重症动脉瘤性蛛网膜下腔出血患者术后发生认知功能障碍的预测模型构建

Establishment of predictive model for postoperative cognitive impairment in patients with severe aneurysmal subarachnoid hemorrhage

目的分析重症动脉瘤性蛛网膜下腔出血(aSAH)患者术后发生认知功能障碍的影响因素,并构建影响因素预测重症aSAH患者术后发生认知功能障碍的风险模型。方法抽取2019年1月2020年8月于南阳市中心医院接受手术治疗的80例重症aSAH患者为研究对象,术后随访6个月,评估认知功能障碍[蒙特利尔认知评估量表(MoCA)评分]的发生情况并进行分组。采集纳入患者的基线资料,经Logistic回归分析找出可能导致重症aSAH患者术后发生认知功能障碍的影响因素,构建影响因素预测重症aSAH患者术后发生认知功能障碍的风险模型。结果随防6个月,80例重症aSAH患者中28例发生认知功能障碍,发生率为35.00%。认知功能障碍组合并脑血管痉挛占比高于认知功能正常组,血清β-淀粉样蛋白1-42(Aβ1-42)水平低于认知功能正常组(P<0.05)。经多元Logistic回归分析,结果显示,合并脑血管痉挛、血清Aβ1-42低表达为重症aSAH患者术后发生认知功能障碍的影响因素(OR>1,P<0.05)。绘制受试者工作特征曲线结果显示,由合并脑血管痉挛、血清β-淀粉样蛋白1-42水平构建的影响因素风险模型预测重症aSAH患者术后发生认知功能障碍的曲线下面积为0.898(95%CI:0.833~0.963),预测价值较理想;且阈值取2.255分时可获得最佳预测效能,敏感度、特异性、约登指数分别为0.821、0.731、0.552。Hosmer-Lemeshow拟合优度检验结果显示,重症aSAH患者术后发生认知功能障碍的影响因素风险模型拟合未见显著差异(P>0.05),拟合满意。结论重症aSAH患者术后发生认知功能障碍可能受到合并脑血管痉挛、血清Aβ1-42低表达的影响,构建的风险模型预测重症aSAH患者术后发生认知功能障碍的准确度良好。

Objective To analyze the influencing factors of postoperative cognitive impairment in patients with severe aneurysmal subarachnoid hemorrhage(aSAH),and to establish a risk model with the influencing factors that can predict the occurrence of postoperative cognitive dysfunction.Methods Eighty patients with severe aSAH who received surgical treatment in Nanyang Central Hospital from January 2019 to August 2020 were selected as the study objects.They were followed up for 6 months after surgery to evaluate the occurrence of cognitive dysfunction assessed by Montreal cognitive assessment scale(MoCA)score,by which the selected patients were grouped.The general data of the selected patients were investigated to find out the influencing factors that may lead to the postoperative cognitive dysfunction in severe aSAH patients by Logistic regression analysis;and the risk model of influencing factors to predict the postoperative cognitive dysfunction in severe aSAH patients was established.Results During the 6-month follow-up,28 of 80 patients with severe aSAH had cognitive dysfunction,and the incidence was 35.00%.Proportion of patients with cerebral vasospasm in the cognitive dysfunction group was higher than that in the normal cognitive function group,while the level of serum amyloidβ-protein1-42(Aβ1-42)was lower than that in the normal cognitive function group(P<0.05).Results of multivariate Logistic regression analysis showed that cerebral vasospasm and low expression of serum Aβ1-42 were influencing factors of postoperative cognitive dysfunction in patients with severe aSAH(OR>1,P<0.05).The results of receiver operating characteristic curve showed that the area under curve of the risk model fitting of cerebral vasospasm and level of serum Aβ1-42 in predicting the postoperative cognitive dysfunction in severe aSAH patients was 0.898(95%CI:0.833-0.963),suggesting an ideal predictive value;when the cut-off was 2.255,the predictive efficacy was the best,and the sensitivity,specificity and Youden index were 0.821,0.731,and 0.552,respectively.The results of Hosmer-Lemeshow goodness of fit test showed that there was no significant difference in the risk model fitting of the influencing factors of postoperative cognitive dysfunction in patients with severe aSAH(P>0.05),and the fitting was satisfactory.Conclusions Postoperative cognitive impairment in patients with severe aSAH may be affected by cerebral vasospasm and low expression of serum Aβ1-42.The risk model based on cerebral vasospasm and low expression of serum Aβ1-42 has a good accuracy in predicting postoperative cognitive dysfunction in patients with severe aSAH.