摘要
目的探讨颅内动脉瘤破裂(rupture intracranial aneurysms,RIAs)介入治疗后神经系统并发症的危险因素,并建立列线图预测模型。方法回顾性研究2016年1月至2019年1月在新乡医学院附属南阳市第二人民医院89例行血管内治疗的RIAs患者临床资料,收集相关临床影像资料并进行为期6个月的术后随访,分为无神经相关并发症组(61例)和有神经相关并发症组(28例)。分析临床各指标与RIAs介入治疗术后神经相关并发症的可能有关因素;依据多因素Logistic回归分析结果,建立列线图对各影响因素进行评分,构建评分预测模型;通过一致性系数(consistency index,C-index)和校准曲线来评估模型的临床校准度,通过列线图依赖ROC曲线来评估模型的临床区分度。结果多因素Logistic回归分析结果显示,Hunt-Hess分级(OR=4.927,95%CI:1.189~20.426,P=0.028)、Fisher分级(OR=4.633,95%CI:1.012~21.208,P=0.048)、动脉瘤囊小阜(OR=5.918,95%CI:1.104~24.948,P=0.015)、宽颈动脉瘤(OR=4.381,95%CI:1.029~18.645,P=0.046)以及治疗策略(OR=4.887,95%CI:1.235~19.329,P=0.024)是RIAs介入治疗术后神经相关并发症的独立危险因素。列线图预测模型显示,Hunt-Hess分级(Ⅳ、Ⅴ级)为100分、动脉瘤囊小阜(有)为98分、治疗策略(支架植入)95分、宽颈动脉瘤(是)92分、Fisher分级(Ⅲ、Ⅳ级)为81分;该预测模型的一致性系数为0.871;列线图依赖ROC曲线AUC为0.871,对应的敏感度、特异度分别为85.71%(24/28)、77.05%(47/61)。结论Hunt-Hess分级、Fisher分级、动脉瘤囊小阜、宽颈动脉瘤以及治疗策略会影响RIAs介入治疗术后神经相关并发症的发生,以此建立的列线图能够为临床提供直观可靠的参考依据。
Objective To explore the risk factors of neurological complications after interventional treatment of ruptured intracranial aneurysms(RIAS),and to establish a predictive model of nomogram.Methods The clinical data of 89 patients with RIAS who underwent endovascular treatment in Nanyang Second General Hospital Affiliated to Xingxiang Medical University from January 2016 to January 2019 were retrospectively studied.The clinical imaging data were collected and followed up for 6 months.The patients were divided into two groups:no neurological complications group(61 cases)and neurological complications group(28 cases).To analyze the clinical indicators and the possible related factors of neurological complications after RIAS interventional therapy.A nomogram was established to score the influencing factors,and a scoring prediction model was constructed;the clinical calibration of the model was evaluated by consistency index(C-index)and calibration curve,and the clinical differentiation of the model was evaluated by nomogram relying on ROC curve.Results Multivariate logistic regression analysis showed that Hunt-Hess classification(OR=4.927,95%CI:1.189-20.426,P=0.028),Fisher classification(OR=4.633,95%CI:1.012-21.208,P=0.048),aneurysm cyst xiaofu(OR=5.918,95%CI:1.104-24.948,P=0.015),wide carotid aneurysm(OR=4.381,95%CI:1.029-18.645,P=0.046)and treatment Strategy(OR=4.887,95%CI:1.235-19.329,P=0.024)is an independent risk factor for nerve-related complications after RIAs interventional therapy.The predictive model of nomogram showed that Hunt-Hess classification(grade IV,V)was 100,aneurysm bleb(with)98,treatment strategy(stent implantation)95,wide-necked aneurysm(yes)92 and Fisher grade(grade III,IV)81;the C-index of the predictive model was 0.871;the nomogram relied on ROC curve AUC 0.871,and the treatment strategy(stent implantation)was 95;the Fisher grade(grade III,IV)was 81;the C-index of the predictive model was 0.871.The sensitivity and specificity were 85.71%(24/28)and 77.05%(47/61)respectively.Conclusion Hunt Hess classification,Fisher classification,aneurysmal sac caruncle,wide necked aneurysms and treatment strategies will affect the occurrence of neurological complications after RIAS interventional therapy.The nomogram established by this method can provide intuitive and reliable reference for clinical practice.
作者
王栋
陈昊
酒晓盈
吴环立
Wang Dong;Chen Hao;Jiu Xiaoying;Wu Huanli(Department of Neurosurgery,Nanyang Second General Hospital Affiliated to Xinxiang Medical University,Nanyang 473012,China)
出处
《中国综合临床》
2021年第1期1-6,共6页
Clinical Medicine of China
基金
河南省医学科技攻关计划联合共建项目(LHGJ20191469)
河南省医学科技攻关计划(2018020983)
南阳市科技攻关计划(KJGG143)。
关键词
颅内动脉瘤
破裂
介入治疗
神经系统相关并发症
列线图
Intracranial aneurysm
Rupture
Interventional therapy
Neurological complications
Nomograph
