發(fā)布時(shí)間：2018-05-20 22:13

  本文選題：顱內(nèi)動(dòng)脈瘤 + 血管內(nèi)治療�。� 參考：《中國(guó)腦血管病雜志》2017年06期

【摘要】：目的建立一個(gè)綜合、簡(jiǎn)易、有效的復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)評(píng)分模型以評(píng)估顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)可能性大小,為手術(shù)方案的選擇及術(shù)后處理提供指導(dǎo)意義。方法回顧性納入長(zhǎng)海醫(yī)院神經(jīng)外科2012年5月至2014年5月接受血管內(nèi)栓塞治療的顱內(nèi)動(dòng)脈瘤患者434例(共441個(gè)動(dòng)脈瘤)并作為建模組,模型建立后,前瞻性納入2015年1月至6月接受血管內(nèi)栓塞治療的顱內(nèi)動(dòng)脈瘤患者109例(共109個(gè)動(dòng)脈瘤)并作為驗(yàn)證組。在建模隊(duì)列中,依據(jù)前期動(dòng)脈瘤復(fù)發(fā)危險(xiǎn)因素的多因素Logistic回歸分析結(jié)果建立復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)評(píng)分模型;在驗(yàn)證隊(duì)列中對(duì)模型進(jìn)行驗(yàn)證。根據(jù)建模組評(píng)分模型受試者工作特征(ROC)曲線最佳cut-off值將評(píng)分表分為復(fù)發(fā)低危和復(fù)發(fā)高危。將復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)評(píng)分模型與北美復(fù)發(fā)風(fēng)險(xiǎn)分層評(píng)分(ARSS)模型和Raymond分級(jí)進(jìn)行比較。結(jié)果多因素Logistic回歸分析顯示,納入評(píng)分并最終建立復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)評(píng)分模型的3個(gè)因素為非支架輔助栓塞(1分)、Raymond分級(jí)≥Ⅱ級(jí)(1分)及動(dòng)脈瘤大小[動(dòng)脈瘤25 mm(3分),動(dòng)脈瘤10~25 mm(1分),動(dòng)脈瘤10 mm(0分)]。驗(yàn)證提示該評(píng)分體系具有較高的預(yù)測(cè)價(jià)值(AUC=0.738,95%CI:0.641~0.834,P0.05)和擬合優(yōu)度(Hosmer-Lemeshowχ2=2.109,P=0.146);將評(píng)分模型進(jìn)一步分為復(fù)發(fā)低危(0~1分)和復(fù)發(fā)高危(2~5分),其敏感度為72.73%(48/66),特異度為68.80%(258/375)。動(dòng)脈瘤復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)評(píng)分模型的預(yù)測(cè)能力與ARSS評(píng)分相似(χ2=0.54,P=0.462),并且優(yōu)于Raymond分級(jí)(χ2=15.10,P0.01)。結(jié)論該研究所構(gòu)建的簡(jiǎn)易動(dòng)脈瘤復(fù)發(fā)風(fēng)險(xiǎn)預(yù)測(cè)評(píng)分模型可準(zhǔn)確預(yù)測(cè)動(dòng)脈瘤復(fù)發(fā),但尚需開(kāi)展多中心大樣本的前瞻性研究以進(jìn)一步驗(yàn)證。
[Abstract]:Objective to establish a comprehensive, simple and effective prediction model of recurrence risk to evaluate the possibility of recurrence after endovascular embolization of intracranial aneurysms, and to provide guidance for the selection of operative scheme and postoperative management. Methods 434 patients (441 aneurysms) who received endovascular embolization from May 2012 to May 2014 in Changhai Hospital were included as modeling group. 109 patients (109 aneurysms) who received endovascular embolization from January to June 2015 were prospectively included as the validation group. Based on the results of multivariate Logistic regression analysis of the risk factors for recurrence of aneurysms, a predictive model of recurrence risk was established in the modeling cohort, and the model was validated in the validation cohort. According to the best cut-off value of the operating characteristics of the model group, the score table was divided into low risk of recurrence and high risk of recurrence. The recurrence risk prediction score model was compared with the North American recurrence risk stratification score (ARSS) model and the Raymond classification. Results Multivariate Logistic regression analysis showed that, The three factors that were included in the score and established the prediction model of recurrence risk were non-stent-assisted embolization (1min, Raymond grade 鈮，

本文編號(hào)：1916458