动脉瘤性蛛网膜下腔出血患者继发分流依赖性脑积水的危险因素分析

Analysis of risk factors of shunt dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

目的分析动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者继发分流依赖性脑积水(secondary shunt dependent hydrocephalus,SDHC)的危险因素。方法研究纳入2022年1月至2022年12月入住郑州大学第一附属医院125例aSAH患者,其中SDHC组40例,对照组85例。进行两组间一般临床资料比较,危险因素分析采用多因素logistic回归分析,采用ROC曲线分析计算AUC值。结果SDHC组患者较大年龄、入院时低GCS评分、更高的改良Fisher分级、Hunt-Hess分级,合并全身炎症反应综合征、脑室积血、发生症状性血管痉挛、继发性颅内感染、更高的白细胞水平、更高的血糖、更高的D二聚体水平与SDHC存在相关性(P<0.05)。多因素logistic回归分析显示脑室积血(OR=92.335,95%CI:6.304~1352.366)、症状性血管痉挛(OR=15.388,95%CI:1.188~199.323)及血糖升高(OR=1.411,95%CI:1.018~1.956)是发生SDCH的独立危险因素。应用ROC曲线分析,显示脑室积血AUC=0.834(95%CI:0.747~0.921,P<0.001),敏感度为75%;症状性血管痉挛AUC=0.657(95%CI:0.546~0.768,P=0.005),敏感度为35%;血糖升高AUC=0.788,(95%CI:0.704~0.873,P<0.001),敏感度为70%。结论脑室积血、发生症状性血管痉挛及血糖升高是患者发生SDHC的独立危险因素,脑室积血的敏感度更高。

Objective To analyze the risk factors of secondary shunt dependent hydrocephalus(SDHC)in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods This study included 125 hospitalized patients admitted to the First Affiliated Hospital of Zhengzhou University with the diagnosis of aSAH between January 2022 to December 2022,including 40 patients with SDHC and 85 patients in the control group.The clinical data of the two groups were compared,the risk factors were analyzed by multi-factor logistic regression,and AUCs were calculated by ROC curve.Results Patients with SDHC were older,had lower GCS score at admission,and had higher modified Fisher grade and Hunt-Hess grade.There were statistically significant correlations between systemic inflammatory response syndrome and intraventricular hemorrhage,symptomatic vasospasm and secondary intracranial infection,higher leukocyte level,higher blood glucose level and higher D-dimer level with SDHC(P<0.05).Multivariate logistic regression analysis showed intraventricular hemorrhage(OR=92.335,95%CI:6.304-1352.366),symptomatic vasospasm(OR=15.388,95%CI:1.188-199.323)and elevated blood glucose(OR=1.411,95%CI:1.018-1.956)was an independent risk factor for SDCH in patients.ROC curve analysis showed that the AUC was 0.834(95%CI:0.747-0.921,P<0.001),and the sensitivity was 75%.Symptomatic vasospasm AUC was 0.657(95%CI:0.546-0.768,P=0.005)and sensitivity was 35%;AUC was 0.788,(95%CI:0.704-0.873,P<0.001),sensitivity was 70%.Conclusion Intraventricular hemorrhage,symptomatic vasospasm and elevated blood glucose are independent risk factors for SDHC,and the sensitivity of Intraventricular hemorrhage is higher.