下肢深静脉血栓形成与脑出血患者预后的关系研究 Relationship between Deep Vein Thrombosis of the Lower Extremity and Prognosis of Patients with IntracerebralHemorrhage

目的 探讨急性脑出血患者住院期间下肢深静脉血栓形成（deep vein thrombosis，DVT）与预后之间的关系。 方法 本研究分析2012年5月-2013年1月中国国家卒中登记Ⅱ数据库连续纳入的脑出血患者，收集患者的一般临床资料、既往病史、入院后首次实验室检查结果、血压水平、住院期间是否进行手术治疗、住院医疗花费、出院时NIHSS和mRS评分。发病3个月、6个月、12个月分别对患者进行随访，记录mRS。根据住院期间下肢静脉超声结果将患者分为DVT组和无DVT组，比较2组间基线资料和随访时预后不良（mRS≥3分）率的差异。通过logistic回归分析DVT对患者出院时和12个月时功能预后的影响，进一步分析不同年龄亚组中DVT对预后的影响。 结果 研究共纳入脑出血患者3020例，住院期间发生DVT者22例，无DVT者2998例。出院时不良预后患者1365例（45.2%），发病12个月不良预后患者905例（30.0%）。l ogi sti c回归分析发现，下肢DVT是急性脑出血患者短期及长期不良预后的独立危险因素（出院时OR 4.157，95%CI 1.530～11.296 P =0.0052；12个月时OR 2.894，95%CI 1.027～8.155，P =0.0444）。在＞60岁的患者人群中，下肢DVT是出院时不良预后的独立危险因素（OR 4.575，95%CI 1.299～16.115，P =0.0179）。 结论 下肢DVT增加急性脑出血患者短期和长期的不良预后率，尤其在高龄患者中更应引起关注。 Abstract: Objective To investigate the relationship between deep vein thrombosis (DVT) of the lower extremity and prognosis of patients with acute intracerebral hemorrhage (ICH). Methods This study enrolled the consecutive ICH patients from the China national stroke registry (CNSR) Ⅱ database from May 2012 to January 2013. The baseline clinical data and mRS scores at 3-month, 6-month and 12-month follow-up were collected. All the included patients were divided into DVT group and non-DVT group according to having DVT of the lower extremity or not. Logistic regression analysis was used to analyze the effect of DVT on the functional prognosis at discharge and 12 months in ICH patients. The effect of DVT on prognosis in different age subgroups was further analyzed. Results A total of 3020 ICH participants were finally included in this study. There were 22 DVT patients and 2998 non-DVT ones during the hospitalization. 1365 patients (45.2%) had poor prognosis at discharge and 905 patients (30.0%) had poor prognosis at 12 months. Logistic regression analysis showed that DVT of the lower extremity was an independent risk factor for short-term and long-term prognosis of patients with acute ICH (at discharge: OR 4.157, 95%CI 1.530-11.296, P=0.0052; 12 months: OR 2.894, 95%CI 1.027-8.155, P=0.0444), especially in patients >60 years old subgroup (OR 4.575, 95%CI 1.299-16.115, P=0.0179). Conclusions DVT of the lower extremity may increase the risk of poor prognosis of ICH patients, especially in elder patients.