare the measurements, and the χ² test was used to compare the count data between the two groups. The kappa consistency test was used to analyze the consistency of presenting swirl sign interpretated by the two doctors. Logistic regression analysis was used to identify the risk factors of early HE. The PSM method was used to pair the two groups, and the value of swirl sign in predicting early HE before and after PSM was compared. Result The history of hypertension, the admission systolic blood pressure, initial hematoma volume, and the positive rate of swirl sign in the HE group were higher than those in the non-HE group, and the Glasgow coma score (GCS) in the HE group was lower than that in the non-HE group(all P<0.05). There was a good consistency of presenting swirl sign interpretated by the two doctors (kappa=0.905). The logistic regression analysis showed that higher admission systolic blood pressure and initial hematoma volume, lower admission GCS score, and positive swirl sign were independent risk factors for predicting early HE (all P<0.05). Univariate analysis after PSM matching showed that the presence of swirl sign was more often in the HE group than in the non-HE group (P<0.05). Conclusion Using the PSM method to evaluate the swirl sign after balancing variables and reducing bias is more accurate to predict early HE in sICH patients. Clinicians can take timely and effective treatment measures to reduce the poor prognosis of sICH patients with early HE risk based on the presence of swirl sign.