颅内椎基底动脉干大动脉瘤栓塞的时机及术后脑血管痉挛的因素分析  

Timing of embolization of intracranial vertebral basilar trunk large aneurysm and the factors for postoperative cerebral vasospasm

作　　者：段佳[1] 潘飞豹 谭关平 DUAN Jia;PAN Feibao;TAN Guanping(Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院,四川遂宁629000

出　　处：《中国实用神经疾病杂志》2023年第12期1488-1494,共7页Chinese Journal of Practical Nervous Diseases

基　　金：四川省医学青年创新科研项目(编号:Q22014)。

摘　　要：目的探究颅内椎基底动脉干大动脉瘤(VBTLAs)栓塞的时机及术后脑血管痉挛的因素。方法选取2017-01—2021-03收治的颅内VBTLAs患者186例,治疗时机≤3d为早期组(n=109)和>3d为延期组(n=77)。比较2组患者的临床资料、栓塞效果及并发症情况。随访24个月,根据术后是否出现脑血管痉挛情况分为脑血管痉挛组(n=47)和无脑血管痉挛组(n=139)。比较2组VBTLAs患者的临床资料,多因素分析影响VBTLAs患者术后脑血管痉挛的因素,构建列线图预测模型并评价其预测效能,通过X-tile软件将模型分层,探讨其临床应用价值。结果延期组的Raymond动脉瘤栓塞程度分级(Ⅰ、Ⅱ级)、治疗后NIHSS评分、MBI评分及术后并发症优于早期组(P<0.05)。186例患者治疗后发生脑血管痉挛47例(25.27%)。脑血管痉挛组在年龄≥55岁、出血次数≥2次、Hunt-Hess分级(Ⅲ、Ⅳ级)、Fisher分级(3、4级)、手术时机(晚期)、HIF-2α、MMP-2、MMP-9、HMGB1、CRP、IL-6、PCT、TNF-α方面高于无脑血管痉挛组(P<0.05)。年龄≥55岁、出血次数≥2次、Hunt-Hess分级(Ⅲ、Ⅳ级)、Fisher分级(3、4级)、手术时机(晚期)、HIF-2α≥97.66ng/L、MMP-2≥118.03μg/L、MMP-9≥223.79μg/L、HMGB1≥91.99μg/L、CRP≥4.29mg/L是影响VBTLAs患者术后脑血管痉挛的独立危险因素(P<0.05)。基于9个危险因素建立的预测模型,验证前后的C-index值为0.834(95%CI:0.333~1.345)、0.812(95%CI:0.245~1.367),验证前后的ROC曲线下面积(AUC)分别为0.843(95%CI:0.778~0.898,P<0.001)和0.814(95%CI:0.773~0.864,P<0.001),具有较高的净获益值,安全可靠,实用性强。高风险组脑血管痉挛发生率明显高于中风险组和低风险组(χ2=6.456,P=0.005)。结论颅内VBTLAs患者早期栓塞治疗,并发症越少;年龄≥55岁、出血次数≥2次、Hunt-Hess分级(Ⅲ、Ⅳ级)、Fisher分级(3、4级)、手术时机(晚期)、HIF-2α≥97.66ng/L、MMP-2≥118.03μg/L、MMP-9≥223.79μg/L、HMGB1≥91.99μg/L、CRP≥4.2Objective To investigate the timing of embolization of vertebral basilar trunk large aneurysmsand the factors for postoperative cerebral vasospasm.Methods A total of 186 patients with intracranial VBTLAs who were admitted from January 2017 to March 2021 were selected as early group(n=109)and delayed group(n=77)according to treatment time≤3 days.The clinical data,embolization effect and complications of the two groups were compared.After 24 months of follow-up,the patients were divided into cerebral vasospasm group(n=47)and non-cerebral vasospasm group(n=139)according to the occurrence of postoperative cerebral vasospasm.The clinical data of two groups of VBTLAs patients were compared.Multi-factor analysis of factors affecting postoperative cerebral vasospasm in patients with VBTLAs.The prediction model of line graph was constructed and its prediction efficiency was evaluated.The model was stratified by X-tile software to discuss its clinical application value.Results Raymond aneurysm embolization grade(gradeⅠ,gradeⅡ),NIHSS score after treatment,MBI score and postoperative complications in the delayed group were better than those in the early group(P<0.05).After treatment,47 cases(25.27%)of 186 patients developed cerebral vasospasm.Age≥55 years old,bleeding frequency≥2 times,Hunt-Hess grade(ⅢandⅣ),Fisher grade(3 and 4),timing of operation(late stage),HIF-2α,MMP-2,MMP-9,HMGB1,CRP,IL-6,PCT and TNF-αin cerebral vasospasm group were higher than those in non-cerebral vasospasm group(P<0.05).Age≥55 years old,bleeding frequency≥2 times,Hunt-Hess grade(ⅢandⅣ),Fisher grade(3 and 4),timing of operation(late stage),HIF-2α≥97.66 ng/L,MMP-2≥118.03μg/L,MMP-9≥223.79μg/L,HMGB1≥91.99μg/L and CRP≥4.29 mg/L were independent risk factors for postoperative cerebral vasospasm in patients with VBTLAs(P<0.05).The prediction model was established based on 9 risk factors.The C-index values before and after validation were 0.834(95%CI:0.333-1.345)and 0.812(95%CI:0.245-1.367),and the area under ROC curve

关 键 词：椎基底动脉干大动脉瘤 后循环动脉瘤 栓塞时机 脑血管痉挛 

分 类 号：R743[医药卫生—神经病学与精神病学]