本文選題：動(dòng)脈瘤介入栓塞 + 術(shù)后復(fù)發(fā)危險(xiǎn)因素�。� 參考：《第二軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：第一部分:顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)的影響因素分析及復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表建立研究目的:本文旨在篩選顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)的危險(xiǎn)因素,并根據(jù)邏輯回歸模型建立復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表,以簡(jiǎn)便直觀地評(píng)價(jià)顱內(nèi)動(dòng)脈瘤患者經(jīng)血管內(nèi)栓塞治療后的復(fù)發(fā)風(fēng)險(xiǎn)。研究方法:本文回顧性分析了自2012年5月至2014年5月間在第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院腦血管病中心接受血管內(nèi)栓塞治療的顱內(nèi)動(dòng)脈瘤患者,共計(jì)441枚動(dòng)脈瘤。根據(jù)隨訪時(shí)的復(fù)發(fā)情況將動(dòng)脈瘤分為復(fù)發(fā)組和未復(fù)發(fā)組,收集與術(shù)后復(fù)發(fā)有關(guān)的患者相關(guān)因素、解剖學(xué)因素、技術(shù)及材料因素等,通過單因素分析比較兩組之間上述相關(guān)因素是否具有差異。進(jìn)一步采用logistic逐步回歸分析對(duì)單因素分析結(jié)果中具有統(tǒng)計(jì)學(xué)意義的相關(guān)因素進(jìn)行分析,篩選出與復(fù)發(fā)有關(guān)的危險(xiǎn)因素并得到相應(yīng)的復(fù)發(fā)風(fēng)險(xiǎn)回歸模型,并根據(jù)回歸模型的β系數(shù)對(duì)有統(tǒng)計(jì)學(xué)意義的影響因素進(jìn)行賦值后建立術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表。采用ROC曲線下面積檢驗(yàn)風(fēng)險(xiǎn)評(píng)分預(yù)測(cè)復(fù)發(fā)的有效性。研究結(jié)果:本研究共納入動(dòng)脈瘤441枚,其中復(fù)發(fā)組66枚,未復(fù)發(fā)組375枚。在單因素分析中,動(dòng)脈瘤大小(P0.01)、破裂與否(P=0.04)、是否使用支架(P=0.002)、術(shù)后即刻栓塞結(jié)果(P=0.001)在兩組之間具有統(tǒng)計(jì)學(xué)差異。年齡(P=0.521)、性別(P=0.377)、吸煙史(P=0.53)、高血壓病史(P=0.781)、糖尿病病史(P=0.253)、瘤頸大小(P=0.216)、側(cè)壁/分叉動(dòng)脈瘤(P=0.661)、前循環(huán)/后循環(huán)動(dòng)脈瘤(P=0.208)在兩組之間無統(tǒng)計(jì)學(xué)差異。方差膨脹因子診斷法評(píng)價(jià)各因素間相關(guān)性結(jié)果顯示:動(dòng)脈瘤大小、破裂與否、是否使用支架、術(shù)后即刻栓塞結(jié)果的方差膨脹因子分別為1.041、1.323、1.296和1.146。Logistic逐步回歸分析顯示:動(dòng)脈瘤大小(P0.001)、非支架輔助栓塞(P0.001)、術(shù)后即刻栓塞程度(P=0.012)具有統(tǒng)計(jì)學(xué)意義,其中動(dòng)脈瘤25mm,動(dòng)脈瘤10.1-25mm,非支架輔助栓塞,Raymond II和III的β系數(shù)分別為3.571,1.620,1.406,1.439,1.502.根據(jù)β系數(shù)與最小β系數(shù)的比值對(duì)危險(xiǎn)因素進(jìn)行賦值后得出復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表各因素得分為動(dòng)脈瘤25mm-3分,動(dòng)脈瘤10.1-25mm-1分,非支架輔助栓塞-1分,Raymond II和III-1分。利用ROC曲線下檢驗(yàn)?zāi)Ｐ陀行?經(jīng)檢驗(yàn)復(fù)發(fā)風(fēng)險(xiǎn)logistic回歸模型、復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表二者的ROC曲線下面積分別為:復(fù)發(fā)風(fēng)險(xiǎn)logistic回歸模型-0.737、復(fù)發(fā)風(fēng)險(xiǎn)得分-0.735.二者無統(tǒng)計(jì)學(xué)差異。研究結(jié)論:顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)的危險(xiǎn)因素為動(dòng)脈瘤大小、單純栓塞、術(shù)后即刻栓塞程度,本研究建立的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表能直觀地反映患者術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)大小。第二部分:顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表的驗(yàn)證和評(píng)價(jià)研究目的:本研究基于第一部分建立的顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表,為了進(jìn)一步驗(yàn)證該評(píng)分表的預(yù)測(cè)復(fù)發(fā)風(fēng)險(xiǎn)的有效性,在第二部分中本研究通過建立驗(yàn)證隊(duì)列,將驗(yàn)證隊(duì)列動(dòng)脈瘤進(jìn)行評(píng)分后評(píng)價(jià)評(píng)分表預(yù)測(cè)顱內(nèi)動(dòng)脈瘤復(fù)發(fā)風(fēng)險(xiǎn)的效果有效性,同時(shí)與ARSS模型進(jìn)行比較。研究方法:本部分回顧性分析了自2015年1月至2015年6月間在第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院腦血管病中心接受血管內(nèi)栓塞治療的顱內(nèi)動(dòng)脈瘤患者,共計(jì)納入109枚動(dòng)脈瘤組成驗(yàn)證組病例用于本課題第二部分顱內(nèi)動(dòng)脈瘤血管內(nèi)栓塞術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表的驗(yàn)證和評(píng)價(jià)。收集患者年齡、性別、吸煙史、高血壓病史、糖尿病病史、動(dòng)脈瘤大小、瘤頸大小、動(dòng)脈瘤部位、破裂與否、是否使用支架、術(shù)后即刻栓塞結(jié)果等信息。將第一部分建模組與第二部分驗(yàn)證組基線資料進(jìn)行比較,并將驗(yàn)證組109枚動(dòng)脈瘤帶入本研究第一部分所建立的復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表及Aneurysm Recanalization Stratification Scale進(jìn)行評(píng)分后,利用ROC曲線下面積評(píng)價(jià)兩種模型預(yù)測(cè)復(fù)發(fā)的有效性。利用評(píng)分表對(duì)本課題所有納入的動(dòng)脈瘤進(jìn)行復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分,將動(dòng)脈瘤帶入評(píng)分表評(píng)分后得出不同得分的復(fù)發(fā)率,比較兩組不同得分間復(fù)發(fā)率,合并無統(tǒng)計(jì)學(xué)差異的得分將復(fù)發(fā)風(fēng)險(xiǎn)進(jìn)行分層。將風(fēng)險(xiǎn)分層同真實(shí)復(fù)發(fā)結(jié)果進(jìn)行比較,評(píng)價(jià)復(fù)發(fā)分層預(yù)測(cè)復(fù)發(fā)的敏感度和特異度。研究結(jié)果:將驗(yàn)證組患者基線資料與建模組比較結(jié)果顯示,年齡、性別、吸煙、高血壓病史、糖尿病病史、動(dòng)脈瘤大小、破裂因素經(jīng)檢驗(yàn)P值分別為0.161、0.466、0.876、0.391、0.444、0.434、0.257,建模組和驗(yàn)證組患者基線資料經(jīng)檢驗(yàn)具有可比性。將109例動(dòng)脈瘤帶入本研究第一部分建立的復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表進(jìn)行評(píng)分后結(jié)果顯示,0分-20例,1分-48例,2分-37例,3分-2例,4分-2例。將109例動(dòng)脈瘤帶入ARSS評(píng)分后結(jié)果顯示-1分-9例,0分11例,1分-28例,2分-13例,3分-31例,4分-10例,5分-6例,6分-1例。將復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分及ARSS評(píng)分與實(shí)際復(fù)發(fā)情況比較,利用ROC曲線下面積檢驗(yàn)其有效性,結(jié)果兩種模型曲線下面積分別是:復(fù)發(fā)風(fēng)險(xiǎn)得分為73.8%;ARSS模型為69.0%.將本課題所有納入動(dòng)脈瘤進(jìn)行評(píng)分后,利用卡方檢驗(yàn)比較不同得分間復(fù)發(fā)率差異進(jìn)行復(fù)發(fā)風(fēng)險(xiǎn)分層,不同得分的復(fù)發(fā)率分別為0分-1.59%,1分-8.90%,2分-28.79%,3分-55.55%,4分-83.33%。合并無統(tǒng)計(jì)學(xué)差異的得分后,將0-1分定義為低風(fēng)險(xiǎn)組,≥2分定義為高風(fēng)險(xiǎn)組。利用ROC曲線下面積檢驗(yàn)復(fù)發(fā)風(fēng)險(xiǎn)分層預(yù)測(cè)有效性,結(jié)果顯示曲線下面積為70.4%。結(jié)論:本研究建立的術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表可以有效地顯示顱內(nèi)動(dòng)脈瘤術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)大小。相較于現(xiàn)有的單因素結(jié)果預(yù)測(cè),復(fù)發(fā)風(fēng)險(xiǎn)評(píng)分表的預(yù)測(cè)結(jié)果更為準(zhǔn)確和穩(wěn)定。
[Abstract]:The first part: analysis of the influencing factors of recurrence after intravascular embolization of intracranial aneurysm and the purpose of setting up a recurrence risk score table: This article aims to screen the risk factors of recurrence after intravascular embolization of intracranial aneurysms, and establish a recurrence risk score table according to the logistic regression model, so as to evaluate the patients with intracranial aneurysm easily and intuitively. The risk of recurrence after intravascular embolization. A retrospective analysis of 441 intracranial aneurysms from May 2012 to May 2014 at the cerebral vascular disease center, Changhai Hospital, Second Military Medical University. The aneurysms were divided into recurrent and non recurrent aneurysms according to the recurrence. The related factors, anatomical factors, technology and material factors related to the recurrence of postoperative recurrence were collected, and the differences between the two groups were compared by single factor analysis. The logistic stepwise regression analysis was used to analyze the relevant factors of statistical significance in the results of single factor analysis. The recurrence risk regression model was obtained with the recurrence related risk factors and the recurrence risk score table was set up after the evaluation of the statistically significant influencing factors according to the beta coefficient of the regression model. The effectiveness of the recurrence was predicted by the area test risk score under the ROC curve. The results of the study were included in the aneurysm 44. 1, of which 66 were relapsed and 375 were not recurred. In single factor analysis, aneurysm size (P0.01), rupture or failure (P=0.04), stent (P=0.002) and immediate postoperative embolization (P=0.001) were statistically different among the two groups. Age (P=0.521), sex (P=0.377), smoking history (P=0.53), hypertension history (P=0.781), diabetes history (P=0.253) the size of the tumor neck (P=0.216), the lateral wall / branched aneurysm (P=0.661), the anterior circulation / posterior circulation aneurysm (P=0.208) between the two groups. The variance expansion factor diagnostic method evaluated the correlation between the size of the aneurysm, the rupture or not, the use of the stent, and the variance expansion factor of the postoperative immediate embolization results. 1.041,1.323,1.296 and 1.146.Logistic stepwise regression analysis showed that aneurysm size (P0.001), non stent assisted embolization (P0.001) and postoperative immediate embolization (P=0.012) were statistically significant, of which aneurysm 25mm, aneurysm 10.1-25mm, non stent embolic plug, and Raymond II and III beta coefficients were 3.571,1.620,1.406,1.439,1.50. 2. according to the ratio of the beta coefficient and the minimum beta coefficient to the risk factors, the scores of the factors of the recurrence risk score were 25mm-3 score of aneurysm, 10.1-25mm-1 score of aneurysm, non stent assisted embolization -1, Raymond II and III-1. The validity of the model under the ROC curve was tested, and the recurrence risk logistic regression model was tested, and the recurrence was recurred. The area under the ROC curve of the risk score table two were the recurrence risk logistic regression model -0.737 and the recurrence risk score of -0.735. two. The study concluded that the risk factors of recurrence after intravascular embolization for intracranial aneurysms were aneurysm size, simple embolism, immediate postoperative embolism, and the postoperative recurrence was established in this study. The risk score table can directly reflect the recurrence risk of patients after operation. Second part: the purpose of verification and evaluation of the recurrence risk score of intracranial aneurysm after intravascular embolization: This study was based on the first part of the recurrence risk score of intracranial aneurysm after intravascular embolization in order to further verify the preview of the score The effectiveness of the risk of recurrence was measured in the second part. In this study, the effectiveness of predicting the recurrence risk of intracranial aneurysms in a cohort of aneurysms was verified by establishing a verification queue. The results were compared with the ARSS model. The methods of research were retrospectively analyzed from January 2015 to June 2015 in second. The patients with intracranial aneurysm treated with intravascular embolization in the center for cerebrovascular disease in Changhai Hospital, Military Medical University, were included in a total of 109 aneurysms to verify and evaluate the recurrence risk score table after intravascular embolization of intracranial aneurysms in the second part of the subject. The history of diabetes, the size of the aneurysm, the size of the aneurysm, the location of the aneurysm, the rupture or not, whether the stent was used, and the outcome of the immediate embolization. The first part of the modeling group was compared with the baseline data of the second part of the validation group, and 109 aneurysms in the verifying group were brought into the recurrence risk score table and Aneury established in the first part of this study. After the score of SM Recanalization Stratification Scale, the two models of area evaluation under the ROC curve were used to predict the recurrence. The score table was used to score the recurrence risk of all the aneurysm included in the subject, and the recurrence rate of the different scores was obtained after the score of the aneurysm, and the recurrence rate was compared between the two groups. Rate, stratified the risk of recurrence without statistical difference. Compare the risk stratification with the real recurrence results and evaluate the sensitivity and specificity of recurrent stratified prediction. Results of the comparison of the baseline data of the patients with the model group showed that the age, sex, smoking, history of hypertension, diabetes history, and movement were compared with the modeling group. The size of the aneurysm, the factor of rupture, the P value was 0.161,0.466,0.876,0.391,0.444,0.434,0.257, the baseline data of the model group and the verification group were comparable. 109 cases of aneurysm were taken into the first part of this study and the results of the recurrence risk score showed that 0 -20 cases, 1 -48 cases, 2 -37 cases, 3 -2 cases, 4 -2 cases, 109 cases of aneurysm were brought into ARSS score, and the results showed -1 -9 cases, 0 points, 1 -28, 2 -13 cases, 3 -31 cases, 4 -10 cases, 5 -6 cases, 6 -1 cases. The recurrence risk score and ARSS score were compared with the actual recurrence, and the area under the ROC curve was the recurrence of the recurrent area under the two model curve area respectively: recrudescent The risk score was 73.8%. After the ARSS model was used to score all the aneurysms in 69.0%., the recurrence rates of different scores were compared with the chi square test. The recurrence rates of different scores were 0 -1.59%, 1 -8.90%, 2 -28.79%, 3 -55.55%, and 4 -83.33%. with no statistical difference. The 0-1 point is defined as a low risk group, which is defined as a high risk group with more than 2 points. The area under the area of ROC curve is used to predict the effectiveness of the recurrence risk stratification. The results show that the area under the curve is 70.4%. conclusion: the postoperative recurrence risk score table established in this study can effectively show the risk of recurrence of intracranial aneurysms after operation. Results the prediction of recurrence risk score was more accurate and stable.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R651.12

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