高血压脑出血患者入院时血总钙水平与预后的相关性

doi:10.3969/j.issn.1673-8640.2022.05.005

摘要/Abstract

摘要： 目的探究高血压脑出血患者入院时血清总钙离子（简称血总钙）水平与其发病30 d内死亡和6个月功能预后之间的关系。方法选取高血压脑出血患者107例,收集其入院时的临床资料[年龄、性别、合并症、美国国立卫生研究院卒中量表（NIHSS）评分、颅内血肿体积和部位、实验室相关指标检测结果等],根据入院血总钙水平将患者分为血总钙>2.75 mmol/L组（15例）、血总钙2.25~2.75 mmol/L组（63例）及血总钙<2.25 mmol/L组（29例）。采用改良Rankin量表（mRS）评价患者发病后6个月的功能状态。采用Logistic回归分析评估血总钙水平与高血压脑出血患者发病30 d内死亡及6个月功能预后的关系。采用受试者工作特征（ROC）曲线评价血总钙水平区分高血压脑出血患者预后功能良好和功能较差的效能。结果与血总钙2.25~2.75 mmol/L组和血总钙>2.75 mmol/L组比较,血总钙<2.25mmol/L组入院血肿体积更大（P<0.05）,NIHSS评分和mRS评分更高（P<0.05）,早期血肿增大例数和30 d内死亡例数更多（P<0.05）,3组之间其他指标差异均无统计学意义（P>0.05）。ROC曲线分析结果显示,血总钙水平判断高血压脑出血患者发病30 d内死亡和6个月功能预后的曲线下面积（AUC）分别为0.74、0.71。Logistic回归分析结果显示,血总钙是高血压脑出血患者的入院血肿体积和早期血肿增大的危险因素比值比[（OR）值分别为0.24、0.15,95%可信区间（CI）分别为0.11~0.69、0.08~0.87],血总钙<2.25 mmol/L组发病30 d内死亡和6个月功能预后差的风险分别是血总钙>2.75 mmol/L组的1.12倍和1.39倍。结论低血总钙水平与高血压脑出血患者发病30 d内死亡和6个月功能预后不良有关,检测血总钙水平可能有助于临床判断患者预后。

关键词: 钙离子, 高血压脑出血, 预后

Abstract: Objective To investigate the correlation between admission blood calcium level and 30 d mortality rate and 6-month functional outcome in patients with hypertensive intracerebral hemorrhage. Methods The data of patient age,sex,complications,the National Institutes of Health Stroke Scale （NIHSS）,intracranial hematoma volume and location and clinical laboratory results from 107 patients with hypertensive intracerebral hemorrhage were analyzed retrospectively. The patients were classified into >2.75 mmol/L group（15 cases）,2.25-2.75 mmol/L group（63 cases）and <2.25 mmol/L group（29 cases）. A modified Rankin Scale（mRS）>2 denoted poor functional outcome at 6 months. The correlations between calcium level,30 d mortality rate and 6-month functional outcome in hypertensive intracerebral hemorrhage was evaluated by Logistic regression analysis. Receiver operating characteristic （ROC） curve was used to distinguish hypertensive intracerebral hemorrhage patients with favorable and unfavorable functional outcome. Results Compared with >2.75 mmol/L group and 2.25-2.75 mmol/L group,the patients in <2.25 mmol/L group were presented with significantly larger intracranial hematoma（P<0.05）,higher NIHSS score and mRS score（P<0.05）,and more early hematoma enlargement 30 d mortality cases（P<0.05）and there was no statistical significance among the 3 groups（P>0.05）. Calcium level at admission predicted 30 d mortality and 6-month functional outcome with areas under curves（AUC） of 0.74 and 0.71,respectively. Calcium levels at admission were correlated with hematoma volume and early hematoma enlargement [odds ratio（OR）=0.24,95% confidence interval（CI）0.11-0.69;OR=0.15,95%CI 0.08-0.87,respectively]. The OR of 30 d mortality and poor functional outcome at 6 months of <2.25 mmol/L group were 1.12 and 1.39 as compared with >2.75 mmol/L group. Conclusions A low calcium level at admission is correlated with 30 d mortality and poor 6-month functional outcome for patients with hypertensive intracerebral hemorrhage. Blood calcium level determination may conduce to patients' prognosis identification.

Key words: Calcium, Hypertensive intracerebral hemorrhage, Prognosis

黄黎莹, 赛芳芳, 张科蓓, 孟超. 高血压脑出血患者入院时血总钙水平与预后的相关性[J]. 检验医学, 2022, 37(5): 423-428.

HUANG Liying, SAI Fangfang, ZHANG Kebei, MENG Chao. Correlation between admission blood calcium level and the prognosis of patients with hypertensive intracerebral hemorrhage[J]. Laboratory Medicine, 2022, 37(5): 423-428.

图/表 5

参考文献 18

[1]	Writing Group Members, LLOYD-JONES D, ADAMS R J, et al. Heart disease and stroke statistics--2010 update:a report from the American Heart Association[J]. Circulation, 2010, 121(7):e46-e215.
[2]	ROSAMOND W D, FOLSOM A R, CHAMBLESS L E, et al. Stroke incidence and survival among middle-aged adults:9-year follow-up of the Atherosclerosis Risk in Communities(ARIC) cohort[J]. Stroke, 1999, 30(4):736-743. DOI URL
[3]	CAO D, LI Q, FU P, et al. Early hematoma enlargement in primary intracerebral hemorrhage[J]. Curr Drug Targets, 2017, 18(12):1345-1348.
[4]	钟永盛, 陈伟强, 蔡世荣, 等. 自发性脑出血早期血清钙离子浓度及其变化趋势的临床研究[J]. 数理医药学杂志, 2017, 30(12):1760-1762.
[5]	马潞, 李浩, 吴波, 等. 自发性脑出血诊断治疗中国多学科专家共识[J]. 中华急诊医学杂志, 2015, 24(12):1319-1323.
[6]	INOUE Y, MIYASHITA F, TOYODA K, et al. Low serum calcium levels contribute to larger hematoma volume in acute intracerebral hemorrhage[J]. Stroke, 2013, 44(7):2004-2006. DOI URL
[7]	LIU J, YANG H, YU B. The correlation between blood calcium level,hematoma volume,stroke severity and prognosis in patients with acute cerebral hemorrhage[J]. Eur Rev Med Pharmacol Sci, 2016, 20(19):4119-4123.
[8]	MOROTTI A, CHARIDIMOU A, PHUAH C L, et al. Association between serum calcium level and extent of bleeding in patients with intracerebral hemorrhage[J]. JAMA Neurol, 2016, 73(11):1285-1290. DOI URL
[9]	SHAH Q A, EZZEDDINE M A, QURESHI A I. Acute hypertension in intracerebral hemorrhage:pathophysiology and treatment[J]. J Neurol Sci, 2007, 261(1-2):74-79. DOI URL
[10]	BROWN R C, DAVIS T P. Calcium modulation of adherens and tight junction function:a potential mechanism for blood-brain barrier disruption after stroke[J]. Stroke, 2002, 33(6):1706-1711. DOI URL
[11]	LIN K I, CHATTOPADHYAY N, BAI M, et al. Elevated extracellular calcium can prevent apoptosis via the calcium-sensing receptor[J]. Biochem Biophys Res Commun, 1998, 249(2):325-331. DOI URL
[12]	BICKLER P E, FAHLMAN C S. Moderate increases in intracellular calcium activate neuroprotective signals in hippocampal neurons[J]. Neuroscience, 2004, 127(3):673-683. DOI URL
[13]	PEULER J D, SCHELPER R L. Partial protection from salt-induced stroke and mortality by high oral calcium in hypertensive rats[J]. Stroke, 1992, 23(4):532-538. DOI URL
[14]	MA T Y, TRAN D, HOA N, et al. Mechanism of extracellular calcium regulation of intestinal epithelial tight junction permeability:role of cytoskeletal involvement[J]. Microsc Res Tech, 2000, 51(2):156-168. DOI URL
[15]	YOU S, HAN Q, XU J, et al. Serum calcium and phosphate levels and short- and long-term outcomes in acute intracerebral hemorrhage patients[J]. J Stroke Cerebrovasc Dis, 2016, 25(4):914-920. DOI URL
[16]	D'ERASMO E, PISANI D, ROMAGNOLI S, et al. Acute serum calcium changes in transient ischemic attack and cerebral infarction[J]. J Med, 1998, 29(5-6):331-337.
[17]	ISO H, STAMPFER M J, MANSON J E, et al. Prospective study of calcium,potassium,and magnesium intake and risk of stroke in women[J]. Stroke, 1999, 30(9):1772-1779. DOI URL
[18]	UMESAWA M, ISO H, DATE C, et al. Dietary intake of calcium in relation to mortality from cardiovascular disease:the JACC Study[J]. Stroke, 2006, 37(1):20-26. DOI URL

组别	例数	年龄/岁	性别		糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
组别	例数	年龄/岁	男性/例	女性/例	糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
血总钙<2.25 mmol/L组	29	67.52±7.38	16	13	14（48.28）	18（62.07）	24.17±9.96	8.97±2.69
血总钙2.25~2.75 mmol/L组	63	65.59±5.37	41	22	27（42.86）	44（69.84）	19.04±9.04	7.02±1.82
血总钙>2.75 mmol/L组	15	68.00±6.34	10	5	6（40.00）	11（73.33）	17.15±7.25	7.93±3.01
统计值		1.31	0.10		0.35	0.76	4.13	7.45
P值		0.28	0.62		0.84	0.68	0.02	0.001

组别	例数	年龄/岁	性别		糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
组别	例数	年龄/岁	男性/例	女性/例	糖尿病史/[例（%）]	吸烟史/ [例（%）]	血肿体积/mL	NIHSS评分/分
血总钙<2.25 mmol/L组	29	67.52±7.38	16	13	14（48.28）	18（62.07）	24.17±9.96	8.97±2.69
血总钙2.25~2.75 mmol/L组	63	65.59±5.37	41	22	27（42.86）	44（69.84）	19.04±9.04	7.02±1.82
血总钙>2.75 mmol/L组	15	68.00±6.34	10	5	6（40.00）	11（73.33）	17.15±7.25	7.93±3.01
统计值		1.31	0.10		0.35	0.76	4.13	7.45
P值		0.28	0.62		0.84	0.68	0.02	0.001

项目	单因素分析			多因素分析
项目	OR值（95%CI）	标准误	P值	OR值（95%CI）	标准误	P值
血总钙	0.14（0.11~0.31）	2.60	0.007	0.24（0.11~0.69）	0.38	0.01
APTT				0.07（0.02~1.12）	0.32	0.44
INR				0.12（0.08~1.23）	0.18	0.23
血小板计数				0.16（0.05~0.33）	0.04	0.01

项目	单因素分析			多因素分析
项目	OR值（95%CI）	标准误	P值	OR值（95%CI）	标准误	P值
血总钙	0.14（0.11~0.31）	2.60	0.007	0.24（0.11~0.69）	0.38	0.01
APTT				0.07（0.02~1.12）	0.32	0.44
INR				0.12（0.08~1.23）	0.18	0.23
血小板计数				0.16（0.05~0.33）	0.04	0.01

项目	单因素分析			多因素分析
项目	OR值（95%CI）	标准误	P值	OR值（95%CI）	标准误	P值
血总钙	0.15（0.08~0.31）	0.68	0.005	0.15（0.08~0.87）	0.70	0.006
APTT				1.03（0.56~2.03）	0.08	0.850
INR				1.25（0.65~1.89）	1.39	0.870
血小板计数				1.00（0.83~1.32）	0.01	0.850