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中华脑科疾病与康复杂志(电子版) ›› 2026, Vol. 16 ›› Issue (03) : 150 -155. doi: 10.3877/cma.j.issn.2095-123X.2026.03.003

临床研究

青中年高血压脑出血患者早期神经功能恶化的影响因素分析
来建梅1, 王如海1,†(), 邓继祥2, 胡海成1, 孙菲琳1, 杨震1, 马鑫梅3   
  1. 1236000　阜阳，阜阳师范大学附属第二医院神经外科
    2236041　阜阳，阜阳师范大学医学院
    3310053　杭州，浙江中医药大学临床医学院
  • 收稿日期:2025-08-12 出版日期:2026-06-15
  • 通信作者: 王如海

Influencing factors for the occurrence of early neurological deterioration in young and middle-aged patients with hypertensive intracerebral hemorrhage

Jianmei Lai1, Ruhai Wang1,†(), Jixiang Deng2, Haicheng Hu1, Feilin Sun1, Zhen Yang1, Xinmei Ma3   

  1. 1Department of Neurosurgery, the Second Affiliated Hospital of Fuyang Normal University, Fuyang 236000, China
    2Medical College of Fuyang Normal University, Fuyang 236041, China
    3School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
  • Received:2025-08-12 Published:2026-06-15
  • Corresponding author: Ruhai Wang
  • Supported by:
    Transversal Medical Research Program of Fuyang Normal University(2024FYNUEY05, 2025FYNUFY04)
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引用本文：

来建梅, 王如海, 邓继祥, 胡海成, 孙菲琳, 杨震, 马鑫梅. 青中年高血压脑出血患者早期神经功能恶化的影响因素分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2026, 16(03): 150-155.

Jianmei Lai, Ruhai Wang, Jixiang Deng, Haicheng Hu, Feilin Sun, Zhen Yang, Xinmei Ma. Influencing factors for the occurrence of early neurological deterioration in young and middle-aged patients with hypertensive intracerebral hemorrhage[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2026, 16(03): 150-155.

目的

探讨青中年高血压脑出血（HICH）患者发生早期神经功能恶化（END）的影响因素。

方法

回顾性分析阜阳师范大学附属第二医院神经外科自2018年1月至2024年12月收治的205例青中年HICH患者的临床资料。根据患者入院后72 h内是否出现END分为END组和非END组。采用多因素Logistic回归分析筛选青中年HICH患者发生END的独立影响因素，并据此构建Logistic回归预测模型。采用受试者工作特征（ROC）曲线及曲线下面积（AUC）评价各影响因素对END的预测价值。

结果

205例患者中，35例发生END（END组），END发生率为17.1%，余170例纳入非END组。2组患者的年龄、入院时GCS评分、入院时血肿体积、脑出血部位、破入脑室、首次CT扫描时间、复发性呕吐、入院时收缩压、入院时舒张压、纤维蛋白原（FIB）水平比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，年龄、入院时血肿体积、首次CT扫描时间、复发性呕吐是青中年HICH患者发生END的独立影响因素（P<0.05）。ROC曲线分析结果显示，年龄、入院时血肿体积、首次CT扫描时间、复发性呕吐预测END发生的AUC分别为0.700（截断值为47岁）、0.880（截断值为15 mL）、0.843（截断值为2.1 h）、0.824，所有指标联合预测END发生的AUC为0.948（95%CI：0.908~0.974，P<0.001），预测效能高于单项指标。

结论

青中年HICH患者END发生率较高，年龄、入院时血肿体积、首次CT扫描时间、复发性呕吐是其发生END的独立影响因素。临床应警惕上述特征，早期识别并干预END，以改善患者预后。

关键词: 高血压脑出血, 早期神经功能恶化, 青中年, 影响因素
Objective

To investigate influencing factors for the occurrence of early neurological deterioration (END) in young and middle-aged patients with hypertensive intracerebral hemorrhage (HICH).

Methods

A retrospective study was used to analyze the clinical data of 205 young and middle-aged patients with HICH admitted to Neurosurgery Department of the Second Affiliated Hospital of Fuyang Normal University from January 2018 to December 2024. The patients were divided into END group and non-END group according to whether the patients suffered from END within 72 h after admission. Independent influencing factors for the occurrence of END were determined by multivariate Logistic regression analysis, and the Logistic regression prediction model was constructed based on them. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were employed to assess the capacity of different influencing factors in determining END.

Results

Among 205 HICH patients, 35 cases showed END (the END group), and the incidence of END was 17.1%, the remaining 170 patients were in the non-END group. There was statistically significant difference in age, admission GCS score, admission volume of hematoma, site of HICH, rupturing into the ventricular system, first CT scan time, recurrent vomiting, systolic blood pressure at admission, diastolic blood pressure at admission and level of fibrinogen between the two groups (P<0.05). Multivariate binary Logistic regression analysis showed age, admission volume of hematoma, first CT scan time, recurrent vomiting were independent influencing factors for END. ROC curves showed that AUC of age, admission volume of hematoma, first CT scan time, recurrent vomiting were 0.700 (47 years as the threshold for age), 0.880 (15 mL as the threshold for admission volume of hematoma), 0.843 (2.1 h as the threshold for first CT scan time), 0.824. The AUC of the influencing factors combined to predict END was 0.948 (95%CI: 0.908-0.974, P<0.001), demonstrating superior predictive performance compared with individual single indicators.

Conclusions

Young and middle-aged patients with HICH show a high incidence of END, which is associated with age, admission hematoma volume, first CT scan time, and recurrent vomiting. In clinical practice, attention should be paid to these features to enable early identification and intervention of END, thereby improving patient prognosis.

Key words: Hypertensive intracerebral hemorrhage, Early neurological deterioration, Young and middle-aged, Influencing factors
图1 青中年HICH患者发生END的影像学资料A：发病20 min后的CT表现（血肿17 mL）；B：发病6 h后的CT表现（20 mL）；C：发病21 h后的CT表现（血肿75 mL）；D：术后CT表现（术前双侧瞳孔散大，术后形成右侧大面积脑梗死）；HICH：高血压脑出血；END：早期神经功能恶化
Fig.1 Imaging data of END in young and middle-aged patients with HICH
表1 2组青中年HICH患者临床资料比较
Tab.1 Comparison of clinical data between two groups of young and middle-aged patients with HICH
项目 END组（n=35） 非END组（n=170） χ2/t/Z值 P值
性别[例（%）]     0.932 0.334
男 26（74.3） 112（65.9）    
女 9（25.7） 58（34.1）    
年龄(岁，mean±SD) 46.9±7.7 51.9±5.6 -3.656 <0.001
糖尿病[例(%)] 3（8.6） 18（10.6） 0.128 0.720
入院时GCS评分（分，mean±SD） 11.9±1.4 14.1±1.0 -8.285 <0.001
入院时血肿体积（mL，mean±SD） 18.0±4.3 10.0±5.4 9.564 <0.001
脑出血部位[例(%)]     5.099 0.024
基底节 31（88.6） 119（70.0）    
丘脑 4（11.4） 51（30.0）    
破入脑室[例（%）]     4.383 0.036
是 10（28.6） 24（14.1）    
否 25（71.4） 146（85.9）    
首次CT扫描时间（h，mean±SD） 1.3±0.6 2.6±1.2 -9.364 <0.001
复发性呕吐[例(%)]     26.742 <0.001
是 21（60.0） 31（18.2）    
否 14（40.0） 139（81.8）    
入院时收缩压（mmHg，mean±SD） 180.7±25.6 169.2±30.9 2.064 0.040
入院时舒张压（mmHg，mean±SD） 109.3±15.2 98.4±19.3 3.653 0.001
WBC（×109/L，mean±SD） 8.5±3.0 7.8±2.6 1.477 0.141
PLT（×109/L，mean±SD） 201.6±57.5 201.0±60.7 0.053 0.958
血清总钙浓度（mmol/L，mean±SD） 2.3±0.2 2.3±0.2 -0.641 0.524
血钾水平（mmol/L，mean±SD） 3.3±0.4 3.4±0.5 -1.229 0.220
血糖水平（mmol/L，mean±SD） 7.6±2.4 7.0±2.9 1.085 0.279
D-二聚体[mg/L，M（P25，P75）] 0.2（0.2，0.3） 0.3（0.1，0.6） -0.773 0.440
FIB（g/L，mean±SD） 2.4±0.8 2.9±0.8 -3.484 0.001
PT（s，mean±SD） 11.8±1.1 11.8±0.9 -0.274 0.784
TT（s，mean±SD） 17.6±1.8 17.1±1.7 1.539 0.125
APTT（s，mean±SD） 26.0±4.0 26.5±4.5 -0.571 0.568
表2 青中年HICH患者发生END的多因素Logistic回归分析
Tab.2 Multivariate Logistic regression analysis for the occurrence of END in young and middle-aged patients with HICH
指标 偏回归系数 标准误 Wald χ2值 OR值 95%CI P值
年龄 -0.113 0.051 4.843 0.893 0.807~0.988 0.028
入院时GCS评分 -0.407 0.339 1.439 0.666 0.343~1.294 0.230
入院时血肿体积 0.186 0.091 4.189 1.204 1.008~1.438 0.041
脑出血部位 -0.085 0.881 0.009 0.918 0.163~5.162 0.923
破入脑室 0.746 1.024 0.532 0.474 0.064~3.525 0.466
首次CT扫描时间 -1.449 0.509 8.662 0.223 0.082~0.606 0.003
复发性呕吐 -1.471 0.643 5.225 0.230 0.065~0.811 0.022
入院时收缩压 0.009 0.018 0.257 1.009 0.974~1.045 0.612
入院时舒张压 -0.010 0.029 0.115 0.990 0.935~1.048 0.735
FIB -0.497 0.403 1.518 0.609 0.276~1.341 0.218
常量 11.744 6.389 3.378 - - 0.066
图2 青中年HICH患者发生END影响因素的ROC曲线HICH：高血压脑出血；END：早期神经功能恶化；ROC：受试者工作特征
Fig.2 ROC curve analysis of influencing factors for END occurrence in young and middle-aged HICH patients
表3 青中年HICH患者END发生影响因素的ROC曲线结果
Tab.3 Results of ROC curve analysis for influencing factors predicting END in young and middle-aged HICH patients
指标 曲线下面积 截断值 灵敏度（%） 特异度（%） 95%CI P值
年龄 0.700 47岁 48.57 82.35 0.632~0.752 <0.001
入院时血肿体积 0.880 15 mL 80.00 85.29 0.827~0.921 <0.001
首次CT扫描时间 0.843 2.1 h 91.43 68.82 0.786~0.890 <0.001
复发性呕吐 0.824 - 78.79 86.08 0.789~0.856 <0.001
联合预测 0.948 - 91.43 90.00 0.908~0.974 <0.001
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[15] 吴太南, 杨丽霞, 张雯杰, 陈敬芳. 急诊抢救室滞留患者"下转"代理决策现状及影响因素分析[J/OL]. 中华卫生应急电子杂志, 2026, 12(02): 65-70.
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