蛛网膜下腔出血老年患者神经功能预后与年龄界值的关系研究

Relationship between the prognosis of neurological function and age cut-off in elderly patients with subarachnoid hemorrhage

目的探讨影响蛛网膜下腔出血(SAH)老年患者神经功能预后不良的危险因素,分析SAH患者神经功能预后与年龄界值的关系。方法收集武警特色医学中心(原武警后勤学院附属医院)自2010年1月至2015年12月行手术治疗的SAH老年患者212例,分析SAH患者术后1年神经功能预后情况,采用多因素Logistic回归分析影响SAH预后的相关因素,通过绘制受试者工作特征曲线(ROC),确定影响患者神经功能预后的年龄界值。根据手术方式的不同将患者分为夹闭组和栓塞组,对比2组患者的相关资料。结果多因素Logistic回归分析发现年龄、高Hunt-Hess(H-H)分级(4~5)、Fisher高分级(3~4)是SAH老年患者不良预后的危险因素。ROC曲线提示年龄对SAH老年患者不良预后预测的最佳界值为70岁(敏感度:89.3%;特异性:28.4%;准确性:87.7%)。2组治疗方式在入院时H-H分级(1~3级)差异无统计学意义。夹闭组(60~70岁、低H-H分级)患者的1年期预后良好率为83.3%,栓塞组为88.3%;夹闭组(>70岁、低H-H分级)患者的1年期预后良好率为18.8%,栓塞组为32.8%;2组比较差异均有统计学意义(P<0.05)。结论SAH老年患者神经功能不良预后与患者入院时的病情严重程度(H-H分级)及临界年龄(>70岁)相关,而与治疗方式的选取(开颅动脉瘤颈夹闭或血管介入栓塞治疗)无关。

Objective To explore the risk factors affecting the poor prognosis of neurological function in elderly patients with subarachnoid hemorrhage(SAH),and to analyze the relationship between the prognosis of neurological function and age cut-off in SAH patients.Methods Two hundred and twelve elderly patients with SAH who underwent surgical treatment from January 2010 to December 2015 in the Characteristic Medical Center of Armed Police Force(Affiliated Hospital of Armed Police Logistics College)were collected.The neurological function prognosis of SAH patients was analyzed one year after operation.Logistic regression analysis was used to analyze the relevant factors that affected the prognosis of SAH.The ROC curve was drawn to determine the age cut-off that affected the prognosis of neurological function of patients.According to the different surgical methods,the patients were divided into clip group and embolization group,and the related data of the two groups were compared.Results Multivariate Logistic regression analysisshowed that age and high Hunt-Hess(H-H)grade(4-5)and Fisher high grade(3-4)were risk factors for poor prognosis in elderly patients with SAH.ROC curve showed that the best cut-off value for age to predict poor prognosis in elderly patients with SAH was 70 years old(sensitivity:89.3%;specificity:28.4%;accuracy:87.7%).There was no statistical difference in the H-H grade(grade 1-3)at admission between the two groups.The rate of 1-year good prognosis of the clip group(60-70 years old,low H-H grade)was 83.3%,and the embolization group was 88.3%.The 1-year good prognosis of the clip group(>70 years old,low H-H grade)was 18.8%,and the embolization group was 32.8%.The difference of good prognosis rate was statistically significant(P<0.05).Conclusion The prognosis of neurological dysfunction in elderly patients with SAH was related to the severity of the patient’s condition(H-H classification)and age cut-off(>70 years old)at the time of admission,and is not related to the choice of treatment(craniotomy aneurysm clipping or endovascular embolization therapy).