高血压性小脑出血患者神经内镜微创术后免疫功能及其与预后的关系

Relationship between immune function and prognosis of patients with hypertensive cerebellar hemorrhage after neuroendoscopic minimally invasive surgery

目的观察高血压性小脑出血患者神经内镜微创术后免疫功能变化,并分析其与预后的关系。方法纳入2018年9月至2020年9月襄阳市中心医院收治的80例高血压性小脑出血患者,采用非随机临床同期对照研究,根据患者家属意愿选择的手术方式分为2组,分别实施神经内镜微创手术(观察组)和枕下开颅去骨瓣血肿清除术(对照组),最终分别纳入观察组42例,对照组38例。比较2组患者围术期指标(手术耗时、术中出血量、血肿清除率)、预后评分分级(Glasgow评分)、手术前后免疫功能相关指标[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)]及其与预后的关系。结果观察组手术耗时、术中出血量少于对照组[(82.20±19.64)min vs(171.92±31.21)min;(46.37±11.63)ml vs(193.56±43.98)ml],血肿清除率高于对照组[(88.97±6.68)%vs(73.82±5.91)%],差异有统计学意义(t=15.542、20.909、10.696,P均<0.05)。术后3 d,2组患者IgA、IgG、IgM均较术前降低,但观察组高于对照组[IgA:(1.85±0.31)g/L vs(1.42±0.29)g/L;IgG:(1.04±0.19)g/L vs(0.91±0.22)g/L;IgM:(1.03±0.20)g/L vs(0.82±0.17)g/L],差异有统计学意义(t=6.388、2.835、5.033,P均<0.05)。观察组Glasgow评分分级优于对照组(Z=4.191,P<0.05)。Spearman相关性分析显示,IgA、IgG、IgM指标水平与患者预后分级呈正相关性(r=0.363、0.359、0.365,P<0.05)。全部80例患者中预后良好25例,预后不良55例,免疫功能指标评价预后的ROC曲线分析显示,IgA+IgG+IgM的曲线下面积为0.982,明显高于各单项指标(0.908、0.843、0.887;Z=2.259、2.958、2.846,P<0.05)。结论与枕下开颅去骨瓣血肿清除术相比,神经内镜微创手术治疗高血压性小脑出血疗效较好,可减少手术时间,血肿清除较彻底,对IgA、IgG、IgM免疫指标影响较小,有助于改善预后。

Objective To observe the changes of immune function in patients with hypertensive cerebellar hemorrhage after neuroendoscopic minimally invasive surgery,and to analyze its relationship with prognosis.Methods A total of 80 patients with hypertensive cerebellar hemorrhage admitted to Xiangyang Central Hospital from September 2018 to September 2020 were enrolled in this non-randomized controlled clinical study.All patients were divided into two groups according to the surgical method chosen by the patients'families:those treated by neuroendoscopic minimally invasive surgery(observation group)and those treated by suboccipital craniotomy to remove bone flap hematoma(control group).Finally,42 cases were included in the observation group and 38 cases in the control group.Perioperative indicators(operative time,intraoperative blood loss,and hematoma clearance rate),prognosis score(Glasgow score),preoperative and postoperative immune function related indicators[immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM)]and their relationship with prognosis were compared between the two groups.Results The operative time and intraoperative blood loss in the observation group were significantly less than those in the control group[(82.20±19.64)min vs(171.92±31.21)min,t=15.542,P<0.05;(46.37±11.63)ml vs(193.56±43.98)ml,t=20.909,P<0.05].The hematoma clearance rate was significantly higher in the observation group than in the control group[(88.97±6.68)%vs(73.82±5.91)%,t=10.696,P<0.05].Three days after surgery,IgA,IgG,and IgM in both groups were lower than those before surgery;these values were significantly higher in the observation group than in the control group[IgA:(1.85±0.31)g/L vs(1.42±0.29)g/L,t=6.388,P<0.05;IgG:(1.04±0.19)g/L vs(0.91±0.22)g/L,t=2.835,P<0.05;IgM:(1.03±0.20)g/L vs(0.82±0.17)g/L,t=5.033,P<0.05].Glasgow score of the observation group was better than that of the control group(Z=4.191,P<0.05).Spearman correlation analysis showed that there was a positive correlation between IgA,IgG,and IgM and the prognosis of patients(r=0.363,0.359,and 0.365,respectively;P<0.05).Among the 80 patients,25 had a good prognosis and 55 had a poor prognosis.ROC curve analysis of immune function indexes showed that the area under the curve of IgA+IgG+IgM was 0.982,which was significantly higher than that of each single index(0.908,0.843,and 0.887;Z=2.259,2.958,and 2.846,respectively;P<0.05).Conclusion Compared with suboccipital craniotomy for hematoma removal,neuroendoscopic minimally invasive surgery has better efficacy in the treatment of hypertensive cerebellar hemorrhage,which can shorten the operative time,remove the hematoma more thoroughly,and have little influence on IgA,IgG,and IgM,thus helping to improve the prognosis.