摘要
目的探讨入院血清同型半胱氨酸水平与定量脑电图指标对于脑出血患者不良预后的预测价值。方法回顾性连续收集2017年1月至2022年12月在开滦总医院神经内科重症加强治疗病房诊治的出血性卒中患者89例临床资料。根据出院30 d后的改良Rankin评分(modified Rankin scale,mRS)将患者分为两组:预后良好组(mRS≤2分)、预后不良组(mRS 3~6分)。收集患者临床资料、定量脑电图(quantitative electroencephalogram,qEEG)监测16导联各脑区相关脑电指标。出血预后的影响因素分析采用多因素Logistic回归分析。采用受试者特征(receiver operating characteristic,ROC)曲线分析脑电相关指标及入院同型半胱氨酸预测出血性卒中患者出现不良预后的价值。结果(1)脑出血预后不良组年龄大于预后良好组[(66.51±13.64)岁比(60.53±11.69)岁],t=2.15,P=0.034;入院血清同型半胱氨酸水平显著高于预后良好组[17.28(15.52,24.72)mmol/L比14.50(10.28,16.00)mmol/L,Z=4.14,P<0.001]。(2)脑出血预后不良组10-20导联中Fp1-2、F4、C4、P4、F8、T4导联δ脑波功率值高于预后良好组[87.99(41.57,196.69)比50.67(26.64,54.75),Z=2.76,P=0.006];[79.17(40.71,200.00)比45.06(20.22,61.00),Z=2.10,P=0.036];[72.64(34.97,219.78)比34.42(19.81,63.4),Z=2.03,P=0.043];[65.06(33.36,177.45)比28.12(15.88,63.36),Z=2.08,P=0.038];[52.92(25.64,187.91)比23.61(11.67,43.26),Z=2.21,P=0.027];[66.67(32.56,180.76)比36.31(17.2,53.78),Z=2.46,P=0.014];[57.30(25.24,127.04)比29.57(11.91,41.89),Z=2.26,P=0.024].Fp1-2、F3、F4、C3、C4、P3-4、O1、F7-8、T3-4导联θ脑波功率值高于预后良好组[77.45(47.63,138.72)比35.88(20.92,44.81),Z=3.50,P<0.001];[77.05(35.16,120.22)比38.74(19.86,58.09),Z=2.27,P=0.023];[85.24(52.53,147.90)比35.42(14.7,52.59),Z=2.61,P=0.009];[75.81(37.90,124.97)比36.85(17.92,55.43),Z=2.30,P=0.021];[72.00(43.92,123.54)比28.37(14.02,51.9),Z=2.22,P=0.027];[67.08(32.01,104.05)比31.32(17.98,45.28),Z=2.10,P=0.035];[55.33(32.29,94.30)比25.64(11.87,34.01),Z=2.24,P=0.025];[48.84(20.64,96.28)比19.85(9.83,28.58),Z=2.30,P=0.022];[48.46(25.06,81.78)比23.95(8.80,29.16),Z=2.51,P=0.012];[64.46(39.38,112.44)比26.85(15.74,39.58),Z=2.80,P=0.005];[65.68(31.78,102.00)比31.09(15.98,46.96),Z=2.38,P=0.017];[45.26(28.34,73.14)比21.45(10.57,36.59),Z=2.04,P=0.042];[43.50(22.58,78.67)比25.45(11.91,32.26),Z=2.22,P=0.027];Fp1-2、F3-4、C3-4、P4、F7-8、T4、全脑平均导联慢波指数功率值高于预后良好组[6.64(2.98,10.42)比3.65(2.31,4.30),Z=2.65,P=0.01];[6.53(3.96,11.65)比3.53(2.56,4.51),Z=2.30,P=0.022];[7.38(4.62,13.12)比3.83(1.70,4.71),Z=2.38,P=0.017];[5.88(4.02,12.15)比3.18(2.21,4.46),Z=2.29,P=0.022];[6.13(3.83,11.22)比2.97(1.53,4.58),Z=2.01,P=0.044];[6.07(3.53,9.39)比2.74(2.00,3.81),Z=2.40,P=0.016];[4.11(2.51,9.23)比2.18(1.37,2.82),Z=2.25,P=0.024];[5.71(3.81,10.44)比3.22(1.86,4.04),Z=2.28,P=0.023];[6.00(3.65,10.37)比3.04(2.00,4.00),Z=2.39,P=0.017];[4.08(2.56,8.33)比2.08(1.60,3.14),Z=2.50,P=0.013],其中全脑平均慢波指数导联差异有统计学意义[5.45(3.31,10.08)比3.17(2.02,4.88),Z=3.62,P=0.005]。(3)Logistic回归结果显示,入院血清同型半胱氨酸(homocysteine,HCY)值(OR 1.311,95%CI 1.008~1.705,P=0.044)、入院国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分(OR1.588,95%CI 1.074~2.349,P=0.020)和全脑平均慢波指数(OR 8.596,95%CI 1.088~67.889,P=0.041)是脑出血预后不良的影响因素。(4)通过绘制ROC曲线,发现入院HCY值、全脑平均慢波指数、入院NIHSS评分预测脑出血不良预后的ROC曲线下面积(area under curve,AUC)分别为0.768(95%CI 0.665~0.872)、0.743(95%CI 0.634~0.852)、0.896(95%CI 0.827~0.965),截断值分别为15.67,3.62,8.50,灵敏度分别为77.8%、71.1%、68.9%,特异度分别为59.4%、68.7%、100.0%,约登指数分别为0.372、0.398、0.689。结论脑出血急性期,脑电生理表现为δ、θ、慢波指数在全脑出现增多。入院HCY值越高,提示脑出血患者预后越差。入院HCY值、全脑平均慢波指数对急性脑出血不良预后有一定预测价值。
Objective To explore the predictive value of admission serum homocysteine levels and quantitative electroencephalogram(qEEG)indicators for adverse outcomes in patients with cerebral hemorrhage.Methods A retrospective study was conducted on 89 patients,who were collected as the study objects with hemorrhagic stroke treated in the neurology intensive care unit at Kailuan General Hospital from January 2017 to December 2022.Patients were categorized into two groups based on modified Rankin Scale(mRS)scores at discharge:a good prognosis group(mRS≤2)and a poor prognosis group(mRS 3-6).Clinical data and qEEG monitoring of various brain regions were collected.The impact factors of hemorrhagic prognosis were analyzed using multifactorial logistic regression.ROC curve analysis was performed to assess the predictive value of qEEG and admission homocysteine levels for adverse outcomes in hemorrhagic stroke patients.Results(1)The age of the poor prognosis group was higher than that of the good prognosis group((66.51+13.64)to(60.53+11.69),t=2.15,P=0.034)and admission serum homocysteine levels were significantly higher in the poor prognosis group than in the good prognosis group(17.28(15.52,24.72)mmol/L to 14.50(10.28,16.00)mmol/L,Z=4.14,P<0.001).(2)In the poor prognosis group,power values ofδbrain waves in leads Fp1-2,F4,C4,P4,F8,and T4 were higher than those in the good prognosis group(87.99(41.57,196.69)to 50.67(26.64,54.75),Z=2.76,P=0.006);(79.17(40.71,200.00)to 45.06(20.22,61.00),Z=2.10,P=0.036);(72.64(34.97,219.78)to 34.42(19.81,63.4),Z=2.03,P=0.043);(65.06(33.36,177.45)to 28.12(15.88,63.36),Z=2.08,P=0.038);(52.92(25.64,187.91)to 23.61(11.67,43.26),Z=2.21,P=0.027);(66.67(32.56,180.76)to 36.31(17.2,53.78),Z=2.46,P=0.014);(57.30(25.24,127.04)to 29.57(11.91,41.89),Z=2.26,P=0.024).Power values ofθbrain waves in leads Fp1-2,F3,F4,C3,C4,P3-4,O1,F7-8,and T3-4 were higher in the poor prognosis group(77.45(47.63,138.72)比35.88(20.92,44.81),Z=3.50,P<0.001);(77.05(35.16,120.22)to 38.74(19.86,58.09),Z=2.27,P=0.023);(85.24(52.53,147.90)to 35.42(14.7,52.59),Z=2.61,P=0.009);(75.81(37.90,124.97)to 36.85(17.92,55.43),Z=2.30,P=0.021);(72.00(43.92,123.54)to 28.37(14.02,51.9),Z=2.22,P=0.027);(67.08(32.01,104.05)to 31.32(17.98,45.28),Z=2.10,P=0.035);(55.33(32.29,94.30)to 25.64(11.87,34.01),Z=2.24,P=0.025);(48.84(20.64,96.28)to 19.85(9.83,28.58),Z=2.30,P=0.022);(48.46(25.06,81.78)to 23.95(8.80,29.16),Z=2.51,P=0.012);(64.46(39.38,112.44)to 26.85(15.74,39.58),Z=2.80,P=0.005);(65.68(31.78,102.00)to 31.09(15.98,46.96),Z=2.38,P=0.017);(45.26(28.34,73.14)to 21.45(10.57,36.59),Z=2.04,P=0.042);(43.50(22.58,78.67)to 25.45(11.91,32.26),Z=2.22,P=0.027).Power values of slow-wave index in leads Fp1-2,F3-4,C3-4,P4,F7-8,and T4,as well as the overall brain average,were higher in the poor prognosis group(6.64(2.98,10.42)to 3.65(2.31,4.30),Z=2.65,P=0.01);(6.53(3.96,11.65)to 3.53(2.56,4.51),Z=2.30,P=0.022);(7.38(4.62,13.12)to 3.83(1.70,4.71),Z=2.38,P=0.017);(5.88(4.02,12.15)to 3.18(2.21,4.46),Z=2.29,P=0.022);(6.13(3.83,11.22)to 2.97(1.53,4.58),Z=2.01,P=0.044);(6.07(3.53,9.39)to 2.74(2.00,3.81),Z=2.40,P=0.016);(4.11(2.51,9.23)to 2.18(1.37,2.82),Z=2.25,P=0.024);(5.71(3.81,10.44)to 3.22(1.86,4.04),Z=2.28,P=0.023);(6.00(3.65,10.37)to 3.04(2.00,4.00),Z=2.39,P=0.017);(4.08(2.56,8.33)to 2.08(1.60,3.14),Z=2.50,P=0.013),with significant statistical differences noted(5.45(3.31,10.08)to 3.17(2.02,4.88),Z=3.62,P=0.005).(3)Logistic regression results showed that admission homocysteine levels(OR 1.311,95%CI 1.008-1.705,P=0.044),admission NIHSS scores(OR 1.588,95%CI 1.074-2.349,P=0.020),and overall brain average slow-wave index were influencing factors for poor prognosis in cerebral hemorrhage(OR 8.596,95%CI 1.088-67.889,P=0.041).(4)ROC curve analysis revealed that the AUC for predicting adverse outcomes in cerebral hemorrhage was 0.768(95%CI(0.665,0.872))for admission homocysteine levels,0.743(95%CI(0.634,0.852))for the overall brain average slow-wave index,and 0.896(95%CI(0.827,0.965))for admission NIHSS.The cutoff values were 15.67,3.62,and 8.5,respectively.Sensitivity was 77.8%,71.1%,and 68.9%,and specificity was 59.4%,68.7%,and 100%,respectively.The Youden indices were 0.372,0.398,and 0.689.Conclusion In the acute phase of cerebral hemorrhage,electroencephalographic physiological changes manifest shows an increase in theδ,θ,and slow-wave index throughout the entire brain.Higher admission homocysteine levels suggest a worse prognosis in patients with cerebral hemorrhage.Admission homocysteine levels and overall brain average slow-wave index have certain predictive value for adverse outcomes in acute cerebral hemorrhage.
作者
欧亚
张萍淑
元小冬
张丽丽
王京
赵营
徐斌
马倩
Ou Ya;Zhang Pingshu;Yuan Xiaodong;Zhang Lili;Wang Jing;Zhao Ying;Xu Bin;Ma Qian(Department of Neurology,Kailuan General Hospital,Tangshan 063000,China)
出处
《中国综合临床》
2024年第2期88-95,共8页
Clinical Medicine of China
基金
河北省创新能力提升计划项目(20567622H)
唐山市科技计划项目(22130212G)。
关键词
脑出血
卒中
定量脑电图
同型半胱氨酸
预后
评价
Cerebral hemorrhage
Stroke
Quantitative electroencephalogram
Homocysteine
Prognosis
Evaluate
作者简介
通信作者:元小冬,Email:yxd69@sohu.com。
