CAJ | 학술논문

目的：评价原始脑出血量表在预测脑动静脉畸形脑出血患者预后中的可行性。方法：收集徐州医学院附属医院2005-2012年76名脑动静脉畸形出血患者，并取得人口学、影像学等临床资料。采用改良的Rankin Scale法对3个月时的临床结果进行评估。当结果不良（mRS≥3）时，使用最大的Youden指数区分与预测准确性相关的年龄及出血量的分界值。脑动静脉畸形-脑出血评分量表在oICH量表的基础上使用了新的年龄和出血量的分界值，应用受者作用特征分析法评价两者的预测能力。结果：①患者平均年龄为（31±18）岁，平均脑出血量为（24±10）ml。随访3个月时，2例（2.5%）患者死亡，14例（18%）恶化。②以出血量35 ml、年龄37岁作为预测结果差的最佳分界值，AVM-ICH及oICH两个量表曲线下面积为0.922和0.885，均有较为准确的预测性（P=0.153），两者具有相接近的灵敏度（P=1.00），但前者特异性较高（P<0.05）。结论：oICH量表可较为准确地预测脑动静脉畸形破裂所致脑出血的不良结果，对其年龄和脑出血量的分界值进行简单调整可提高该评分的效果，并能在一定程度上防止对不良结果的风险估计过高。
목적：평개원시뇌출혈량표재예측뇌동정맥기형뇌출혈환자예후중적가행성。방법：수집서주의학원부속의원2005-2012년76명뇌동정맥기형출혈환자，병취득인구학、영상학등림상자료。채용개량적Rankin Scale법대3개월시적림상결과진행평고。당결과불량（mRS≥3）시，사용최대적Youden지수구분여예측준학성상관적년령급출혈량적분계치。뇌동정맥기형-뇌출혈평분량표재oICH량표적기출상사용료신적년령화출혈량적분계치，응용수자작용특정분석법평개량자적예측능력。결과：①환자평균년령위（31±18）세，평균뇌출혈량위（24±10）ml。수방3개월시，2례（2.5%）환자사망，14례（18%）악화。②이출혈량35 ml、년령37세작위예측결과차적최가분계치，AVM-ICH급oICH량개량표곡선하면적위0.922화0.885，균유교위준학적예측성（P=0.153），량자구유상접근적령민도（P=1.00），단전자특이성교고（P<0.05）。결론：oICH량표가교위준학지예측뇌동정맥기형파렬소치뇌출혈적불량결과，대기년령화뇌출혈량적분계치진행간단조정가제고해평분적효과，병능재일정정도상방지대불량결과적풍험고계과고。
Objective: To evaluate the effect of original intracerebral hemorrhage score(oICH) on predicting the prognosis of patients with arteriovenous malformation-associated intracerebral hemorrhage(AVM-ICH). Methods: Seventy-six patients with AVM-ICH were selected from our college during the period 2005-2012. Clinical data on demographics and radiographics were obtained through retrospective chart review. Clinical outcome at 3 months was assessed by the modified Rankin Scale(mRS). Maximum Youden Index was used to identify cutoffs for age and ICH volume that are associated with optimal predictive accuracy for an unfavorable outcome (mRS ≧ 3). Arteriovenous malformation-associated original intracerebral hemorrhage score(AVM-oICH) based on oICH has the cutoff points of new age and ICH volume. The predictive ability of both oICH and AVM-oICH was evaluated by analysis of receiver operating characteristic (ROC). Results: ①The mean age for patients was (31±18)yeas, and mean ICH volume was (24±10) ml. When follow-up was carried out for 3 months, 2 patients(2.5%) were dead, 14 patients(18%) had a poor outcome.②ICH volume of 35 ml and age of 37 years were identiifed as optimal cutoffs for predicting poor outcome. AVM-oICH and oICH showed good predictive accuracy with area under the curve(AUC) of 0.922 and 0.885(P=0.153), and similarly high sensitivity(P=1.00), but the former had a higher speciifcity(P<0.05). Conclusion: oICH has a high accuracy in predicting the functional outcome of AVM-ICH. Simple adjustments of the cutoff points of age and ICH volume can improve its performance and reduce the probability of overestimating the risk of poor outcome after AVM-ICH.