转移性脊髓压迫症术后神经功能恢复的相关因素分析  

Analysis of related factors affecting recovery of nerve function after metastatic spinal cord compression

作　　者：罗志勇 徐源 秦舒 廖宗武 LUO Zhi-yong;XU Yuan;QIN Shu;LIAO Zong-wu(Department of Surgery,Sichuan Provincial Armed Police Corps Hospital,Leshan,Sichuan 614000,China;Department of Orthopedics,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]武警四川省总队医院外三科,四川乐山614000 [2]陆军军医大学第二附属医院骨科,重庆400037

出　　处：《颈腰痛杂志》2023年第5期792-796,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的分析影响转移性脊髓压迫症术后神经功能恢复的相关因素,以提高针对性治疗的效果。方法选取102例转移性脊髓压迫症术后患者临床资料,按术后Frankel神经功能分级分为A组(A-C级,n=32)与B组(D-E级,n=70),比较分析两组基线资料与神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、神经胶质纤维酸性蛋白(GFAP)之间的相关性,分析术后神经功能的相关影响因素。结果多因素Logistic回归分析显示,术前KPS评分<80分、ECOG-PS评分为3~4分、受累椎体数量≥3个、脊柱压迫症状-手术治疗的间隔时间≥48 h、运动障碍进展时间≥7 d,是影响转移性脊髓压迫症患者术后神经功能的独立危险因素。结论术前KPS评分<80分、ECOG-PS评分3~4分、受累椎体数量≥3个、脊柱压迫症状-手术治疗的间隔时间≥48 h、运动障碍进展时间≥7 d的患者术后神经功能较差,可采用NSE、S100B、GFAP进行预测,在出现不可逆神经功能障碍之前可进行有针对性治疗。Objective To analyze the related factors affecting the recovery of nerve function after metastatic spinal cord compression so as to improve the effect of targeted therapy.Methods The clinical data of 102 patients with metastatic spinal cord compression after surgery were selected for retrospective analysis.The selection time was from April 2018 to June 2020.According to the postoperative neurological function(Frankel classification),they were divided into group A(class AC,n=32)and group B(DE grade,n=70).The relevant factors affecting postoperative neurological function were analyzed,and the two groups were compared in terms of neuron-specific enolase(NSE),S100B protein(S100B),glial fibrillary acidic protein(GFAP)content.The correlation between baseline data and NSE,S100B,GFAP was explored,and the AUC,specificity,sensitivity,and Youden index of NSE,S100B,and GFAP in predicting postoperative neurological function were evaluated in patients with metastatic spinal cord compression.Results Multivariate logistic regression analysis showed that the preoperative KPS score was less than 80 points,the preoperative ECOG-PS score was 3~4 points,the number of vertebral bodies involved was≥3,the interval between spinal compression symptoms and surgical treatment was≥48h,and the progress of dyskinesia Time≥7 days were independent risk factors affecting postoperative neurological function in patients with metastatic spinal cord compression(P<0.05).Conclusion The neurological function is poor in patients with preoperative KPS score<80 points,preoperative ECOG-PS score of 3~4 points,number of vertebrae involved≥3,spinal compression symptom-surgical treatment interval≥48h,dyskinesia progression time≥7d after surgery.It is recommended to use NSE,S100B,and GFAP to predict,so as to give targeted treatment before patients have irreversible neurological dysfunction.

关 键 词：转移性脊髓压迫症 神经功能 神经元特异性烯醇化酶 S100B蛋白 神经胶质纤维酸性蛋白 

分 类 号：R687.3[医药卫生—骨科学]