青年动脉瘤性蛛网膜下腔出血患者术后2年生存及预后影响因素的多中心研究  

A multicenter study on factors affecting 2-year postoperative survival and prognosis in young patients with aneurysmal subarachnoid hemorrhage

作　　者：颜荣[1] 安秀虎 汪邦月 张琳[1] 杨新宇[2] 陈镭[1] Yan Rong;An Xiuhu;Wang Bangyue;Zhang Lin;Yang Xinyu;Chen Lei(Department of Neurosurgery,the Fifth Central Hospital of Tianjin,Tianjin 300450,China;Department of Neurosurgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津市第五中心医院神经外科,天津300450 [2]天津医科大学总医院神经外科,天津300052

出　　处：《中华神经外科杂志》2024年第10期984-990,共7页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82271302);天津医科大学总医院临床研究项目(22ZYYLCCG07);天津市卫生健康委员会科技项目(TJWJ2023QN101)。

摘　　要：目的探讨影响青年(年龄≤40岁)动脉瘤性蛛网膜下腔出血(aSAH)患者术后2年生存及预后的相关因素。方法回顾性分析2017年1月至2020年12月天津医科大学总医院等12家医院的神经外科诊治的177例青年aSAH患者的临床资料,根据治疗方法分为动脉瘤开颅夹闭治疗组(简称夹闭组,78例)和血管内栓塞治疗组(简称栓塞组,99例),收集并比较两组患者的临床资料,按1∶1倾向性评分进行匹配,分析匹配后两组患者的基线资料、住院期间并发症及术后2年预后的差异。将改良Rankin量表评分(mRS)0~2分定义为预后良好。对匹配后的青年aSAH患者进行单因素Cox回归分析,将单因素分析中P<0.05的变量及性别、年龄纳入多因素Cox回归模型进行术后2年生存分析;采用单因素和多因素logistic回归分析法分析影响青年aSAH患者术后2年预后的危险因素。采用Kaplan-Meier法计算两组患者术后2年生存率,并采用log-rank检验比较两组患者生存率的差异。结果夹闭组与栓塞组患者按1∶1倾向性评分匹配后(共计匹配成功54对),两组患者的年龄、性别、Hunt-Hess分级、随访时间等基线资料,病死率,出院时及术后2年的mRS,住院期间并发症的差异均无统计学意义(均P>0.05),但夹闭组患者的住院时长较栓塞组长,差异具有统计学意义(P=0.001)。单因素Cox回归分析结果显示,Hunt-Hess分级Ⅳ~Ⅴ级及术后并发脑缺血、应激性溃疡出血、肝功能异常、尿路感染、贫血是影响青年aSAH患者术后2年生存的风险因素(均P<0.05);多因素Cox回归分析结果显示,Hunt-Hess分级Ⅳ~Ⅴ级是影响青年aSAH患者术后2年生存的危险因素(HR=13.61,95%CI:3.11~59.63,P=0.001)。单因素logistic回归分析结果显示,Hunt-Hess分级Ⅳ~Ⅴ级及术后并发脑缺血、肺炎是青年aSAH患者术后2年预后不良的影响因素(均P<0.05);多因素logistic回归分析结果显示,Hunt-Hess分级Ⅳ~Ⅴ级(OR=8.47,95%CI:1.75~41.05ObjectiveTo explore the related factors affecting 2-year postoperative survival and prognosis of young patients with aneurysmal subarachnoid hemorrhage(aSAH).MethodsA retrospective analysis was conducted on the clinical data of 177 young patients(age≤40 years)with aSAH treated in the Department of Neurosurgery at 12 hospitals including Tianjin Medical University General Hospital from January 2017 to December 2020.According to the treatment methods,they were divided into two groups:aneurysm surgical clipping group(SC group,78 cases)and endovascular coiling group(EC group,99 cases).The clinical data of the two groups of patients were collected and compared,and matched according to a 1∶1 propensity score.The differences in baseline data,complications during hospitalization,and 2-year outcome between the two groups of patients after matching were analyzed.A modified Rankin scale sore(mRS)of 0-2 was defined as a good prognosis.Univariate Cox regression analysis was performed on the matched young aSAH patients.Variables with P<0.05 in the univariate analysis,gender,and age were included in the multivariate Cox regression model for 2-year survival prognosis analysis.Univariate and multivariate logistic regression analyses were used for analyze the risk factors affecting the 2-year prognosis of young patients with aSAH.The Kaplan-Meier method was used to calculate the 2-year survival rate of the two groups of patients,and the log-rank test was used to compare the difference in survival rates between the two groups.ResultsAfter the patients in the SC group and the EC group were matched according to the 1∶1 propensity score(a total of 54 pairs were successfully matched),there were no statistically significant differences in the baseline data of the two groups of patients(including age,gender,Hunt-Hess classification and follow-up time),mortality rate,mRS at discharge and 2 years post surgery,or complications during hospitalization(all P>0.05).However,the length of hospitalization of patients in the SC group was longe

关 键 词：蛛网膜下腔出血 动脉瘤 破裂 青年人 血管内操作 预后 动脉瘤夹闭 

分 类 号：R651.12[医药卫生—外科学]