脑血流自动调节功能与中青年脑出血患者预后的相关性研究Association of Cerebral Autoregulation with Outcomes after Intracerebral Hemorrhage in Young and Middle-Aged Patients

目的 探讨中青年脑出血（intracerebral hemorrhage，ICH）患者动态脑血流自动调节（cerebral autoregulation，CA）功能与预后的相关性。 方法 本研究采用前瞻性队列设计，纳入2024年11月—2025年10月于吉林大学第一医院卒中中心就诊的ICH患者，分别于发病3 d内与发病后7～10 d完成CA功能检测。应用传递函数分析计算CA参数：相位差、增益、相干函数。以发病90 d mRS评分作为预后评估标准，将患者分为良好预后（mRS评分0～1分）组与不良预后（mRS评分2～6分）组。采用多因素logistic回归模型分析CA与预后的相关性，并绘制ROC曲线评估CA参数对ICH患者良好预后的预测效能。 结果 本研究最终共纳入73例患者，年龄（49.8±7.2）岁，男性51例。其中，良好预后组33例，不良预后组40例。良好预后组发病3 d内患侧相位差高于不良预后组（P<0.001）。多因素logistic回归分析显示，发病3 d内患侧相位差与90 d良好预后独立相关（OR 0.947，95%CI 0.898～0.999，P=0.046）。ROC曲线分析显示，发病3 d内患侧相位差预测90 d良好预后的AUC为0.771，具有较好的区分能力。发病3 d内健侧相位差、双侧增益及发病后7～10 d的所有CA参数在两组间差异均无统计学意义。 结论 发病3 d内患侧相位差与中青年ICH患者90 d功能预后相关，且具有一定预测价值。 Objective To explore the association between dynamic cerebral autoregulation (CA) and outcomes in young and middle-aged patients with intracerebral hemorrhage (ICH). Methods This prospective study enrolled patients with ICH at the Stroke Center of the First Hospital of Jilin University from November 2024 to October 2025. CA function was tested within 3 days and at 7-10 days after ICH onset. Phase difference, gain, and coherence function were obtained through transfer function analysis. The mRS score at 90 days was used as the prognostic assessment criterion, and patients were divided into a favorable outcome (mRS score 0-1) group and an unfavorable outcome (mRS score 2-6) group. A multivariate logistic regression model was used to analyze the association between CA and clinical outcome, and the ROC curve was plotted to evaluate the predictive efficacy of CA parameters for favorable outcome. Results A total of 73 patients were included in this study, with a mean age of (49.8±7.2) years, 51 of whom were male. Of the 73 patients, 33 were in the favorable outcome group and 40 in the unfavorable outcome group. The phase difference on the affected side within 3 days after onset was higher in the favorable outcome group than in the unfavorable outcome group (P<0.001). Multivariate logistic regression analysis showed that the phase difference on the affected side within 3 days after onset was independently associated with a favorable outcome at 90 days (OR 0.947, 95%CI 0.898-0.999, P=0.046). ROC analysis showed that the phase difference on the affected side within 3 days after onset had an AUC of 0.771 for predicting a favorable outcome at 90 days, indicating good discriminatory ability. No statistically significant differences were found between the two groups in the phase difference on the contralateral side within 3 days, bilateral gain within 3 days, or any CA parameters at 7-10 days after onset. Conclusions The phase difference on the affected side within 3 days after onset is significantly associated with the 90-day functional outcomes of young and middle-aged ICH patients and may have predictive value.