脑铁沉积与脑血管畸形患者栓塞术后脑出血的关系

Relationship between cerebral iron deposition and cerebral hemorrhage after embolization in patients with cerebral vascular malformation

目的分析脑铁沉积与脑血管畸形患者栓塞术后脑出血的关系,为临床诊疗、预后评估等提供参考。方法收集2020年6月—2022年6月北京市平谷区医院神经外科和北京天坛医院神经血管一病区收治的脑动静脉畸形患者77例为研究对象,均行血管内栓塞术治疗,根据栓塞术后7 d内的头颅CT结果分为非脑出血组65例和脑出血组12例。比较2组临床资料、栓塞术前脑铁沉积(磁化率);观察脑出血患者出血第1天、3天、7天脑血肿体积值及脑铁沉积的变化情况。采用点二列相关性分析脑血管畸形患者脑铁沉积与临床资料的关系,绘制受试者工作特征曲线(ROC)评估脑铁沉积预测脑血管畸形患者栓塞术后脑出血的价值。结果栓塞术后7 d内,经CT检查证实颅内出血12例(15.58%)。脑出血组引流静脉栓塞占比高于非脑出血组(χ^(2)/P=4.663/0.031);脑出血组栓塞术前丘脑、壳核、海马、红核、黑质的磁化率值均高于非脑出血组患者(t/P=4.340/0.001、2.944/0.004、4.833/<0.001、2.326/0.023、2.742/0.008),2组栓塞术前尾状核、苍白球磁化率值比较,差异无统计学意义(P>0.05);经点二列相关性分析,性别与丘脑的脑铁沉积有关(r=0.293,P=0.010),其他基线资料与脑铁沉积无关(P>0.05)。ROC曲线分析显示,丘脑、壳核、海马、红核、黑质及五者联合的磁化率值预测血管畸形患者栓塞术后脑出血的曲线下面积(AUC)分别为0.845、0.741、0.850、0.706、0.750、0.979,且五者联合预测效能高于丘脑、壳核、红核、黑质单独预测(Z/P=2.129/0.033、2.560/0.010、3.243/0.001、2.490/0.013)。栓塞术后脑出血患者出血第1天、3天、7天,脑铁沉积与脑血肿体积值变化趋势一致。结论脑铁沉积与脑血管畸形患者栓塞术后脑出血有关,脑铁沉积过量可增加脑出血的风险,且脑铁沉积可能与患者脑出血的严重程度有关。

Objective To analyze the relationship between cerebral iron deposition and cerebral hemorrhage in patients with cerebral vascular malformation after embolization,so as to provide reference for clinical diagnosis,treatment and prognosis evaluation.Methods From June 2020 to June 2022,77 patients with cerebral arteriovenous malformations admitted to the Neurosurgery Department of Beijing Pinggu District Hospital and the Neurovascular Department of Beijing Tiantan Hospital were collected as the study subjects.All patients were treated with intravascular embolization.According to the head CT results within 7 days after embolization,they were divided into 65 patients in the non-cerebral hemorrhage group and 12 patients in the cerebral hemorrhage group.Compare the clinical data of the two groups,cerebral iron deposition(magnetic susceptibility)before embolization.Observe the changes of brain hematoma volume and brain iron deposition in patients with intracerebral hemorrhage on the 1st,3rd and 7th day of hemorrhage.The relationship between cerebral iron deposition and clinical data in patients with cerebral vascular malformation was analyzed by point binary correlation,and the value of cerebral iron deposition in predicting cerebral hemorrhage after embolization in patients with cerebral vascular malformation was evaluated by drawing the working characteristic curve(ROC)of subjects.Results Within 7 days after embolization,12 cases(15.58%)of intracranial hemorrhage were confirmed by CT examination.The proportion of drainage vein embolism in cerebral hemorrhage group was higher than that in non-cerebral hemorrhage group(χ^(2)/P=4.663/0.031).The magnetic susceptibility values of thalamus,putamen,hippocampus,red nucleus and substantia nigra in patients with intracerebral hemorrhage before embolization were higher than those in patients without intracerebral hemorrhage(t/P=4.340/0.001,2.944/0.004,4.833/<0.001,2.326/0.023,2.742/0.008).There was no significant difference in the magnetic susceptibility values of caudate nucleus and globus pallidus between the two groups before embolization(P>0.05).Through point binary correlation analysis,gender was related to cerebral iron deposition in thalamus(r=0.293,P=0.010),while other baseline data were not related to cerebral iron deposition(P>0.05).ROC curve analysis showed that the area under the curve(AUC)of thalamus,putamen,hippocampus,red nucleus,substantia nigra and their combined magnetic susceptibility values for predicting cerebral hemorrhage after embolization in patients with vascular malformation were 0.845,0.741,0.850,0.706,0.750,and 0.979,respectively,and the combined prediction efficiency of the five was higher than that of the thalamus,putamen,red nucleus and substantia nigra alone(Z/P=2.129/0.033,2.560/0.010,3.243/0.001,2.490/0.013).On the 1st,3rd and 7th day of cerebral hemorrhage after embolization,the change trend of cerebral iron deposition was consistent with the volume value of cerebral hematoma.Conclusion Cerebral iron deposition is related to cerebral hemorrhage after embolization in patients with cerebral vascular malformation.Excessive cerebral iron deposition can increase the risk of cerebral hemorrhage,and cerebral iron deposition may be related to the severity of cerebral hemorrhage in patients.