标题：颅内动脉瘤患者血管内介入术后发生迟发性脑缺血的危险因素及预测模型的建立

      作者：陈裕春 1，徐化 2，朱禛菁 2    1.复旦大学附属华山医院虹桥院区NICU，上海 201399；2.复旦大学附属华山医院浦东院区手术室，上海 201206

      卷次： 2024年35卷10期

      【摘要】 目的 分析颅内动脉瘤(IA)患者血管内介入术(EVT)后发生迟发性脑缺血(DCI)的危险因素，并建立相关预测模型。方法 回顾性收集2020年6月至2023年6月期间于复旦大学附属华山医院虹桥院区接受EVT治疗的106例 IA患者的病历资料，根据患者术后是否发生DCI分为DCI组(n=35)和非DCI组(n=71)，详细收集和记录患者的临床资料，并对其进行单因素与多因素Logistic回归分析，确定DCI的危险因素并建立预测模型，采用受试者工作特征曲线(ROC)分析该预测模型的效能。结果 DCI组患者的高血压比例、吸烟史比例、D-二聚体>1.3 mg/L比例、纤维蛋白原>3.3 g/L比例、WFNS分级≥Ⅳ级比例、改良Fisher分级≥Ⅲ级比例、术中瘤体破裂比例、手术时间>148 min比例、血管痉挛比例明显高于非DCI组，差异均有统计学意义(P<0.05)；经多因素 Logistic回归分析结果显示，高血压、D-二聚体>1.3 mg/L、纤维蛋白原>3.3 g/L、WFNS分级≥Ⅳ级、改良 Fisher分级≥Ⅲ级、手术时间>148 min、术后血管痉挛均为发生DCI的独立危险因素(P<0.05)；根据多因素Logistic回归分析结果建立预测模型为Logit (P)=(-0.651)+0.623×(高血压)+0.701×(D-二聚体)+0.682×(纤维蛋白原)+0.672×(WFNS≥Ⅳ级)+0.703×(Fisher分级≥Ⅲ级)+0.655×(手术时间)+0.697×(术后血管痉挛)；经ROC分析证实其预测效能尚可。结论 IA患者EVT术后存在DCI发生风险，其与高血压、D-二聚体、纤维蛋白原、WFNS分级、改良Fisher分级、手术时间、血管痉挛等因素有关，建议临床应对上述因素予以重视，并积极开展针对性干预措施。
      【关键词】 颅内动脉瘤；血管内介入术；迟发性脑缺血；危险因素；预测模型
      【中图分类号】 R739.41 【文献标识码】 A 【文章编号】 1003—6350（2024）10—1411—05

Analysis of the risk factors for delayed cerebral ischemia in patients with intracranial aneurysm afterendovascular treatment and construction of prediction model.
CHEN Yu-chun 1, XU Hua 2, ZHU Zhen-jing 2. 1.NICU,Hongqiao Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 201399, CHINA; 2.Operating Room, PudongBranch, Huashan Hospital Affiliated to Fudan University, Shanghai 201206, CHINA
【Abstract】 Objective To analyze the risk factors for delayed cerebral ischemia (DCI) in patients with intracra-nial aneurysm (IA) after endovascular treatment (EVT) and to construct a prediction model. Methods The medical re-cords of 106 patients with IA who received EVT treatment in the Hongqiao Branch, Huashan Hospital Affiliated to Fu-dan University from June 2020 to June 2023 were collected retrospectively. According to whether the patients had DCIafter treatment, they were divided into DCI group (35 patients with DCI) and non-DCI group (71 patients without DCI).Univariate analysis and multivariate logistic regression analysis were conducted to identify the risk factors for DCI and aprediction model was constructed. The efficacy of this model was analyzed using the Receiver Operating Characteristic(ROC) curve. Results The proportions of patients with hypertension and smoking history, the proportions of D-dimer>1.3 mg/L, fibrinogen>3.3 g/L, WFNS grade≥Ⅳ, modified Fisher grade≥Ⅲ, and intraoperative tumor rupture, surgicaltime>148 min, and the proportion of vasospasm in DCI group were significantly higher/longer than those in non-DCIgroup (P<0.05). Logistic regression analysis found that hypertension, D-dimer>1.3 mg/L, fibrinogen>3.3 g/L, WFNSgrade≥Ⅳ, modified Fisher grade≥Ⅲ, surgical time>148 min, and postoperative vasospasm were independent riskfactors for DCI (P<0.05). The prediction model constructed based on these factors was logit (P)=(-0.651)+0.623×(hypertension) + 0.701 × (D-dimer) + 0.682 × (fibrinogen) + 0.672 × (WFNS grade≥ Ⅳ) + 0.703 × (Fisher grade≥Ⅲ) +0.655×(surgical time)+0.697×(postoperative vasospasm). ROC analysis confirmed that its prediction performancewas acceptable. Conclusion There is a risk of DCI in patients with IA after EVT, which is related to factors such ashypertension, D-dimer, fibrinogen, WFNS grade, modified Fisher grade, surgical time, and vasospasm. It is recommend-ed that clinical attention should be paid to these factors and targeted intervention measures should be taken actively.
      【Key words】 Intracranial aneurysm; Endovascular treatment; Delayed cerebral ischemia; Risk factor; Prediction