列线图预测经翼点入路夹闭破裂前循环动脉瘤患者的预后  

A nomogram predicts the prognosis of patients with ruptured anterior circulation aneurysms after clipping surgery via the pterional approach

作　　者：李继波 代金龙 杜向阳 吕楠 LI Ji-bo;DAI Jin-long;DU Xiang-yang;LV Nan(Department of Neurosurgery,LuAn Traditional Chinese Medicine Hospital,LiuAn 237001,China;Department of Neurosurgery,The First Affiliated Hospital,Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]安徽省六安市中医院神经外科,安徽六安237001 [2]海军军医大学第一附属医院神经外科,上海200433

出　　处：《实用医院临床杂志》2021年第2期37-42,共6页Practical Journal of Clinical Medicine

基　　金：上海市卫生健康委员会科研课题计划(编号:20194Y0131)。

摘　　要：目的探讨影响经翼点入路夹闭破裂前循环动脉瘤患者预后的因素,构建预测患者预后情况的列线图模型。方法选择六安市中医院收治的71例前循环动脉瘤破裂的患者,均采用经翼点入路夹闭术治疗。术后6个月采用格拉斯哥预后评级(GOS)评估患者预后,Ⅰ~Ⅲ级纳入预后不良组,Ⅳ~Ⅴ级纳入预后良好组。采用多因素logistic回归筛选影响患者预后的独立危险因素,并建立列线图预测前循环动脉瘤破裂患者采用经翼点入路夹闭术治疗后预后不良的风险。结果预后不良组共12例(16.90%),预后良好组共59例(83.10%)。多因素Logistic回归显示,年龄、IL-6、NLR、改良Fisher评分、Hunt-Hess分级是预测经翼点入路夹闭破裂前循环动脉瘤患者预后的独立影响因素。基于上述因子建立的列线图具有良好的区分度(AUC=0.916)和校准度(χ2=9.125,P=0.362),能够准确预测经翼点入路夹闭破裂前循环动脉瘤患者预后不良的风险。结论列线图可以精确预测采用经翼点入路夹闭术治疗后预后不良的风险,有助于及时采取防治措施以改善患者预后。Objective To analyze the factors affecting the prognosis of patients with ruptured anterior circulation aneurysms after clipping surgery via the pterional approach,and construct a nomogram model for predicting the prognosis of the patients.Methods A total of 71 patients with ruptured anterior circulation aneurysms after clipping surgery via the pterional approach in our hospital were recruited.The prognosis of the patients after 6 months of surgery was evaluated by the Glasgow outcome scale(GOS).Patients with gradeⅠ~Ⅲwere included in poor outcome group,and those with gradeⅣ~Ⅴwere in good outcome group.Multivariate logistic regression was used to screen independent risk factors that affect the prognosis of the patients,and a nomogram was established to predict the risks of poor outcome in these patients.Results There were 12 cases(16.90%)in the poor outcome group and 59 cases(83.10%)in the good outcome group.Multivariate logistic regression analysis showed that age,IL-6,neutrophil to lymphocyte ratio(NLR),modified Fisher score and Hunt-Hess classification were independent influencing factors for the prognosis of the patients.The nomogram established based on the above factors showed good discrimination(AUC=0.916)and calibration(χ2=9.125,P=0.362),indicating an accurate prediction for the risk of poor outcome.Conclusion The nomogram can accurately predict the risk of poor outcome in patients with ruptured anterior circulation aneurysms after clipping surgery via the pterional approach.It helps to take timely preventive measures to improve the prognosis of the patients.

关 键 词：前循环动脉瘤 蛛网膜下腔出血 格拉斯哥预后评级 经翼点入路 列线图 预测 

分 类 号：R651.1[医药卫生—外科学]