摘要
目的探讨交通性脑积水(CHP)脑室-腹腔分流(VPS)术后迟发性颅内出血(DICH)发生的危险因素,构建预测术后DICH发生的列线图模型,并对模型的预测效果予以评估。方法选取淮安市第二人民医院神经外科自2016年2月至2021年8月行VPS术的307例CHP患者为研究对象进行病例对照研究,根据术后是否发生DICH分为DICH组(49例)和对照组(258例)。收集所有患者的基本资料(包括年龄、性别、原发病、是否合并基础疾病、既往颅脑手术史、抗凝药使用史、有无颅骨缺损等)及治疗信息(穿刺侧别、1周内调节分流阀门)行单因素分析,通过多因素Logistic回归分析确定术后CHP的危险因素,并通过受试者工作特征(ROC)曲线和校准曲线评估列线图模型的预测能力。另选取104例行VPS术的CHP患者为验证集,并对列线图模型做外部验证。结果DICH组年龄、既往颅脑手术史比例、颅骨缺损比例、1周内调节分流阀门比例明显较对照组高(P<0.05);Logistic回归分析结果显示,年龄、既往颅脑手术史、颅骨缺损、1周内调节分流阀门是CHP患者VPS术后DICH发生的主要危险因素(P<0.05);ROC曲线分析结果显示,构建的CHP患者VPS术后DICH发生的列线图预测模型具有较好的区分度[曲线下面积(AUC)为0.858,95%CI:0.804~0.913]和精准度(拟合优度HL检验χ^(2)=7.831,P=0.396);104例行VPS术的CHP患者中16例发生DICH,发生率为15.38%,外部验证中AUC为0.792(95%CI:0.729~0.855),校准曲线拟合优度HL检验(χ^(2)=8.319,P=0.351),提示精准度较高。结论基于年龄、既往颅脑手术史、颅骨缺损、1周内调节分流阀门4项危险因素构建的CHP患者VPS术后DICH发生的列线图模型具有较高的预测效能。
ObjectiveTo investigate the risk factors of delayed intracranial hemorrhage(DICH)after ventriculo-peritoneal shunt(VPS)for communicating hydrocephalus(CHP),to construct a nomogram model for predicting the occurrence of DICH after surgery,and the prediction effect of the model was evaluated.MethodsA case-control study was conducted on 307 CHP patients who underwent VPS surgery in Neurosurgery Department of Huai'an Second People's Hospital from February 2016 to August 2021.They were divided into the DICH group(n=49)and the control group(n=258)according to whether DICH occurred after surgery.The basic data(including age,gender,primary disease,whether combined with underlying diseases,the history of previous craniocerebral surgery,the history of anticoagulant use,presence or absence of skull defects,etc.)and treatment information(side puncture,adjustment of the shunt valve within 1 week)were collected for single factor analysis,multivariate Logistic regression analysis was used to determine the risk factors of postoperative CHP,and ROC curve and calibration curve were used to evaluate the predictive ability of the nomogram model.Another 104 CHP patients who underwent VPS were selected as the validation set,and the nomogram model was externally validated.ResultsThe age,the proportion of previous craniocerebral surgery history,the proportion of skull defects,and the proportion of adjustment of the shunt valve within 1 week in the DICH group were significantly higher than those in the control group(P<0.05);Logistic regression analysis showed that the age,the history of previous craniocerebral surgery,skull defect,and adjustment of the shunt valve within 1 week were the main risk factors for DICH after VPS in patients with CHP(P<0.05);ROC curve analysis results showed that the constructed nomogram prediction model of DICH after VPS in CHP patients had good discrimination[area under curve(AUC)was 0.858,95%CI:0.804-0.913]and accuracy(goodness of fit HL testχ^(2)=7.831,P=0.396);Among 104 cases in the validation set,16 case
作者
吴晓凡
罗书引
冯二艳
Wu Xiaofan;Luo Shuyin;Feng Eryan(Department of Neurosurgery,Huai'an Second People's Hospital,Huai'an 223002,China)
出处
《中华神经创伤外科电子杂志》
2022年第5期276-281,共6页
Chinese Journal Of Neurotraumatic Surgery：Electronic Edition
关键词
交通性脑积水
脑室-腹腔分流术
迟发性颅内出血
列线图预测模型
Communicating hydrocephalus
Ventriculo-peritoneal shunt
Delayed intracranial hemorrhage
Nomogram prediction model
