NCCT征象对脑出血早期血肿扩大的预测价值研究
The Predictive Value of NCCT Signs for Early Hematoma Expansion in Cerebral Hemorrhage

目的：探讨非增强计算机断层扫描中混合征、黑洞征及岛征对脑出血早期血肿扩大的预测价值。方法：选取2020年10月至2022年7月期间华北理工大学附属医院收入院的247例脑出血患者作为研究对象。根据血肿的早期进展情况将患者分为血肿扩大组(86例)及未扩大组(161例)，分析比较两组患者资料，利用多变量Logistic回归和ROC曲线分析影响血肿扩大的因素，分析不同影像学特征的预测价值。结果：两组患者入院SBP、入院格拉斯哥昏迷量表(GCS)评分、初始血肿体积、中线是否移位、岛征、黑洞征、混合征及其联合征象差异均有统计学意义(P < 0.05)。岛征、黑洞征、混合征预测血肿扩大的敏感度、特异度、阳性预测值、阴性预测值分别为76.70%、65.10%、62.80%，67.10%、76.40%、72.00%，55.46%、59.57%、54.55%，84.38%、80.39%、78.38%；联合三种征象可提高预测早期血肿扩大的特异度及阳性预测值(43.00%, 95.65%, 84.09%, 75.86%)。结论：混合征、黑洞征、岛征是血肿扩大的良好预测指标，且三者联合的预测价值更高。
Objective: To investigate the predictive value of the mixed sign, black hole sign and island sign in non-enhanced computed tomography for early hematoma enlargement in cerebral hemorrhage. Methods: A total of 247 patients with cerebral hemorrhage admitted to the Affiliated Hospital of North China University of Technology between October 2020 and July 2022 were selected for the study. The patients were divided into the group with enlarged hematoma (86 patients) and the group without enlargement (161 patients) according to the early progression of the hematoma. The clinical baseline data and imaging data of the two groups were analyzed and compared, and the factors affecting the enlargement of the hematoma were analyzed using multivariate logistic re-gression and ROC curves to analyze the predictive value of different imaging features. Results: The differences in admission systolic blood pressure, admission Glasgow Coma Scale (GCS) score, base-line hematoma volume, whether the midline was displaced, island sign, black hole sign, mixed sign and their combined signs were statistically significant between the two groups (P < 0.05). The sen-sitivity, specificity, positive predictive value and negative predictive value of the island, black hole and mixed signs in predicting haematoma enlargement were 76.70%, 65.10%, 62.80%; 67.10%, 76.40%, 72.00%; 55.46%, 59.57%, 54.55%; 84.38%, 80.39% and 78.38% respectively; combining the three signs could improve the specificity and positive predictive value of predicting early hae-matoma enlargement (43.00%, 95.65%, 84.09%, 75.86%). Conclusion: The mixed sign, black hole sign and island sign are good predictors of haematoma enlargement, and the combination of the three signs has a higher predictive value.