血管内介入栓塞术后迟发性脑梗死危险因素分析  

Analysis of risk factors for delayed cerebral infarction after intravascular interventional emboli⁃zation

作　　者：丁永强 武跃辉[1] 李信晓 陈超[1] 王新军[1] DING Yongqiang;WU Yuehui;LI Xinxiao;CHEN Chao;WANG Xinjun(The Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第五附属医院,河南郑州450052

出　　处：《中国实用神经疾病杂志》2023年第10期1227-1231,共5页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20190418)。

摘　　要：目的分析血管内介入栓塞术后迟发性脑梗死(DCI)的危险因素以及相关临床意义。方法选择2010-01—2020-01在郑州大学第五附属医院因颅内动脉瘤行单纯弹簧圈栓塞术或支架辅助弹簧圈栓塞术的患者83例。依据术后是否发生DCI分为迟发性脑梗死组(DCI组)11例患者,非迟发性脑梗死组(NDCI组)72例患者。采用单因素和多因素Logistic回归分析筛选出与DCI发生相关的危险因素,构建受试者工作特征(ROC)曲线对危险因素的预测效能进行验证。结果单因素分析显示性别(P<0.010)、D-二聚体(P=0.010)、动脉瘤直径(P<0.010)、脑血管痉挛(P<0.010)与支架辅助弹簧圈栓塞(SAC)(P=0.014)是血管内介入栓塞术后发生DCI的危险因素。多因素Logistic回归分析显示女性(P=0.028,OR=0.024,95%CI:1.507~9.664)、脑血管痉挛(P=0.009,OR=31.330,95%CI:2.372~413.875)、SAC(P=0.049,OR=25.949,95%CI:1.009~67.090)是血管内介入栓塞术后发生DCI的危险因素。基于多因素Logistic回归分析的危险因素来构建ROC曲线,结果显示女性(AUC=0.802,灵敏度90.9%,特异度69.4%,P<0.010)、脑血管痉挛(AUC=0.745,灵敏度54.6%,特异度94.4%,P<0.010)和SAC(AUC=0.686,灵敏度63.6%,特异度73.6%,P=0.048)均能有效预测DCI的发生。结论性别、脑血管痉挛以及SAC治疗是血管内介入栓塞术后发生DCI的危险因素并且具有良好的预测效能。Objective To analyze the risk factors for delayed cerebral infarction(DCI)after interventional vascular embolization and its clinical significance.Methods From January 2010 to January 2020,83 patients with intracranial aneurysm underwent no-stent coil or stent-assisted coil in the Fifth Affiliated Hospital of Zhengzhou University were selected.According to the occurrence of postoperative DCI,11 patients were divided into delayed cerebral infarction group(DCI group).Non-delayed cerebral infarction group(NDCI group),a total of 72 patients.Univariate and multivariate Logistic regression analysis was used to screen out the risk factors associated with DCI,and receiver operating characteristic(ROC)curve was constructed to verify the predictive efficiency of risk factors.Results Univariate analysis showed gender(P<0.010),D-dimer(P=0.010),aneurysm diameter(P<0.010),cerebrovascular spasm(P<0.010)and stent-assisted Coil(SAC)(P=0.014)were risk factors for DCI after interventional embolization.Multivariate Logistic regression analysis showed that women(P=0.028,OR=0.024,95%CI:1.507-9.664),cerebrovascular spasm(P=0.009,OR=31.330,95%CI:2.372-413.875)and SAC(P=0.049,OR=25.949,95%CI:1.009-67.090)were risk factors for DCI after vascular interventional embolization.The ROC curve was constructed based on the risk factors of multivariate Logistic regression analysis.The results showed that women(AUC=0.802,sensitivity 90.9%,specificity 69.4%,P<0.010),cerebrovascular spasm(AUC=0.745,sensitivity 54.6%,specificity 94.4%,P<0.010)and SAC(AUC=0.686,sensitivity 63.6%,specificity 73.6%,P=0.048)could effectively predict the occurrence of DCI.Conclusion Gender,cerebral vasospasm and SAC are risk factors for DCI after interventional embolization and have good predictive efficacy.

关 键 词：颅内动脉瘤 支架辅助弹簧圈栓塞 迟发性脑梗死 危险因素 ROC曲线 

分 类 号：R743.34[医药卫生—神经病学与精神病学]