血清钙浓度与高血压性脑出血患者预后的相关性研究
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摘要
目的探讨血钙浓度与高血压脑出血(hypertensive intracerebral hemorrhage, HICH)患者预后之间的关系。方法前瞻性连续纳入在我院入住的HICH患者220例,根据入院时测得的血钙浓度将患者分为正常血钙组145例,低血钙组45例,高血钙组30例,同时收集患者基线资料和头部CT/MRI扫描等结果,随访预后情况使用格拉斯预后量表(Grasse Prognosis Scale, GCS)进行评估;采用多因素Logistic回归分析评估入院时血钙浓度对HICH预后的影响。结果低血钙组血肿量大、格拉斯哥昏迷评分评分低、血肿破入脑室和再出血的风险高、需要手术治疗的比例高,预后不良的比例(71.1%)显著高于正常组(35.1%)和高血钙组(33.3%)(均P<0.05);Logistic回归分析结果显示,低钙血症是影响HICH预后的一个独立危险因素。结论入院时伴有低钙血症的HICH患者病情危重、预后不良的风险高。
Objective To investigate the effect of serum calcium concentration on the prognosis of patients with hypertensive intracerebral hemorrhage(HICH). Methods According to the blood calcium concentration measured at the admission, the patients were divided into three groups, normal blood calcium group(n=145), hypocalcemia group(n=45) and hypercalcemia group(n=30). At the same time, baseline data and head CT/MRI scans were collected, and follow-up prognosis was assessed using Grasse Prognosis Scale(GCS). Multivariate logistic regression analysis was used to evaluate the effect of serum calcium concentration at admission on the prognosis of HICH. Results The hypocalcemia group had a larger amount of hematoma, a lower GCS score, a higher risk of hematoma breaking into the ventricle and rebleeding, and a higher proportion of patients requiring surgery. The proportion of poor prognosis(71.1%) was significantly higher than that of normal group(35.1%) and hypercalcemia group(33.3%)(P<0.05). Logistic regression analysis showed hypocalcemia is an independent risk factor affecting prognosis of HICH. Conclusion HICH patients with hypocalcemia at admission are at high risk of critical illness and poor prognosis.
Objective To investigate the effect of serum calcium concentration on the prognosis of patients with hypertensive intracerebral hemorrhage(HICH). Methods According to the blood calcium concentration measured at the admission, the patients were divided into three groups, normal blood calcium group(n=145), hypocalcemia group(n=45) and hypercalcemia group(n=30). At the same time, baseline data and head CT/MRI scans were collected, and follow-up prognosis was assessed using Grasse Prognosis Scale(GCS). Multivariate logistic regression analysis was used to evaluate the effect of serum calcium concentration at admission on the prognosis of HICH. Results The hypocalcemia group had a larger amount of hematoma, a lower GCS score, a higher risk of hematoma breaking into the ventricle and rebleeding, and a higher proportion of patients requiring surgery. The proportion of poor prognosis(71.1%) was significantly higher than that of normal group(35.1%) and hypercalcemia group(33.3%)(P<0.05). Logistic regression analysis showed hypocalcemia is an independent risk factor affecting prognosis of HICH. Conclusion HICH patients with hypocalcemia at admission are at high risk of critical illness and poor prognosis.
引文
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[14] Hock-Kean L, Hung-Yu C, Li-Chuan H et al. Acute alcohol intoxication aggravates brain injury caused by intracerebral hemorrhage in rats[J]. J Stroke Cerebrovasc Dis, 2016, 25(1): 15-25.
[15] Sten O, Boris Z, Pierlugig N. Regulation of cell death: the calcium-apoptosis link[J]. Nat Rev Mol Cell Biol, 2003, 4(7): 552-565.
[16] Zou M, Dong H, Meng X, et al.Store-operated Ca2+ entry plays a role in HMGB1-induced vascular endothelial cell hyperpermeability[J]. PLoS One, 2015, 10(4): e0123432.
[17] Chen Y, Strasser S, Cao Y, et al.Calcium intake and hypertension among obese adults in United States: associations and implications explored[J]. J Hum Hypertens, 2015, 29(9): 541-547.
[18] 张福征, 王才永, 张磊, 等. 血清钙与急性脑出血患者血肿量的相关性研究[J]. 中华神经外科杂志, 2016, 32(11): 1147-1150.
[2] Chang JJ, Khorchid Y, Dillard K, et al. Elevated pulse pressure levels are associated with increased in-hospital mortality in acute spontaneous intracerebral hemorrhage[J]. Am J Hypertens, 2017, 30(7): 719-725.
[3] 王忠诚.神经外科学.第2版[M]. 长沙:湖北科学技术出版社,2015.
[4] Buck BH, Liebeskind DS, Saver JL, et al. Association of higher serum calcium levels with smaller infarct volumes in acute ischemic stroke[J]. Arch Neurol, 2007, 64(9): 1287-1291.
[5] Versteeg HH, Heemskerk JW, Levi M, et al. New fundamentals in hemostasis[J]. Physiol Rev, 2016, 93(1): 327-358.
[6] Borah M, Dhar S, Gogoi DM, et al. Association of serum calcium levels with infarct size in acute ischemic stroke: observations from Northeast India[J]. J Neurosci Rural Pract, 2016, 7(Suppl 1):S41-S45.
[7] You S, Han Q, Xu J, et al. Serum calcium and phosphate levels and short- and long-term outcomes in acute intracerebral hemorrhage patients[J]. J Stroke Cerebrovasc Dis, 2016, 25(4): 914-920.
[8] 中华医学会神经病学分会. 中国脑出血诊治指南(2014)[J]. 中华神经科杂志, 2015, 48(6): 435-444.
[9] Drimmelen-Krabbe JJ, Van Bradley WG, Orgogozo JM, et al. The application of the International Statistical Classification of Diseases to neurology: ICD-10 NA[J]. J Neurol Sci, 1998, 161(1): 2-9.
[10] 刘茂春, 郑晓梅, 普摇. 血清钙镁与急性脑出血病情及预后的相关性研究[J]. 现代临床医学, 2018, 44(2):118-120.
[11] Inoue Y, Miyashita F, Toyoda K, et al. Low serum calcium levels contribute to larger hematoma volume in acute intracerebral hemorrhage[J]. Stroke, 2013, 44(7):2004-2006.
[12] Berridge MJ. The inositol trisphosphate/calcium signaling pathway in health and disease[J]. Physiol Rev, 2016, 96(4): 1261-1296.
[13] Aksoy D, Bammer R, Mlynash M, et al. Magnetic resonance imaging profile of blood-brain barrier injury in patients with acute intracerebral hemorrhage[J]. J Am Heart Assoc, 2013, 2(3): e000161.
[14] Hock-Kean L, Hung-Yu C, Li-Chuan H et al. Acute alcohol intoxication aggravates brain injury caused by intracerebral hemorrhage in rats[J]. J Stroke Cerebrovasc Dis, 2016, 25(1): 15-25.
[15] Sten O, Boris Z, Pierlugig N. Regulation of cell death: the calcium-apoptosis link[J]. Nat Rev Mol Cell Biol, 2003, 4(7): 552-565.
[16] Zou M, Dong H, Meng X, et al.Store-operated Ca2+ entry plays a role in HMGB1-induced vascular endothelial cell hyperpermeability[J]. PLoS One, 2015, 10(4): e0123432.
[17] Chen Y, Strasser S, Cao Y, et al.Calcium intake and hypertension among obese adults in United States: associations and implications explored[J]. J Hum Hypertens, 2015, 29(9): 541-547.
[18] 张福征, 王才永, 张磊, 等. 血清钙与急性脑出血患者血肿量的相关性研究[J]. 中华神经外科杂志, 2016, 32(11): 1147-1150.
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