预测自发性脑出血早期血肿扩大：低钙、高血糖和CT征象

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-20 DOI:10.1016/j.jstrokecerebrovasdis.2025.108433

Xiaoxue Tan , Yuzhao Zhu , Fei Liu , Tianzhuang Han , Yuegao Liu

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引用次数: 0

摘要

自发性脑出血（sICH）是一种严重的脑卒中亚型，早期血肿增大（HE）强烈预测死亡和残疾。本研究旨在探讨低钙血症、高血糖和CT影像学征象对脑出血早期HE的预测价值。方法回顾性分析上海交通大学附属第一人民医院于2021年11月至2024年11月收治的脑出血患者238例。根据HE的发生情况将患者分为HE组（103例）和非HE组（135例）。进行单因素和多因素logistic回归分析以确定HE的独立危险因素。采用受试者工作特征（ROC）曲线评价生化指标[血钙（Ca 2 +）、血糖（GLU）]和CT征象（混合征象、黑洞征象、岛状征象）的预测效果，并构建联合预测模型。结果he患者的Ca +水平明显低于非he患者（1.92 mmol/L vs. 2.41 mmol/L, P < 0.001）， GLU水平明显高于非he患者（8.38 mmol/L vs. 6.31 mmol/L, P < 0.001）。多因素分析显示，低血钙（≤2.24 mmol/L， OR=0.001, P < 0.001）、高血糖（≥7.96 mmol/L， OR=1.791, P = 0.006）、易扩张血肿CT征像（OR=2.990, P < 0.001）是HE的独立危险因素。ROC曲线分析表明，Ca + (AUC=0.853)、GLU （AUC=0.752）、CT征（AUC=0.791）联合预测模型对HE的预测效果最佳（AUC=0.959，灵敏度= 98.1%，特异性= 98.4%）。结论低血钙（≤2.24 mmol/L）、高血糖（≥7.96 mmol/L）、易扩张血肿CT征像联合应用可显著提高sICH早期HE预测的准确性，为临床个性化治疗提供依据。这些发现对于优化siich的风险分层和干预策略具有重要意义。

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Predicting early hematoma enlargement in spontaneous intracerebral hemorrhage: Hypocalcemia, Hyperglycemia, and CT signs

Background

Spontaneous intracerebral hemorrhage (sICH) is a severe, stroke subtype, and early hematoma enlargement (HE) strongly predicts mortality and disability. This study aimed to investigate the predictive value of hypocalcemia, hyperglycemia, and computed tomography (CT) imaging signs for early HE in sICH.

Methods

A total of 238 sICH patients admitted to the First People’s Hospital Affiliated to Shanghai Jiao Tong University from November 2021 to November 2024 were retrospectively included. Patients were divided into the HE group (n = 103) and non-HE group (n = 135) based on HE occurrence. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for HE. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiency of biochemical indicators [serum calcium (Ca²⁺), blood glucose (GLU)] and CT signs (blend sign, black hole sign, island sign), and a combined prediction model was constructed.

Results

HE patients showed significantly lower Ca²⁺ levels (1.92 mmol/L vs. 2.41 mmol/L, P < 0.001) and higher GLU levels (8.38 mmol/L vs. 6.31 mmol/L, P < 0.001) compared with non-HE patients. Multivariate analysis revealed that hypocalcemia (≤2.24 mmol/L; OR=0.001, P < 0.001), hyperglycemia (≥7.96 mmol/L; OR=1.791, P = 0.006), and expansion-prone hematoma CT signs (OR=2.990, P < 0.001) were independent risk factors for HE. ROC curve analysis indicated that the combined prediction model of Ca²⁺ (AUC=0.853), GLU (AUC=0.752), and CT signs (AUC=0.791) achieved the optimal efficiency for HE prediction (AUC=0.959, sensitivity=98.1 %, specificity=98.4 %).

Conclusion

The combination of hypocalcemia (≤2.24 mmol/L), hyperglycemia (≥7.96 mmol/L), and expansion-prone hematoma CT signs significantly improves the accuracy of predicting early HE in sICH, providing a basis for clinical personalized treatment. These findings are of great significance for optimizing risk stratification and intervention strategies in sICH.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.