陈宇箴.脑动脉瘤破裂致蛛网膜下腔出血患者尽早接受血管介入栓塞治疗有利于患者的预后[J].内科急危重症杂志,2021,27(3):200-204
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| DOI：10.11768/nkjwzzzz20210306 |
| 中文关键词: 动脉瘤性蛛网膜下腔出血 不同时机 血管介入栓塞 预后 S100钙结合蛋白B |
| 英文关键词: |
| 基金项目:广西壮族自治区卫生健康委员会自筹经费科研项目（No:Z20200169） |
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| 中文摘要: |
| 目的：探讨不同时机血管介入栓塞治疗对动脉瘤性蛛网膜下腔出血(aSAH)患者的预后及血清S100钙结合蛋白B(S100B)水平的影响。方法：选取2016年1月-2020年1月广西医科大学附属武鸣医院收治的aSAH患者229例作为研究对象，根据血管介入栓塞治疗时机分为早期组(66例)、中期组(95例)及晚期组(68例)。比较患者的基线资料、血清指标及临床结局，分析影响患者预后的因素，评估血清S100B水平对预后的预测价值。结果：3组患者术后1周S100B、单核细胞趋化蛋白-1(MCP-1)及C反应蛋白(CRP)显著降低，且早期组、中期组及晚期组降低程度依次减小，任意2组间差异有统计学意义(P均＜0.05)。早期组并发症总发生率低于晚期组，早期组和中期组完全栓塞率高于晚期组(P＜0.0167)；早期组格拉斯哥预后量表（GOS）评分最高，中期组和晚期组依次降低(P均＜0.05)。年龄大、动脉瘤直径大、入院Hunt-Hess分级高、晚期手术治疗及S100B水平高是导致预后不良的危险因素。S100B预测患者预后的最佳临界值为2.785μg/L，曲线下面积为0.892，敏感性84.3%，特异性86.3%，约登指数为0.706，95%置信区间为0.844～0.940。结论：脑动脉瘤破裂致蛛网膜下腔出血患者尽早接受血管介入栓塞治疗，能及早减轻脑组织损伤，降低血清S100B水平，且预后良好，并发症较少。 |
| 英文摘要: |
| Objective: To investigate the effects of vascular interventional embolization at different time points on the prognosis and serum S100 calcium binding protein B (S100B) level in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: A total of 229 aSAH patients admitted to the Affiliated Wuming Hospital of Guangxi Medical University from January 2016 to January 2020 were selected as the research subjects, and divided into early group (66 cases), middle group (95 cases) and late group (68 cases) according to the timing of vascular interventional embolization therapy. The baseline data, serum indexes and clinical outcomes of patients were compared, and the prognostic factors of patients were analyzed to evaluate the predictive value of serum S100B level for prognosis. Results: S100B, monocyte chemoattractant protein 1 (MCP-1) and C-reactive protein (CRP) were significantly decreased in the three groups at 1st week after operation, and the degree of decrease in the early group, the middle group and the late group decreased in turn, and the differences between any two groups were statistically significant (all P< 0.05). The total incidence of complications in the early group was lower than that in the late group, and the complete embolization rate in the early group and the middle group was higher than that in the late group (P< 0.0167). The Glasgow Outcome Scale (GOS) score was the highest in the early group, and decreased in the middle group and the late group in turn (all P< 0.05). Older age, larger aneurysm diameter, higher hunt-Hess grade, advanced surgical treatment and high S100B level were risk factors for poor prognosis. The optimal cutoff of S100B for predicting the prognosis was 2.785μg/L, the area under the curve was 0.892, the sensitivity was 84.3%, the specificity was 86.3%, the Youden index was 0.706 and the 95% confidence interval was 0.844-0.940. Conclusion: Early treatment with vascular interventional embolization for patients with subarachnoid hemorrhage caused by ruptured cerebral aneurysm can reduce brain tissue damage and serum S100B level as soon as possible, with good prognosis and fewer complications. |
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