幕上胶质瘤患者瘤周水肿与镇静药物诱发神经功能缺陷之间的关系

Relationship between peritumoral edema and sedative-induced neurological deficits in patients with supratentorial glioma

目的观察幕上胶质瘤水肿程度与镇静诱发神经功能缺陷之间的关系,为探索胶质瘤对网络功能连接的影响提供参考。方法研究回顾性纳入头部磁共振诊断为幕上胶质瘤(额-颞-顶区域)且经术后病理确定为胶质瘤的患者。采集患者瘤周水肿程度,以Steinhoff分级划分;以术前镇静诱发的神经功能缺陷作为对病变大脑的药物应激测试,神经功能评估采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)进行,分为2组,即镇静后变化阳性(NIHSS改变≥2分)及阴性(NIHSS改变<2分)组。分析Steinhoff分级与镇静诱发神经功能缺陷的关系。结果在纳入的76例患者中,术前镇静药物应激测试中呈现阳性的患者共32例(42.1%),术前Steinhoff分级与测试结果没有相关性(Ⅰ级:34.4%vs 40.9%;Ⅱ级:43.8%vs 38.6%;Ⅲ级:21.9%vs 20.5%,P=0.842)。肿瘤世界卫生组织(World Health Organization,WHO)分级显著影响测试的结果,高级别胶质瘤患者在镇静药物应激测试中呈现阳性反应的比例显著高于低级别胶质瘤(Ⅱ级:40.6%vs 70.5%;Ⅲ~Ⅳ级:59.4%vs 29.5%,P=0.009)。另外,测试呈阳性的患者住院花费显著升高[6.65(4.11,10.30)万元vs 4.49(3.46,7.13)万元,P=0.006],且这类患者术后卡氏功能状态(Karnofsky Performance Status,KPS)评分有较低倾向(P=0.052)。结论幕上胶质瘤患者瘤周水肿的程度与镇静药物诱发的神经缺陷阳性率之间无显著关联。但药物应激测试呈现阳性的患者住院花费显著增高,术后功能状态也相对较差。

Objective The study is to observe the relationship between the degree of peritumoral edema in supratentorial gliomas and sedation-induced neurological deficits to provide a reference for exploring the impact of gliomas on the functional connectivity of brain networks.Methods The study retrospectively included patients with supratentorial gliomas(frontal-temporal-parietal region)diagnosed by brain magnetic resonance imaging.All patients were also confirmed as gliomas by postoperative pathology.The Steinhoff grade of peritumoral edema was recorded,and sedative-induced neurological deficits as a brain stress test were evaluated by the National Institutes of Health Stroke Scale(NIHSS)score change.The NIHSS score change after sedation was defined as positive change(NIHSS change≥2 points)and negative change(NIHSS change<2 points).The association between Steinhoff grades and sedative-induced neurological deficits was analyzed.Results Of the 76 patients enrolled,32(42.1%)were positive on preoperative sedative stress tests,and preoperative Steinhoff classification was not associated with test results(gradeⅠ:34.4%vs 40.9%;gradeⅡ:43.8%vs 38.6%;gradeⅢ:21.9%vs 20.5%,P=0.842).Patients with high-grade glioma had significant higher incidence of positive change in the brain stress test(gradeⅡ:40.6%vs 70.5%;gradeⅢ-Ⅳ:59.4%vs 29.5%,P=0.009).In addition,hospitalization costs were significantly higher in patients with positive changes[6.65(4.11-10.30)thousand Yuan vs 4.49(3.46-7.13)thousand Yuan,P=0.006],and such patients tended to have lower postoperative Karnofsky Performance Status(KPS)scores(P=0.052).Conclusion There was no significant association between the degree of peritumoral edema in patients with supratentorial glioma and the positive rate of sedative-induced neurological deficits.However,patients with positive changes in brain stress tests by sedation had significantly higher hospitalization costs and poor postoperative functional status.