脑脊液分析对动脉瘤性蛛网膜下腔出血介入术后亚急性脑积水的预测价值

Prediction value of cerebrospinal fluid analysis for subacute hydrocephalus after interventional operation of aneurysmal subarachnoid hemorrhage

目的:探索动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者30 d内发生脑积水的预测因素。方法:选择2017年1月至2021年8月在福建省立医院神经内科住院并急诊行血管内介入栓塞术治疗的147例aSAH患者,按照发病30 d内CT检查结果分为亚急性脑积水组(n=50)与无脑积水组(n=97),所有患者术后3 d内均行腰椎穿刺脑脊液置换治疗,记录首次脑脊液压力、白细胞数、红细胞数、蛋白含量及IL-6等定量分析指标,另收集两组临床、影像等指标并进行比较,应用单因素和多因素Logistic回归分析亚急性脑积水的危险性因素;并通过受试者工作特征(ROC)曲线分析,确定脑积水的预测界值。结果:两组患者年龄、Hunt-Hess分级、改良Fisher分级、术前脑积水、合并脑室出血及脑脊液红细胞计数、IL-6水平比较,差异均有统计学意义(P<0.01或P<0.05),其余指标差异均无统计学意义(P均>0.05)。多因素Logistic回归分析显示,破入脑室、术前脑积水及脑脊液红细胞计数升高、IL-6水平升高是aSAH患者术后30 d内脑积水的独立危险因素(P<0.05)。ROC曲线结果显示,脑脊液红细胞计数和IL-6预测aSAH患者术后30 d内脑积水的曲线下面积分别为0.627、0.966,诊断界值分别为78950×10^(6)/L及62.25 pg/mL。结论:临床上可通过动脉瘤栓塞术后3 d内脑脊液中IL-6定量分析对aSAH患者进行亚急性脑积水的预测。

Objective:To explore the predictors of hydrocephalus within 30 days in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods:A total of 147 patients with aSAH who were hospitalized in the Department of Neurology of Fujian Provincial Hospital from January 2017 to August 2021 and underwent emergency endovascular interventional embolization were selected and divided into subacute hydrocephalus group(n=50)and non-hydrocephalus group(n=97),according to the results of CT examination within 30 days of onset.Cerebrospinal fluid replacement by lumbar puncture was performed in all patients within 3 days after surgery.Quantitative analysis indexes such as cerebrospinal fluid pressure,white blood cell count,red blood cell count,protein content and IL-6 were recorded for the first time.Clinical and imaging indexes of the two groups were collected and compared,and univariate and multivariate Logistic regression were used to analyze the risk factors for subacute hydrocephalus.The predictive threshold of hydrocephalus was determined by receiver operating characteristic(ROC)curve analysis.Results:There were statistically significant differences in Hunt-Hess grading≥3 points,modified Fisher grading≥gradeⅢ,ventricle hemorrhage,preoperative hydrocephalus,increased red blood cell count and IL-6 level in cerebrospinal fluid between 2 groups(P<0.01 or P<0.05),while no statistically significant differences in other indicators(all P>0.05).Multivariate Logistic regression analysis showed that ventricle hemorrhage,preoperative hydrocephalus,increased red blood cell count and IL-6 level in cerebrospinal fluid were independent risk factors for hydrocephalus within 30 days after surgery in patients with aSAH(P<0.05).ROC curve results showed that the areas under the curve of red blood cell count and IL-6 level in cerebrospinal fluid in predicting hydrocephalus in aSAH patients within 30 days after surgery were 0.627 and 0.966,respectively;and the diagnostic thresholds were 78950×10^(6)/L and 62.25 pg/mL,respectively.Conclusions:Quantitative analysis of IL-6 in cerebrospinal fluid within 3 days after aneurysm embolization could be used to predict subacute hydrocephalus in patients with aSAH.