摘要
目的分析影响动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者介入术后认知功能障碍的影响因素并构建其风险预测模型。方法选取2020年1月至2024年6月中国人民解放军空军军医大学第二附属医院神经外科收治的209例aSAH患者为研究对象,根据介入术后是否发生认知功能障碍分为认知功能障碍组[蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评分<26分,n=82]和认知功能正常组(MoCA评分≥26分,n=127)。采用多因素Logistic回归分析探讨aSAH患者介入术后认知功能障碍的影响因素,并以此构建列线图模型;采用受试者工作特征曲线评估列线图模型对aSAH患者介入术后认知功能障碍的预测价值。结果认知功能障碍组年龄≥60岁、合并高血压、发病至入院时间、入院时格拉斯哥昏迷量表(glasgow coma scale,GCS)评分<9分、Hunt-Hess分级(Ⅲ~Ⅳ级)、Fisher分级(Ⅲ~Ⅳ级)、动脉瘤最大直径≥5 mm、有脑室引流比例、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、D-二聚体高于认知功能正常组,差异均有统计学意义(P<0.05)。多因素Logistic结果显示,合并高血压(OR=2.059,95%CI:1.461~2.901)、入院时GCS<9分(OR=0.429,95%CI:0.294~0.626)、Hunt-Hess分级(Ⅲ~Ⅳ级)(OR=2.729,95%CI:1.777~4.192)、LDL-C升高(OR=2.489,95%CI:1.672~3.706)、D-二聚体升高(OR=3.080,95%CI:1.959~4.844)是aSAH患者介入术后认知功能障碍的独立危险因素(P<0.05)。构建预测aSAH患者介入术后认知功能障碍的列线图模型,结果显示,一致性指数为0.876(95%CI:0.823~0.929)。列线图模型预测aSAH患者介入术后认知功能障碍的曲线下面积为0.879(95%CI:0.826~0.932),特异度为68.15%,灵敏度为92.45%。结论aSAH患者介入术后认知功能障碍的危险因素包括合并高血压、入院时GCS评分、Hunt-Hess分级、LDL-C、D-二聚体,据此构建的列线图模型对aSAH患者介入术后认知功能障碍预测价值较高。
Objective To explore the factors affecting cognitive dysfunction in patients with aneurysmal subarachnoid hemorrhage(aSAH)after interventional surgery and to establish a risk prediction model.Methods 209 patients with aSAH admitted to the Department of Neurosurgery,the Second Affiliated Hospital of the Air Force Medical University from January 2020 to June 2024 were selected as the subjects of this study,and were divided into cognitive dysfunction group[Montreal Cognitive Assessment Scale(MoCA)score<26,n=82]and normal cognitive function group(MoCA score≥26,n=127)according to the occurrence of cognitive dysfunction after interventional surgery.The influencing factors of cognitive dysfunction in patients with aSAH after interventional surgery were explored by Multivariate Logistic regression,and a nomogram model was constructed upon this analysis.The predictive value of the nomogram model for postoperative cognitive impairment in patients with aSAH was evaluated by ROC.Results The age of the cognitive dysfunction group≥60 years old,combined with hypertension,glasgow coma scale(GCS)score<9,Hunt-Hess grade(Ⅲ-Ⅳ),Fisher grade(Ⅲ-Ⅳ),the maximum diameter of aneurysm≥5 mm and the proportion of ventricular drainage were higher than those of the normal cognitive function group,and the time from onset to admission was longer than that of the normal cognitive function group.Low density lipoprotein cholesterol(LDL-C)and D-dimer levels were higher than those in normal cognitive function group(P<0.05).Multivariate analysis showed that patients with hypertension(OR=2.059,95%CI:1.461-2.901),GCS<9 points at admission(OR=0.429,95%CI:0.294-0.626),Hunt-Hess classification(Ⅲ-Ⅳ)(OR=2.729,95%CI:1.777-4.192),elevated LDL-C(OR=2.489,95%CI:1.672-3.706),and elevated D-dimer(OR=3.080,95%CI:1.959-4.844)were independent risk factors for postoperative cognitive impairment in patients with aSAH(P<0.05).A nomogram model was constructed to predict cognitive dysfunction in patients with aSAH after interventional surgery,and the results showed that the consistency index was 0.876(95%CI:0.823-0.929).The area under the curve was 0.879(95%CI:0.826-0.932),the specificity was 68.15%,and the sensitivity was 92.45%.Conclusions The risk factors for postoperative cognitive dysfunction in aSAH patients include hypertension,GCS score at admission,Hunt-Hess grade,LDL-C and D-dimer,and the nomogram model constructed on this analysis has a high predictive value for postoperative cognitive dysfunction in aSAH patients.
作者
张萌
张贞
金小敏
李蒙
邓剑平
杨小林
ZHANG Meng;ZHANG Zhen;JIN Xiaomin;LI Meng;DENG Jianping;YANG Xiaolin(Department of Neurosurgery,2Department of Emergency,the Second Affiliated Hospital of the Air Force Medical University,Xi'an,Shaanxi 710038,China)
出处
《中华神经外科疾病研究杂志》
2025年第2期26-31,共6页
Chinese Journal of Neurosurgical Disease Research
基金
陕西省重点研发计划项目(2023-YBSF-096)。
