脑膜瘤瘤周水肿的临床相关因素分析

Clinical related factors for peritumoral brain edema in meningiomas

目的探讨影响脑膜瘤瘤周水肿(PTBE)及其严重程度的临床相关因素。方法回顾性分析郑州大学第二附属医院神经外科自2017年1月至2020年10月手术治疗的139例脑膜瘤患者临床资料,借助3D-slicer软件在患者术前MRI图像上分别勾画瘤体和水肿区感兴趣区并计算体积,以水肿指数(EI)评估PTBE严重程度,通过统计学方法明确影响PTBE发生及EI的临床因素并进一步分析肿瘤体积在预测PTBE中的价值。结果(1)PTBE发生率:139例患者中47例出现PTBE,发生率为33.8%,EI值为2.47±0.73。(2)PTBE影响因素分析:PTBE组(47例)和无PTBE组(92例)患者肿瘤良恶性例数.部位、体积及Ki-67指数差异均有统计学意义(P<0.05)。多因素二元Logistic回归分析结果显示:肿瘤良恶性和肿瘤体积是PTBE发生的独立危险因素(P<0.05)。(3)EI影响因素分析:不同性别、WHO分级、Ki-67指数及肿瘤体积患者EI值差异均有统计学意义(P<0.05)。多因素线性回归分析结果显示:肿瘤良恶性和肿瘤体积是EI的独立危险因素(P<0.05)。(4)肿瘤体积预测PTBE的价值分析:受试者工作特征曲线显示,颅底脑膜瘤和非颅底脑膜瘤体积预测PTBE的曲线下面积分别为0.824.0.825,敏感性分别为0.800.0.784.特异性分别为0.818.0.729。结论(1)肿瘤良恶性、肿瘤体积是影响PTBE发生的主要因素,且与EI呈正相关。(2)肿瘤体积在PTBE发生中具有较高的预测价值。

Objective To investigate the clinical related factors that affecting peritumoral brain edema(PTBE)and its severity in meningiomas.Methods A total of 139 patients with meningiomas,admitted to and underwent surgery in our hospital from from January 2017 to October 2020 were chosen;their clinical data were analyzed retrospectively.Meningioma volume and edema volume were calculated from drawn regions of interest on preoperative MRI images by 3D-slicer software.Edema index(EI)was used to evaluate the severity of PTBE.The clinical factors affecting PTBE and EI were determined by statistical methods,and the value of meningioma volume in predicting PTBE was further analyzed.Results(1)The PTBE incidence was 33.8%(47/139),and average EI was 2.47±0.73.(2)Univariate analysis showed that there was significant difference in percentage of patients with benign/malignant meningiomas,meningioma location,meningioma volume,and Ki-67 index between patients&om PTBE group(n=47)and non-PTBE group(n=92,P<0.05).Multivariate binary Logistic regression analysis showed that benign/malignant meningiomas and meningioma volumes were independent risk factors for PTBE(P<0.05).(3)There were significant differences in EI values among patients with different gender,WHO grading,KI-67 index and meningioma volumes(P<0.05).Multivariate linear regression analysis showed meningioma malignant degrees and meningioma volume were independent risk factors for EI(P<0.05).(4)Receiver operating characteristic curve showed that the area under curve of meningiomas of the cranial base and nonmeningiomas of the cranial base in predicting PTBE was 0.824 and 0.825,respectively,with sensitivity of 0.800 and 0.784,and with specificity of 0.818 and 0.729.Conclusions(1)Malignant degrees and meningioma volumes are the main factors affecting the incidence of PTBE,and are positively correlated with EI.(2)Meningioma volume has high predictive value in PTBE occurrence.