原发性幕上脑出血急性期继发脑梗死的影响因素与影像学特征分析

Risk factors and radiological features of secondary cerebral infarction in the acute stage of primary supratentorial intracerebral hemorrhage

摘要:

目的 探讨原发性幕上脑出血（ICH）患者急性期继发脑梗死的影响因素及影像学特征。方法 纳入2019年1月—2024年12月中南大学湘雅医院和湖南中医药大学第一附属医院收治的892例原发性幕上ICH患者，根据ICH后14 d内是否发生继发脑梗死分为未继发脑梗死组（n=838）和继发脑梗死组（n=54）。采用Logistic回归分析继发脑梗死的影响因素。结果 继发脑梗死组的脑梗死既往史占比、开颅手术占比及入院时收缩压更高，入院时基线血肿量更大，格拉斯哥昏迷量表（GCS）评分更低，美国国立卫生研究院卒中量表（NIHSS）评分更高。多因素Logistic回归分析显示，接受开颅手术、脑梗死既往史、入院时NIHSS评分及中性粒细胞/淋巴细胞比值（NLR）升高均为ICH急性期继发脑梗死的影响因素（P<0.05）。结论 既往脑梗死病史、开颅手术治疗、入院时较高的NIHSS评分及NLR升高是原发性幕上ICH患者急性期继发脑梗死的影响因素。对高危患者加强神经功能的动态评估与影像学监测，有助于早期进行风险分层并实施个性化干预。

Abstract:

Objective To investigate the factors associated with secondary cerebral infarction and its radiological features in patients with primary supratentorial intracerebral hemorrhage （ICH） during the acute stage.Methods A total of 892 patients with primary supratentorial ICH who were admitted to Xiangya Hospital of Central South University and The First Affiliated Hospital of Hunan University of Chinese Medicine from January 2019 to December 2024 were enrolled， and according to the presence or absence of secondary cerebral infarction within 14 days after ICH， the patients were divided into secondary cerebral infarction group （n=54） and non-secondary cerebral infarction group （n=838）. The logistic regression analysis was used to investigate the factors associated with secondary cerebral infarction.Results Compared with the non-secondary cerebral infarction group， the secondary cerebral infarction group had a significantly higher proportion of patients with a past history of cerebral infarction， a significantly higher proportion of patients undergoing craniotomy， a significantly higher systolic blood pressure on admission， a significantly larger hematoma volume at baseline， a significantly lower Glasgow Coma Scale score， and a significantly higher National Institutes of Health Stroke Scale （NIHSS） score. The multivariate logistic regression analysis showed that craniotomy， a past history of cerebral infarction， an increase in NIHSS score， and an increase in neutrophil-to-lymphocyte ratio （NLR） were associated with secondary cerebral infarction during the acute stage of ICH （all P<0.05）.Conclusion A past history of cerebral infarction， craniotomy， a relatively high NIHSS score on admission， and an increase in NLR are independent factors associated with secondary cerebral infarction in patients during the acute stage of primary supratentorial ICH. Dynamic neurological assessment and radiological monitoring should be strengthened for high-risk patients to facilitate early risk stratification and individualized intervention.