摘要
目的结合患者术前系统免疫炎症指数(SII)与控制营养状况(CONUT)评分,探讨颈动脉内膜剥脱术(CEA)后患者短期预后的影响因素。方法回顾性分析徐州医科大学附属医院神经外科2018年5月—2023年6月行CEA的197例患者的临床资料,纳入患者一般资料、术前影像学表现(对侧颈动脉是否中重度狭窄、颈动脉狭窄长度以及Willis环完整性)、术前血液学指标、术中阻断期平均动脉压(MAP)及颈动脉阻断时间等,计算SII及CONUT评分。将纳入的患者分为2组:有并发症组(n=18)和无并发症组(n=179)。采用单因素及多因素logistic回归分析患者CEA后预后的独立危险因素,并构建列线图模型。以受试者工作特征(ROC)曲线下面积(AUC)评估模型对CEA预后的预测价值。结果单因素及多因素logistic回归分析结果显示,术中阻断期MAP<20%、CONUT评分及C-反应蛋白与血清白蛋白比值(CAR)为颈动脉狭窄患者CEA后不良预后的独立危险因素(P<0.05)。ROC曲线分析结果显示,MAP、COUNT评分、CAR三者联合预测患者不良预后的效果优于三者单一预测,其AUC值为0.984。结论术中阻断期MAP、CAR及CONUT评分可能是辅助评估颈动脉狭窄患者CEA后短期预后的潜在指标,基于术中阻断期MAP、CAR及CONUT评分构建的列线图模型对患者短期预后的预测具有较高的准确性,可为患者带来临床获益。
Objective To explore the factors influencing the short-term prognosis of patients after carotid endarterectomy(CEA)by preoperative systemic immune-inflammation index(SII)combined with the controlling nutritional status(CONUT)score.Methods A total of 197 patients who underwent CEA in Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University from May 2018 to June 2023 were selected for retrospectively analysis.Their clinical data were collected,including general information,preoperative imaging findings(whether there was moderate to severe contralateral stenosis,the length of stenosis,and the integrity of the Willis circle),preoperative hematological indices,mean arterial pressure(MAP)during the intraoperative occlusion period,and carotid artery occlusion time.The SII and CONUT scores were calculated.The patients were divided into two groups:a complication group(n=18)and a non-complication group(n=179).Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative prognosis after CEA,and a nomogram model was constructed.The predictive value of the model for CEA prognosis was evaluated using the area under the receiver operating characteristic(ROC)curve(AUC).Results Univariate and multivariate logistic regression analyses showed that MAP<20%during the intraoperative occlusion period,CONUT score,and the C-reactive protein to serum albumin ratio(CAR)were independent risk factors for poor postoperative prognosis in patients with carotid artery stenosis undergoing CEA(P<0.05).The ROC curve analysis indicated that the combined prediction model incorporating MAP,CONUT score,and CAR was superior to each predictor alone,with an AUC value of 0.984.Conclusions MAP during the intraoperative occlusion period,CAR,and CONUT score may serve as potential indicators for assessing the prognosis of patients with carotid artery stenosis after CEA.The nomogram model based on these parameters demonstrates high accuracy in predicting patient outcomes,potentially providing clinical benefits.
作者
黎传清
周一凡
王强
谢满意
李中林
LI Chuanqing;ZHOU Yifan;WANG Qiang;XIE Manyi;LI Zhonglin(Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002)
出处
《徐州医科大学学报》
CAS
2024年第8期599-606,共8页
Journal of Xuzhou Medical University
基金
江苏省基础研究计划自然科学基金-面上项目(BK20231160)。
关键词
颈动脉内膜剥脱术
系统免疫炎症指数
控制营养状况评分
术后并发症
预后
危险因素
carotid endarterectomy
systemic immune-inflammation index
controlling nutritional status
postoperative complications
prognosis
risk factor
