Analysis Of Risk Factors Of Spontaneous Intracerebral Hemorrhage Hematoma Expansion

[Background]:Spontaneous intracranial hemorrhage（SICH）is non-traumatic hemorrhage in the brain parenchyma.Spontaneous intracranial hemorrhage（SICH）mostly due to hypertension and the second most common serious disease of stroke,which usually leads to severe disability or death,accounting for 20%of all strokes.However,it accounts for nearly 50%of stroke deaths worldwide.So far,the therapeutic effects of both neurology and surgery are not satisfactory,and multiple risk factors affect the prognosis of ICH patients.Among them,16%-38%of patients with intracerebral hemorrhage will develop hematoma expansion,and its early hematoma expansion is the most common cause of poor prognosis in patients with intracerebral hemorrhage.However,there is no unified and universal standard at home and abroad for the evaluation method and definition of hematoma expansion at present.[Objective]:Through logistics regression analysis to clarify the independent risk factors that affect the increase of cerebral hemorrhage hematoma,create a logistics regression prediction model to predict the early increase of cerebral hemorrhage,explore the factors that may cause the early increase of cerebral hemorrhage in patients with cerebral hemorrhage,for the diagnosis and treatment of cerebral hemorrhage in the future Provide theoretical basis.[Method]:A total of 150 patients with intracerebral hemorrhage with complete data from the Sixth Affiliated Hospital of Guangzhou Medical University were retrospectively enrolled.65 patients with spontaneous intracerebral hemorrhage,had a relative hematoma volume increase of 33%or an absolute hematoma volume increase over 6 m L,were included in the hematoma expansion group.85 patients with spontaneous intracerebral hemorrhage,had not hematoma expansion,were included in the non-hematoma enlargement group.Detailed collect patient general condition,history of medicine,hospital laboratory index,the continuous NCCT inspection results on the day,a number of indicators,and firstly through single factor analysising by software of medical statistics SPSS 25.0,for the risk factors with statistically significant differences between groups,they were included in the final logistics regression analysis and to construct a regression model.Analyze the sensitivity and specificity of the predictive ability of the regression model through receiver operating curve（ROC）,compare the predictive performance of different predictive models with the AUC value of the area under the ROC curve,and compare the predictive performance of a single predictive indicator and the combination of multiple indicators Predictive performance at diagnosis.[Results]:SPSS 25.0 univariate analysis showed that the risk factors were statistically significant（P<0.05）,including GCS score,fasting blood glucose FPG,total blood cholesterol CHOL,high density lipoprotein HDL,low density lipoprotein LDL,initial hematoma volume V_0,history of anticoagulant use;previous antiplatelet;The morphological classification and hematoma density classification of NCCT hematoma proposed by Barras et al;and if the hematoma was irregular or the density of the hematoma was heterogeneous.Hemorrhage from the radial coronal or thalamic or with rupturing into the ventricle are also statistically significant.According to the dichotomous logistics regression analysis,the independent influencing factors of spontaneous intracerebral hemorrhage hematoma enlargement include:previous use of anticoagulant drugs（OR4.855,95%CI:1.102-21.38,P=0.037<0.05）;previous anti-platelet aggregation（OR3.831,95%CI:1.089-13.472,P=0.036<0.05）,the morphological classification of hematoma was irregular（including island sign,satellite sign,and irregular hematoma）（OR2.481,95%CI:1.429-4.308,P=0.001<0.05）,and the density classification was heterogeneous（OR2.28,95%CI:1.312-3.963,P=0.003<0.05）.According to NCCT,the risk of hematoma enlargement increases by 2.481 times for each grade of hematoma morphology,and 2.28 times for each grade of density.GCS score,as the most frequently used and widely used criterion for evaluating the severity of ICH patients,is the most important criterion for evaluating the severity of ICH patients.Higher scores often predict better outcomes,and as a protective factor in predicting HE,ICH patients with higher scores have a lower risk of developing HE（OR0.797,95%CI:0.671-0.947,P=0.01<0.05）,the higher the content of high-density lipoprotein HDL in serum as a preventive factor of atherosclerosis,the lower the risk of HE in ICH patients（OR0.116,95%CI:0.025-0.534,P=0.006<0.05）.In this study,a regression model was established by binary logistics regression analysis,which showed a high degree of fitting between the model and data.Hosmer and Lemeshow Test results showed that P=0.582,indicating a good prediction efficiency of the model and a diagnosis rate of about 84.6%.By analyzing the receiver operating curve（ROC）and using the Barras grading scale to construct the regression model for the classification of hematoma morphological density in ICH patients,the area under the ROC curve:AUC values were all between 0.5 and 1.0,AUC values were:0.907,the prediction efficiency is good.In the construction of logistics regression model,we used Barras grading standard to classify the shape and density of ICH patients’hematoma.[Conclusion]:The patient had a history of long-term use of anticoagulants and antiplatelet aggregation drugs.At admission,the patient had a low GCS score,a high degree of disturbance of consciousness,and a low serum HDL concentration.The CT imaging results included the following features:For example,mixed density and irregular shape of hematoma are independent risk factors for hematoma enlargement after intracerebral hemorrhage.When using the grading scale proposed by Barras,Boulouis et al.,the higher the grade of hematoma shape and density in patients with intracerebral hemorrhage,the higher the risk of patients with increased early hematoma.The predictive model of multi-index combination has good predictive performance for the early hematoma enlargement of spontaneous intracerebral hemorrhage.When ICH patients have multiple risk factors,the risk of early hematoma enlargement is higher.