CAJ | 학술논문

目的：既往临床研究表明脑出血患者急性期C反应蛋白（C-reactive protein， CRP）水平显著升高，但CRP水平与基底节区脑出血早期神经功能恶化（ early neurological deterioration ， END）的关系仍不明确。文中探讨血清CRP和基底节区脑出血END的关系。方法连续收集2010年1月至2012年12月于南京军区南京总医院经头颅CT确诊为基底节区脑出血的患者142例。 END定义为48 h内复评加拿大卒中量表（ Canadian Stroke Scale ， CSS）较入院时减少≥1分。比较END患者组和非END患者组间基线资料，同时Logistic回归分析CRP水平和基底节区脑出血END的相关性。结果纳入的142例基底节区脑出血患者中，31例（21．8％）发生了 END。与非 END 组患者比较，END 组患者高血糖症发生率（29．03％ vs 11．71％， P＝0．018）、中性粒细胞计数[（11．8±1．2）×109／L vs （7．8±7．7）×109／L， P＝0．019]、CRP（P＝0．001）、血肿增大（54．83％vs 19．81％， P＝0．001）、血肿体积[（23．6±21．9）mL vs （14．8±12．7）mL， P＝0．005]及出血破入脑室率（68．75％vs 28．83％， P＜0．001）的差异均有统计学意义。经Logistic回归分析校正混杂因素后示：CRP（OR＝1．072，95％CI：1．034～1．112，P＝0．001）、出血破入脑室（OR＝4．162，95％CI：1．498～11．564，P＝0．006）及血肿增大（OR＝5．297，95％CI：1．906～14．723，P＝0．001）与住院期间发生END显著相关。 ROC曲线分析表明血清CRP水平对基底节区脑出血早期神经功能恶化有预测价值（OR＝0．812，95％CI：0．732～0．891，P＜0．001）。结论血清CRP水平升高和基底节区脑出血END显著相关，故可作为该病的重要预测因素。
목적：기왕림상연구표명뇌출혈환자급성기C반응단백（C-reactive protein， CRP）수평현저승고，단CRP수평여기저절구뇌출혈조기신경공능악화（ early neurological deterioration ， END）적관계잉불명학。문중탐토혈청CRP화기저절구뇌출혈END적관계。방법련속수집2010년1월지2012년12월우남경군구남경총의원경두로CT학진위기저절구뇌출혈적환자142례。 END정의위48 h내복평가나대졸중량표（ Canadian Stroke Scale ， CSS）교입원시감소≥1분。비교END환자조화비END환자조간기선자료，동시Logistic회귀분석CRP수평화기저절구뇌출혈END적상관성。결과납입적142례기저절구뇌출혈환자중，31례（21．8％）발생료 END。여비 END 조환자비교，END 조환자고혈당증발생솔（29．03％ vs 11．71％， P＝0．018）、중성립세포계수[（11．8±1．2）×109／L vs （7．8±7．7）×109／L， P＝0．019]、CRP（P＝0．001）、혈종증대（54．83％vs 19．81％， P＝0．001）、혈종체적[（23．6±21．9）mL vs （14．8±12．7）mL， P＝0．005]급출혈파입뇌실솔（68．75％vs 28．83％， P＜0．001）적차이균유통계학의의。경Logistic회귀분석교정혼잡인소후시：CRP（OR＝1．072，95％CI：1．034～1．112，P＝0．001）、출혈파입뇌실（OR＝4．162，95％CI：1．498～11．564，P＝0．006）급혈종증대（OR＝5．297，95％CI：1．906～14．723，P＝0．001）여주원기간발생END현저상관。 ROC곡선분석표명혈청CRP수평대기저절구뇌출혈조기신경공능악화유예측개치（OR＝0．812，95％CI：0．732～0．891，P＜0．001）。결론혈청CRP수평승고화기저절구뇌출혈END현저상관，고가작위해병적중요예측인소。
Objective Clinical studies show that the level of C-reactive protein ( CRP ) markedly increases in the acute phase of cerebral hemorrhage .However , the correlation of the CRP level with early neurological deterioration ( END) in patients with basal ganglia hemorrhage remains unclear .This study investigated the correlation between CRP and END in basal ganglia hemorrhage . Methods This study included 142 cases of basal ganglia hemorrhage diagnosed by cranial CT between Jan 2010 and Dec 2012 .END was defined as any decrease in Canadian Stroke Scale ( CSS) score≥1 point in the first 48 hours after stroke onset .We compared the baseline data between the END and non-END patients and evaluated the correlation between CRP and END by logistic regression analy -sis. Results END was found in 31 (21.8%) of the 142 patients.Univariate analysis of the END versus non-END cases showed that hyperglycemia (29.03 vs 11.71%, P=0.018), neutrophil count ([11.8 ±1.2] vs [7.8 ±7.7] ×109/L, P=0.019), CRP (P=0.001), hematoma expansion (54.83 vs 19.81%, P=0.001), hematoma volume ([23.6 ±21.9] vs [14.8 ±12.7] mL, P=0.005), and intraventricular hemorrhage (68.75 vs 28.83%, P<0.001) were significantly associated with END .Logistic regression a-nalysis indicated that the CRP level (OR=1.072, 95%CI:1.034-1.112, P=0.001), intraventricular hemorrhage (OR=4.162, 95%CI: 1.498 -11.564, P =0.006), and hematoma expansion (OR=5.297, 95%CI:1.906-14.723, P=0.001) were correlated with END in the patients during their hospital stay .ROC analysis man-ifested the predictive value of the CRP level for END in basal ganglia hemorrhage (OR=0.812, 95%CI: 0.732 -0.891, P <0.001). Conclusion The elevated level of CRP is significantly correlated with END in patients with basal ganglia hemorrhage and therefore can be re-garded as a predictive factor for this condition .