摘要
肝硬化導致的凝血功能異常可能會增加頭部外傷後顱內出血的機會，然而肝硬化病人發生頭部外傷後進行電腦斷層檢查的適應症尚未清楚。我們以台灣健保資料庫來進行這一個以全國人口為基礎的研究，比較肝硬化與無肝硬化病人頭部外傷後顱內出血的風險，以供決定是否需要降低肝硬化病人頭部外傷後進行頭部電腦斷層檢查的閥值。我們共收錄了10,087位病人(917位肝硬化；9,170位無肝硬化)，以條件邏輯回歸的方式來比較二群病人頭部外傷後顱內出血的風險。結果發現共有223個病人發生顱內出血，其中肝硬化病人有21位(2.3%)，無肝硬化病人有202位(2.2%)。條件邏輯回歸顯示肝硬化病人比起無肝硬化病人，並無較高的顱內出血風險(odds ratio [OR]: 1.0; 95% confidence interval [CI]: 0.7–1.6)。二組在立即顱內出血(OR: 1.1; 95% CI: 0.7–1.9)與延遲性顱內出血 (OR: 0.9; 95% CI: 0.4–2.1)的比較上也無明顯差別。我們的結論是肝硬化並不會增加頭部外傷後顱內出血的風險，可能的原因是肝硬化同時減少了促凝血和抗凝血因子所造成的平衡。因此，肝硬化病人發生頭部外傷並不需要降低進行電腦斷層檢查的閥值。
關鍵詞：電腦斷層、頭部外傷、顱內出血、肝硬化Abstract
Coagulopathy in liver cirrhosis (LC) might increase the risk of intracranial hemorrhage (ICH) after a head injury (HI). However, the indications of head computed tomography (CT) in patients with LC do not evidently support this interrelation. We compared the risk of ICH between patients with and without LC to determine whether we should lower the threshold of head CT in patients with LC after HI. We did a nationwide population–based study using Taiwan’s National Health Insurance Research Database. We identified 10,087 patients with HI (917 cases of LC; 9,170 randomly selected controls without LC). Conditional logistic regression was used to measure the post–HI association between LC and ICH. Two hundred twenty–three (2.2%) patients had post–HI ICH: among them, there were 21 (2.3%) patients with LC and there were 202 (2.2%) controls. Conditional logistic regression showed that patients with LC had no greater risk of ICH (odds ratio [OR]: 1.0; 95% confidence interval [CI]: 0.7–1.6) than did controls. There were also no significant differences in the subgroup analyses of immediate ICH (OR: 1.1; 95% CI: 0.7–1.9) and delayed ICH (OR: 0.9; 95% CI: 0.4–2.1). LC did not increase the post–HI risk of ICH. The restored balance of hemostasis provided by the concomitant reduction of procoagulant and anticoagulant factors might explain this. Therefore, lowering the threshold of head CT in patients with LC seems unnecessary.
Keywords: Computed Tomography, Head Injury, Intracranial Hemorrhage, Liver Cirrhosis.