颅内动脉瘤介入栓塞术后近期预后不良的因素分析及风险预测模型绘制

doi:10.3760/cma.j.cn441417-20250115-16027

摘要/Abstract

摘要：

目的　分析颅内动脉瘤（IA）介入栓塞术后近期预后不良的影响因素，绘制风险预测Nomogram模型并验证其效能。方法　采用回顾性分析，选取2020年6月至2024年6月西电集团医院收治的278例IA介入栓塞术患者，其中男107例，女171例，年龄（57.08±8.94）岁，体重指数（BMI）为（23.11±3.88）kg/m²。根据患者术后1个月预后情况分为预后不良组、预后良好组，比较两组临床资料，采用t检验、χ²检验进行统计学比较，多因素logistic回归分析患者预后不良的影响因素。应用R软件构建风险预测Nomogram模型，绘制受试者工作特征曲线（ROC）和校准曲线分析Nomogram模型对IA介入栓塞术后近期预后不良发生风险的预测效能及校准度。结果　IA介入栓塞术后近期预后不良发生率为23.02%（64/278）。预后不良组年龄大于预后良好组［（63.64±9.52）岁比（55.12±7.31）岁］，动脉瘤体纵横比（AR）小于预后良好组（1.63±0.21比2.48±0.39），术前Hunt-Hess分级3~5级、CT Fisher分级3~4级、手术时机>3 d、术后脑梗死占比高于预后良好组［71.88%（46/64）比42.52%（91/214）、67.19%（43/64）比43.93%（94/214）、84.38%（54/64）比57.01%（122/214）、17.19%（11/64）比4.67%（10/214）］，差异均有统计学意义（均P<0.05）。年龄大、术前Hunt-Hess分级3~5级、CT Fisher分级3~4级、AR小、手术时机>3 d、术后脑梗死是IA介入栓塞术后近期预后不良的影响因素（比值比=1.223、2.784、2.507、0.402、2.683、2.134，均P<0.05）。基于上述影响因素构建IA介入栓塞术后近期预后不良的风险预测Nomogram模型，该模型预测IA介入栓塞术后近期预后不良的曲线下面积为0.907，95%置信区间为0.846~0.950，预测灵敏度、特异度分别是93.75%（60/64）、80.37%（172/214），且预测概率与实际概率接近，经Hosmer-Lemeshow拟合优度检验显示拟合良好（χ²=1.905，P=0.309）。结论　IA介入栓塞术后近期预后不良的影响因素为年龄大、术前Hunt-Hess分级3~5级、CT Fisher分级3~4级、手术时机>3 d、AR小、术后脑梗死，基于以上影响因素构建的风险预测Nomogram模型对术后近期预后不良具有良好预测价值。

关键词:

颅内动脉瘤, 介入栓塞术, 预后, 影响因素, Nomogram模型

Abstract:

Objective　To analyze the influencing factors of short-term poor prognosis of intracranial aneurysm (IA) after interventional embolization, to construct a risk prediction Nomogram model, and to verify its efficacy. Methods　The clinical data of 278 patients with IA treated in Xidian Group Hospital from June 2020 to June 2024 were retrospectively analyzed. There were 107 males and 171 females; they were (57.08±8.94) years old; their body mass index (BMI) was (23.11±3.88) kg/m². They were divided into a poor prognosis group and a good prognosis group according to their prognosis one month after the operation. The clinical data of the two groups were compared by t test and χ² test. The influencing factors of poor prognosis were analyzed by the multivariate logistic regression. A risk prediction Nomogram model was constructed by the R software. The receiver operating characteristic curve (ROC) and calibration curve were drawn to analyze the predictive efficacy and calibration degree of the model for the risk of short-term poor prognosis after IA interventional embolization. Results　The incidence rate of short-term poor prognosis after IA interventional embolization was 23.02% (64/278). Compared with the good prognosis group, the poor prognosis group was older [(63.64±9.52) years vs. (55.12±7.31) years], and had a lower aspect ratio (AR) of aneurysm body (1.63±0.21 vs. 2.48±0.39) and higher proportions of the patients with Hunt-Hess grade 3-5, CT Fisher grade 3-4, operation time >3 d, and postoperative cerebral infarction [71.88% (46/64) vs. 42.52% (91/214), 67.19% (43/64) vs. 43.93% (94/214), 84.38%(54/64) vs. 57.01% (122/214), and 17.19% (11/64) vs. 4.67% (10/214)], with statistical differences (all P<0.05). Older age, preoperative Hunt-Hess grade 3-5, CT Fisher grade 3-4, low AR, operation opportunity >3 d, and postoperative cerebral infarction were the influencing factors of the short-term poor prognosis after IA interventional embolization [ratio ratio (OR)=1.223, 2.784, 2.507, 0.402, 2.683, and 2.134; all P<0.05]. A risk prediction Nomogram model for the short-term poor prognosis after IA interventional embolization was constructed; the area under the curve of this model for predicting the short-term poor prognosis after IA interventional embolization was 0.907 (95%CI 0.846-0.950), and the prediction sensitivity and specificity were 93.75% (60/64) and 80.37% (172/214), respectively. The prediction probability was close to the actual probability, and the Hosmer-Lemeshow goodness-of-fit test showed that it had good fit (χ²=1.905; P=0.309). Conclusions　The influencing factors of short-term poor prognosis after IA interventional embolization are old age, preoperative Hunt-Hess grade 3-5, CT Fisher grade 3-4, operation opportunity >3 d, small AR, and postoperative cerebral infarction. The risk prediction Nomogram model based on the above factors has good predictive value for short-term poor prognosis after IA interventional embolization.

Key words:

Intracranial aneurysm, Interventional embolization, Prognosis, Influencing factors, Nomogram model

张海平李娓解利平冯磊.

颅内动脉瘤介入栓塞术后近期预后不良的因素分析及风险预测模型绘制 [J]. 国际医药卫生导报, 2025, 31(16): 2774-2780.

Zhang Haiping, Li Wei, Jie Liping, Feng Lei.

Factors of short-term poor prognosis after intracranial aneurysm interventional embolization and construction of a risk prediction model [J]. International Medicine and Health Guidance News, 2025, 31(16): 2774-2780.

参考文献

[1] Guo XH, Fang JK, Wu Y. Risk factors of intracranial infection in patients after intracranial aneurysm surgery: implication for treatment strategies[J]. Medicine, 2021, 100(48): e27946. DOI: 10.1097/MD.0000000000027946.
[2] 孙奇, 王翼, 边世春, 等. 颅内破裂动脉瘤治疗策略与预后影响因素: 单中心1572例倾向性评分匹配分析[J]. 中国临床神经外科杂志, 2023, 28(12): 673-677. DOI: 10.13798/j.issn.1009-153X.2023.12.001.
[3] 刘强, 高章代, 高喜斌. 介入栓塞治疗颅内动脉瘤患者术后预后不良的相关因素分析[J]. 中国肿瘤临床与康复, 2019, 26(8): 943-946. DOI: 10.13455/j.cnki.cjcor.2019.08.12.
[4] Huang YM, Cao HM, Qi XL, et al. Circular RNA hsa_circ_0000690 as a potential biomarker for diagnosis and prognosis of intracranial aneurysm: closely relating to the volume of hemorrhage[J]. Brain Behav, 2023, 13(4): e2929. DOI: 10.1002/brb3.2929.
[5] Cui YY, Wang B, Jiang B, et al. Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm[J]. Int J Ophthalmol, 2022, 15(8): 1316-1321. DOI: 10.18240/ijo.2022.08.14.
[6] Feng X, Tong X, Peng F, et al. Development and validation of a novel nomogram to predict aneurysm rupture in patients with multiple intracranial aneurysms: a multicentre retrospective study[J]. Stroke Vasc Neurol, 2021, 6(3): 433-440. DOI: 10.1136/svn-2020-000480.
[7] Oshiro EM, Walter KA, Piantadosi S, et al. A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and world federation of neurological surgeons scales in a clinical series[J]. Neurosurgery, 1997, 41(1): 140-147. DOI: 10.1097/00006123-199707000-00029.
[8] 王涛, 陈节, 文立利, 等. 不同方式治疗破裂动脉瘤的临床疗效及预后不良危险因素分析[J]. 临床和实验医学杂志, 2022, 21(18): 1974-1978. DOI: 10.3969/j.issn.1671-4695.2022.18.020.
[9] Wilson L, Boase K, Nelson LD, et al. A manual for the Glasgow outcome scale-extended interview[J]. J Neurotrauma, 2021, 38(17): 2435-2446. DOI: 10.1089/neu.2020.7527.
[10] Van Lieshout JH, Mijderwijk HJ, Nieboer D, et al. Development and internal validation of the ARISE prediction models for rebleeding after aneurysmal subarachnoid hemorrhage[J]. Neurosurgery, 2022, 91(3): 450-458. DOI: 10.1227/neu.0000000000002045.
[11] 谢昌纪, 杨辰龙, 周志宇, 等. 神经轴突导向因子3E与颅内动脉瘤介入栓塞术后1个月不良预后的关系[J]. 中国微创外科杂志, 2024, 24(3): 167-172. DOI: 10.3969/j.issn.1009-6604.2024.03.002.
[12] 徐婷, 张存泰. 免疫衰老和老年营养[J]. 中国临床保健杂志, 2023, 26(4): 446-451. DOI: 10.3969/J.issn.1672-6790.2023.04.002.
[13] 赖年升, 张兵兵, 吴德刚, 等. 血管内治疗高龄颅内破裂动脉瘤患者预后影响因素分析[J]. 皖南医学院学报, 2023, 42(1): 43-45, 49. DOI: 10.3969/j.issn.1002-0217.2023.01.012.
[14] 于建博, 钱宝, 刘婉姣, 等. 老年高级别颅内动脉瘤患者手术预后的影响因素研究[J]. 中华老年心脑血管病杂志, 2022, 24(5): 523-526. DOI: 10.3969/j.issn.1009-0126.2022.05.020.
[15] 陈泽鑫, 王育胜, 林楚纯, 等. 显微手术夹闭治疗前循环破裂动脉瘤的预后影响因素[J]. 国际医药卫生导报, 2024, 30(15): 2506-2510. DOI: 10.3760/cma.j.issn.1007-1245.2024.15.009.
[16] 郭鸣, 李冰洁, 梅利平, 等. 动脉瘤性蛛网膜下腔出血患者Hunt-Hess分级与并发症及功能障碍相关性分析[J]. 神经损伤与功能重建, 2024, 19(4): 217-221. DOI: 10.16780/j.cnki.sjssgncj.20220848.
[17] 张西安, 豆涛涛, 行治国, 等. 颅内动脉瘤患者术前Hunt-Hess分级、手术时机对血管内栓塞治疗预后的影响[J]. 海南医学, 2022, 33(24): 3200-3203. DOI: 10.3969/j.issn.1003-6350.2022.24.018.
[18] 吴江彬. 破裂颅内动脉瘤介入术后不良预后的相关危险因素[D]. 汕头: 汕头大学,2021.DOI:10.27295/d.cnki.gstou.2021.000440.
[19] Jeong JH, Kim JW, Choi DH. Safety and effectiveness of lumbar cerebrospinal fluid drainage to prevent delayed cerebral ischemia after fisher grade 3 subarachnoid hemorrhage with minimal intraventricular hemorrhage[J]. Neurochirurgie, 2020, 66(4): 225-231. DOI: 10.1016/j.neuchi.2020.03.003.
[20] 金祥兵, 邓明均, 吴晓宏, 等. 血清缺氧诱导因子-1α、内皮素-1及基质金属蛋白酶-9联合检测对颅内动脉瘤破裂出血142例手术预后的价值[J]. 安徽医药, 2024, 28(6): 1186-1191. DOI: 10.3969/j.issn.1009-6469.2024.06.028.
[21] 陈昶春, 柯志通, 钟晖东. 动脉瘤性蛛网膜下腔出血后迟发性脑缺血的影响因素及预测模型的构建[J]. 中西医结合心脑血管病杂志, 2023, 21(17): 3262-3265. DOI: 10.12102/j.issn.1672-1349.2023.17.032.
[22] 胡泽军, 陈贵杰, 曹相军, 等. 颅内动脉瘤介入术后预后不良的危险因素分析[J]. 国际神经病学神经外科学杂志, 2020, 47(3): 225-229. DOI: 10.16636/j.cnki.jinn.2020.03.001.
[23] 李继锋, 焦旭博, 许斌. 介入栓塞治疗时机对单发颅内破裂小动脉瘤患者疗效及预后的影响分析[J]. 实用医院临床杂志, 2022, 19(3): 144-147. DOI: 10.3969/j.issn.1672-6170.2022.03.040.
[24] 孙建萍, 吕斌, 张荣举, 等. 早期神经介入栓塞治疗老年破裂颅内动脉瘤患者的临床优势[J]. 中华老年心脑血管病杂志, 2023, 25(1): 53-56. DOI: 10.3969/j.issn.1009-0126.2023.01.014.
[25] 张化彪, 张晓燕, 郑国墩, 等. 支架置入方案在单支架辅助弹簧圈栓塞颅内分叉处宽颈动脉瘤中的应用效果[J]. 中华神经外科杂志, 2024, 40(7): 664-669. DOI: 10.3760/cma.j.cn112050-20240110-00014.