立体定向放射外科治疗脑转移瘤患者颅内出血相关风险因素分析  

Risk factors for intracranial hemorrhage in patients with brain metastases undergoing stereotactic radiosurgery

作　　者：冯学辉 田龙[1] 胡逸民[2] FENG Xuehui;TIAN Long;HU Yimin(Emergency Department,The First Affiliated Hospital of Hebei Northern University,Zhangjiakou,Hebei 075000,China;Department of Radiotherapy,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000 [2]中国医学科学院肿瘤医院,北京100021

出　　处：《国际神经病学神经外科学杂志》2023年第6期34-39,共6页Journal of International Neurology and Neurosurgery

基　　金：张家口市重点研发计划项目(1921002B)。

摘　　要：目的分析接受立体定向放射外科(SRS)治疗的脑转移瘤(BM)患者颅内出血(ICH)发生和致死的风险因素。方法筛选符合纳排标准的BM患者392例,分析其临床资料,包括患者项目、SRS项目、血液学项目和影像学项目。首先,根据患者接受SRS后是否出血分为ICH组(n=134)和非ICH组(n=258)。对两组行Logistic回归分析ICH发生的风险因素。之后,再分析ICH组致死的风险因素。结果有ICH史、原发灶为恶性黑色素瘤是接受SRS后BM患者ICH发生的风险因素,有ICH史和原发灶为恶性黑色素瘤的患者ICH发生风险分别提高了7.433和1.430倍(均P<0.05)。ICH组7 d内和30 d内死亡率分别为11.19%和25.37%。高血压、血小板计数、脑疝和脑积水是7 d内死亡的危险因素(均P<0.05)。脑疝和脑积水是30 d内死亡的危险因素(均P<0.05)。结论对于具备相应风险因素的患者,需提前做好预防和治疗准备,从而降低ICH发生和致死率。Objective To investigate the risk factors for the onset and death of intracranial hemorrhage(ICH)in patients with brain metastases(BM)undergoing stereotactic radiosurgery(SRS).Methods A total of 392 patients with BM who met the inclusion and exclusion criteria were selected,and their clinical data were analyzed,including patient items,SRS items,blood items,and imaging items.According to the presence or absence of bleeding after SRS,the patients were divided into ICH group with 134 patients and non-ICH group with 258 patients.A logistic regression analysis was performed for both groups to investigate the risk factors for the onset of ICH in the two groups,and it was performed for the ICH group to investigate the risk factors for death due to ICH.Results ICH history and the primary lesion of malignant melanoma were risk factors for the onset of ICH in BM patients after SRS,and the risk of ICH was increased by 7.433 times in patients with ICH history and 1.430 times in patients with malignant melanoma as the primary lesion(all P<0.05).The ICH group had a 7-day mortality rate of 11.19% and a 30-day mortality rate of 25.37%.Hypertension,low platelet count,cerebral hernia,and hydrocephalus were risk factors for death within 7 days,and the risk of death due to ICH was increased by 2.998,3.784,2.289,and 3.443 times,respectively,in patients with hypertension,low platelet count(for every 109/L reduction),cerebral hernia or hydrocephalus(all P<0.05).Cerebral hernia and hydrocephalus were risk factors for death within 30 days,and the risk of death due to ICH was increased by 3.250 and 4.453 times,respectively,in patients with cerebral hernia or hydrocephalus(all P<0.05).Conclusions It is necessary to prepare for prevention and treatment in advance for patients with corresponding risk factors,so as to reduce the incidence and mortality rates of ICH.

关 键 词：立体定向放射外科 脑转移瘤 颅内出血 风险因素 

分 类 号：R739.41[医药卫生—肿瘤]