动脉瘤性蛛网膜下腔出血患者介入性血管内栓塞术后发生认知障碍的影响因素及其风险预测列线图模型构建  

Influencing Factors of Cognition Disorders in Patients with Aneurysmal Subarachnoid Hemorrhage after Interventional Intravascular Embolization and Construction of Nomogram Model for Predicting Its Risk

作　　者：李晓洁 席从林 余晶晶 LI Xiaojie;XI Conglin;YU Jingjing(Department of Neurology,Huai'an Second People's Hospital,Huai'an 223002,China)

机构地区：[1]江苏省淮安市第二人民医院神经内科,223002

出　　处：《实用心脑肺血管病杂志》2025年第1期56-60,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：江苏省卫生健康委2019年度医学科研立项项目(Z2019060)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)患者介入性血管内栓塞术后发生认知障碍(CD)的影响因素,并构建其风险预测列线图模型。方法选取2021年6月—2023年12月淮安市第二人民医院收治的192例aSAH患者作为研究对象,根据介入性血管内栓塞术后3个月蒙特利尔认知评估量表(MoCA)评分将患者分为发生CD组(MoCA评分<26分)72例和未发生CD组(MoCA评分≥26分)120例。收集患者的临床资料,采用多因素Logistic回归分析探讨aSAH患者介入性血管内栓塞术后发生CD的影响因素;采用R软件构建aSAH患者介入性血管内栓塞术后发生CD的风险预测列线图模型,绘制ROC曲线以分析该列线图模型预测aSAH患者介入性血管内栓塞术后发生CD的区分度,采用Hosmer-Lemeshow拟合优度检验分析该列线图模型的拟合程度。结果两组发病至手术时间、术后3 d内脑梗死发生率、Fisher分级及神经元特异性烯醇化酶(NSE)、S100钙结合蛋白β(S100β)、超敏C反应蛋白(hs-CRP)比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,发病至手术时间[OR=1.989,95%CI(1.281~3.089)]、术后3 d内脑梗死发生情况[OR=2.361,95%CI(1.413~3.946)]、NSE[OR=2.683,95%CI(1.781~4.042)]、S100β[OR=1.180,95%CI(1.028~1.354)]、hs-CRP[OR=4.320,95%CI(2.616~7.135)]是aSAH患者介入性血管内栓塞术后发生CD的独立影响因素(P<0.05)。基于多因素Logistic回归分析结果构建aSAH患者介入性血管内栓塞术后发生CD的风险预测列线图模型,ROC曲线分析结果显示,该列线图模型预测aSAH患者介入性血管内栓塞术后发生CD的曲线下面积(AUC)为0.885[95%CI(0.839~0.930)]。Hosmer-Lemeshow拟合优度检验结果显示,该列线图模型的拟合程度较好(χ^(2)=8.803,P=0.367)。结论发病至手术时间、术后3 d内脑梗死发生情况、NSE、S100β、hs-CRP是aSAH患者介入性血管内栓塞术后发生CD的独立影响因素,基于上述因素构建的列线图模型对aSObjective To investigate the influencing factors of cognition disorders(CD)in patients with aneurysmal subarachnoid hemorrhage(aSAH)after interventional intravascular embolization and construct its risk prediction nomogram model.Methods A total of 192 patients with aSAH admitted to Huai'an Second People's Hospital from June 2021 to December 2023 were selected as the study objects,and they were divided into the CD group[Montreal Cognitive Assessment Scale(MoCA)score<26]with 72 cases and the non-CD group(MoCA score≥26)with 120 cases according to the MoCA score at 3 months after interventional intravascular embolization.Clinical data of the patients were collected.Multivariate Logistic regression analysis was used to analyze the influencing factors of CD in patients with aSAH after interventional intravascular embolization.R software was used to construct the nomogram model for predicting the risk of CD in patients with aSAH after interventional intravascular embolization,and ROC curve was drawn to analyze the discrimination of the nomogram model for predicting CD in patients with aSAH after interventional intravascular embolization,and Hosmer-Lemeshow goodness of fit test was used to analyze the fitting degree of the nomogram model.Results There were significant differences in the time from onset to operation,incidence of cerebral infarction within 3 days after operation,Fisher grade and levels of neuronspecific enolase(NSE),S100 calcium-binding proteinβ(S100β),and hypersensitive C-reactive protein(hs-CRP)between the two groups(P<0.05).Multivariate Logistic regression analysis showed that,the time from onset to operation[OR=1.989,95%CI(1.281-3.089)],incidence of cerebral infarction within 3 days after operation[OR=2.361,95%CI(1.413-3.946)],NSE[OR=2.683,95%CI(1.781-4.042)],S100β[OR=1.180,95%CI(1.028-1.354)],and hs-CRP[OR=4.320,95%CI(2.616-7.135)]were independent influencing factors of CD in patients with aSAH after interventional intravascular embolization(P<0.05).Based on the results of multivariate Logistic r

关 键 词：蛛网膜下腔出血 认知障碍 介入性血管内栓塞术 影响因素分析 列线图模型 

分 类 号：R743.35[医药卫生—神经病学与精神病学]