發(fā)布時間：2018-05-20 22:13

  本文選題：顱內動脈瘤 + 血管內治療　； 參考：《中國腦血管病雜志》2017年06期

【摘要】：目的建立一個綜合、簡易、有效的復發(fā)風險預測評分模型以評估顱內動脈瘤血管內栓塞術后復發(fā)可能性大小,為手術方案的選擇及術后處理提供指導意義。方法回顧性納入長海醫(yī)院神經(jīng)外科2012年5月至2014年5月接受血管內栓塞治療的顱內動脈瘤患者434例(共441個動脈瘤)并作為建模組,模型建立后,前瞻性納入2015年1月至6月接受血管內栓塞治療的顱內動脈瘤患者109例(共109個動脈瘤)并作為驗證組。在建模隊列中,依據(jù)前期動脈瘤復發(fā)危險因素的多因素Logistic回歸分析結果建立復發(fā)風險預測評分模型;在驗證隊列中對模型進行驗證。根據(jù)建模組評分模型受試者工作特征(ROC)曲線最佳cut-off值將評分表分為復發(fā)低危和復發(fā)高危。將復發(fā)風險預測評分模型與北美復發(fā)風險分層評分(ARSS)模型和Raymond分級進行比較。結果多因素Logistic回歸分析顯示,納入評分并最終建立復發(fā)風險預測評分模型的3個因素為非支架輔助栓塞(1分)、Raymond分級≥Ⅱ級(1分)及動脈瘤大小[動脈瘤25 mm(3分),動脈瘤10~25 mm(1分),動脈瘤10 mm(0分)]。驗證提示該評分體系具有較高的預測價值(AUC=0.738,95%CI:0.641~0.834,P0.05)和擬合優(yōu)度(Hosmer-Lemeshowχ2=2.109,P=0.146);將評分模型進一步分為復發(fā)低危(0~1分)和復發(fā)高危(2~5分),其敏感度為72.73%(48/66),特異度為68.80%(258/375)。動脈瘤復發(fā)風險預測評分模型的預測能力與ARSS評分相似(χ2=0.54,P=0.462),并且優(yōu)于Raymond分級(χ2=15.10,P0.01)。結論該研究所構建的簡易動脈瘤復發(fā)風險預測評分模型可準確預測動脈瘤復發(fā),但尚需開展多中心大樣本的前瞻性研究以進一步驗證。
[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：1916458