血浆和肽素水平对急性脑出血患者临床结局的预测研究 Predictive Value of Plasma Copeptin for Outcome of Patients with Acute Cerebral Hemorrhage

目的 研究血浆和肽素水平对脑出血患者临床结局的预测价值。 方法 连续入组2011年1月-2012年5月期间住院的自发性脑出血患者，并收集患者的性别、年龄、既往史及血压、实验室检查、影像学检查信息等。入院时进行GCS评分及NIHSS评分，检测血浆和肽素水平。随访患者30 d生存情况及90 d功能预后（mRS评分）。应用Logistic回归分析上述因素对急性脑出血患者30 d死亡及90 d预后不良（mRS评分≤3分）的预测价值。 结果 共有133例患者纳入研究。9例（6.8%）患者在脑出血后30 d内死亡。在90 d随访期内，55例（41.4%）患者功能预后不良。基线期血肿体积（OR 1.06，95%CI 1.00～1.13，P=0.047）及NIHSS评分（OR 1.21，95%CI 1.05～1.39，P=0.01）是脑出血90 d预后不良的独立预测因素，基线GCS评分（OR1.41，95%CI 1.21～1.63，P=0.03）及血浆和肽素水平（OR 2.50，95%CI 1.16～5.37，P=0.02）是脑出血患者30 d内死亡的独立预测因素。 结论 血浆和肽素水平高是脑出血短期死亡的独立预测因素。 Objective To investigate the predictive value of plasma copeptin in patients with intracranial hemorrhage. Methods Patients with spontaneous cerebral hemorrhage who were hospitalized in Beijing Tian Tan Hospital from January 2011 to May 2012 were consecutively enrolled. Clinical data of patients, such as gender, age, previous history, blood pressure, laboratory test results, imaging information, as well as GCS and NIHSS scores and plama Copeptin levels were collected at admission. The outcome at 30-day and 90-day was assessed by mRS. Logistic regression analysis was used to evaluate the predictive value of plasma copeptin for 30-day mortality and unfavorable prognosis at 90-day. Results A total of 133 patients were included in the study. 9 patients (6.8%) died within 30 days of cerebral hemorrhage. 55 patients (41.4%) had unfavorable functional prognosis at 90-day followup. Baseline hematoma volume (OR 1.06, 95%CI 1.00-1.13, P=0.047) and NIHSS score (OR 1.21, 95%CI 1.05-1.39, P=0.01) were independent predictors of poor prognosis at 90 days after intracerebral hemorrhage. GCS score (OR 1.41, 95%CI 1.21-1.63, P=0.03) and plasma Copeptin level (OR 2.50, 95%CI 1.16-5.37, P=0.02) were independent predictors of 30-day mortality after intracerebral hemorrhage. Conclusions Increased plasma copeptin level is an independent predictive factor of 30-day mortality in patients with spontaneous cerebral hemorrhage.