Graeb评分预测伴脑室出血的高分级动脉瘤性蛛网膜下腔出血患者转归  

Graeb score predicts the outcome of high-grade aneurysmal subarachnoid hemorrhage patients with intraventricular hemorrhage

作　　者：张国锋[1] 梁锐[1] 刘慧 张心勇 曹志 刘卫兵[1] 唐尤佳 Zhang Guofeng;Liang Rui;Liu Hui;Zhang Xinyong;Cao Zhi;Liu Weibing;Tang Youjia(Department of Neurosurgery,No.1 People's Hospital of Jiujiang,Jiujiang 332000,China;Clinical Skills Center,School of Clinical Medicine of Jiujiang University,Jiujiang 332001,China)

机构地区：[1]九江市第一人民医院神经外科,332001 [2]九江学院临床医学院临床技能中心,332001

出　　处：《国际脑血管病杂志》2021年第7期507-513,共7页International Journal of Cerebrovascular Diseases

基　　金：江西省卫生健康委科技计划项目(202140277)。

摘　　要：目的探讨Graeb评分对伴脑室出血(intraventricular hemorrhage,IVH)的高分级动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者转归的预测价值。方法回顾性纳入2012年1月至2020年3月期间九江市第一人民医院连续收治的伴IVH的高分级aSAH患者。高分级aSAH定义为世界神经外科联盟(World Federation of Neurological Surgeons,WFNS)分级Ⅳ~Ⅴ级。在患者出院后3个月时采用改良Rankin量表(modified Rankin Score,mRS)进行转归评估,≤2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归模型评估Graeb评分与临床转归的相关性,并应用受试者工作特征(receiver operating characteristic,ROC)曲线确定Graeb评分对临床转归的预测价值。结果共纳入86例伴IVH的高分级aSAH患者。动脉瘤治疗方式:开颅夹闭42例(48.8%),血管内栓塞21例(24.4%),保守治疗23例(26.7%)。转归良好29例(33.7%),转归不良57例(66.3%)。多变量logistic回归分析结果显示,Graeb评分>6分[优势比(odds ratio,OR)26.360,95%置信区间(confidence interval,CI)4.106~169.235;P<0.001]、改良Fisher分级3~4级(OR 11.674,95%CI 1.540~88.512;P=0.017)以及并发慢性脑积水(OR 21.236,95%CI 2.883~156.431;P=0.003)是患者转归不良的独立危险因素。ROC曲线分析显示,Graeb评分预测转归不良的曲线下面积为0.843(95%CI 0.760~0.926;P<0.001),最佳截断值为6.5分,对应的敏感性和特异性分别为71.9%和86.2%。结论Graeb评分是伴IVH的高分级aSAH患者临床转归的独立影响因素,Graeb评分>6.5分对此类患者转归不良具有较高的预测价值。Objective To investigate the predictive value of Graeb score for the outcome of high-grade aneurysmal subarachnoid hemorrhage(aSAH)patients with intraventricular hemorrhage(IVH).Methods Consecutive high-grade aSAH patients with IVH admitted to the No.1 People's Hospital of Jiujiang from January 2012 to March 2020 were enrolled retrospectively.High-grade aSAH was defined as gradeⅣtoⅤaccording to the World Federation of Neurological Surgeons(WFNS)scale.The outcome of patients was evaluated by the modified Rankin Scale(mRS)at 3 months after discharge.A score of≤2 was defined as a good outcome and a score of>2 were defined as a poor outcome.Multivariate logistic regression model was used to evaluate the correlation between Graeb score and clinical outcome,and the receiver operating characteristic(ROC)curve was used to determine the predictive value of Graeb score for clinical outcome.Results A total of 86 high-grade aSAH patients with IVH were enrolled.Aneurysm treatment:craniotomy clipping in 42 patients(48.8%),intravascular embolization in 21(24.4%),and conservative treatment in 23(26.7%).Twenty-nine patients(33.7%)had a good outcome and 57(66.3%)had a poor outcome.Multivariate logistic regression analysis showed that the Graeb score>6(odds ratio[OR]26.360,95%confidence interval[CI]4.106-169.235;P<0.001),the modified Fisher grade 3-4(OR 11.674,95%CI 1.540-88.512;P=0.017)and complicated with chronic hydrocephalus(OR 21.236,95%CI 2.883-156.431;P=0.003)were the independent risk factors for the poor outcome.ROC curve analysis showed that the area under the curve of the Graeb score predicting for poor outcome was 0.843(95%CI 0.760-0.926;P<0.001),the best cut-off value was 6.5,and the corresponding sensitivity and specificity were 71.9%and 86.2%,respectively.Conclusion The Graeb score is an independent influencing factor affecting the clinical outcome of high-grade aSAH patients with IVH.Graeb score>6.5 had higher predictive value for the poor outcome in such patients.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 疾病严重程度指数 脑出血 脑室 治疗结果 危险因素 

分 类 号：R743.35[医药卫生—神经病学与精神病学]