头颅CT灰质/白质比例对成人心搏骤停后昏迷患者预后的判断价值
The prognostic value of gray-white matter ratio on brain computed tomography in comatose adult survivors from cardiac arrest
目的 探讨头颅CT灰质/白质比例(GWR)对成人心搏骤停(CA)后昏迷患者神经功能预后的判断价值.方法 回顾性分析了2011年1月至2016年1月南京医科大学第一附属医院61例复苏后72 h内行头颅CT检查的成人CA患者,测定其灰质和白质密度(HU值),同时评价不同GWR对神经功能不良预后(CPC评分3~5分)的预测价值.结果 与预后良好组比较,预后不良组灰质密度显著减低,白质密度变化在两组间差异无统计学意义(P<0.05).预后不良组GWR均显著低于预后良好组(P<0.05).基底节区GWR< 1.18预测不良预后的敏感度和特异度分别为50%和88.2% (P=0.012).结论 CA复苏后昏迷患者头颅CT提示GWR降低与神经功能不良预后相关,头颅CT GWR测定可作为预后评估的有效手段.
更多Objective To evaluate the correlation between the gray-white matter ratio (GWR) and the outcomes of comatose adult survivors from cardiac arrest (CA) in Chinese.Methods Sixty-one CA patients checked with CT scans within 72 hours of resuscitation from January 2011 to January 2016 were included in this single-center retrospective study.Gray and white matter density (Hounsfield units) were measured,and the GWRs were calculated according to previous studies.The prognostic values of the GWRs in predicting poor outcomes (Cerebral Performance Category 3-5) were analyzed.Results The density values of gray matter were significantly higher in the good outcome group than those in the poor one.All GWRs were significantly higher in the good outcome group (P < 0.05).A GWR (basal ganglia) < 1.18 predicted poor outcomes with a sensitivity and specificity of 50.0% and 88.2%,respectively (P =0.012).Conclusions Low GWRs,determined from brain CT scans in comatose CA patients after resuscitation,were associated with poor neurological outcomes.GWR determination from brain CT can be a useful indicator for outcome prediction aiding in an optimal clinical decision process in comatose survivors from CA.
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