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Received:June 05, 2025 Published Online:May 22, 2026
Received:June 05, 2025 Published Online:May 22, 2026
中文摘要: 目的 分析同型半胱氨酸（HCY）水平、年龄休克指数在老年自发性脑出血（SICH）不同预后患者中的差异及与预后的关系。方法 回顾性选取2021年12月至2024年12月期间华北理工大学附属医院神经外科收治的404例老年SICH患者，根据患者90 d预后情况分成预后良好组（155例）和预后不良组（249例）。比较两组患者一般资料、格拉斯哥昏迷量表（GCS）评分、生命体征、实验室检查指标等临床资料。通过logistic回归分析探讨老年SICH患者预后的影响因素，绘制受试者工作特征（ROC）曲线分析HCY联合年龄休克指数对老年SICH患者预后的预测价值。结果 随访90 d评价，预后不良组收缩压、GCS评分显著低于预后良好组，年龄、心率、D-二聚体、HCY、血浆凝血酶时间、血糖、年龄休克指数及破入脑室占比显著高于预后良好组（P＜0.05）。Logistic回归分析显示，增高的 HCY 水平（OR =1.220，95%CI：1.133~1.314，P＜0.01）、年龄休克指数（OR =1.241，95%CI：1.178~1.306，P＜0.01）与老年SICH患者预后不良独立相关。ROC曲线分析显示，HCY、年龄休克指数及二者联合预测老年 SICH 患者 90 d 预后的曲线下面积（AUC）分别为 0.769（95%CI：0.725~0.813）、0.878（95%CI：0.845~0.912）、0.920（95%CI：0.894~0.946），以两者联合为优，其敏感度和特异度分别为80.72%、89.67%。结论 HCY联合年龄休克指数可以预测老年SICH患者90 d预后情况。
Abstract:Objective To explore the differences in homocysteine（HCY）levels and Age Shock Index（Age-SI）among elderly spontaneous intracerebral hemorrhage （SICH） patients with different prognoses，and to analyze their relationship with prognosis. Methods A total of 404 elderly patients with SICH admitted to the Department of Neurosurgery，Affiliated Hospital of North China University of Science and Technology from December 2021 to December 2024 were selected and divided into a good prognosis group（155 cases）and a poor prognosis group（249 cases）according to their 90 - day prognosis. General data，Glasgow Coma Scale（GCS）score，admission vital signs，laboratory examination indicators and other clinical data were compared between the two groups. Logistic regression analysis was used to explore the prognostic factors of elderly patients with SICH，and receiver operating characteristic（ROC）curve was used to analyze the predictive value of HCY combined with Age-SI on the prognosis of elderly patients with SICH. Results After a 90-day follow-up，the systolic blood pressure and GCS score in the poor prognosis group were significantly lower than those in the good prognosis group，while the age，heart rate，D-dimer，HCY，plasma thrombin time，blood glucose，Age-SI and the proportion of ventricular rupture were significantly higher than those in the good prognosis group（P＜0.05）. Logistic regression analysis revealed that the increased HCY level（OR =1.220，95%CI：1.133-1.314，P＜0.01），increased Age-SI（OR =1.241，95%CI：1.178-1.306，P＜0.01）were independently associated with poor prognosis in elderly SICH patients. ROC curve analysis showed that the area under the curve（AUC）for predicting 90-day prognosis in elderly SICH patients was 0.769（95%CI：0.725-0.813）for HCY，0.878（95%CI：0.845-0.912）for Age-SI，and 0.920（95%CI：0.894-0.946）for their combination，with the combination being superior. The sensitivity and specificity were 80.72% and 89.67%，respectively. Conclusion HCY combined with Age-SI can predict the 90-day prognosis of elderly patients with SICH.
文章编号： 中图分类号：R743.34 文献标志码：A
基金项目:河北省专业教学精品案例库建设计划（KCJPZ2023031）；河北省高等学校科学研究计划（SQ2024022）
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