皮质视觉等级量表和脑萎缩指数对老年慢性硬膜下血肿的预测价值
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摘要
目的探讨皮质视觉等级量表(cortical atrophy scale,CAS)和脑萎缩指数对老年慢性硬膜下血肿(CSDH)的预测价值。方法选择老年头部创伤患者268例,根据3周后有无CSDH发生分为CSDH组40例,非CSDH组228例。采用磁共振扫描仪记录患者脑脊髓液容量、颅内容量、脑容量、脑室容量、蛛网膜下腔容量,计算脑萎缩指数、双额角径或颅内径(Evans)指数、前角指数、CAS。所有患者入院时详细记录其性别、年龄等一般临床资料。比较2组在临床资料、实验室指标方面差异,分析老年CSDH患者各因素间相关性,并应用单因素和多因素logistic回归分析影响头部创伤老年患者CSDH发生的危险性因素。结果 CSDH组脑萎缩指数、CAS中度和重度萎缩比例明显高于非CSDH组(P<0.01)。相关性分析显示,脑萎缩指数与脑容量呈负相关,与脑室容量、蛛网膜下腔容量呈正相关;脑室容量与蛛网膜下腔容量、Evans指数呈正相关;蛛网膜下腔容量与Evans指数呈正相关(r=0.35,P=0.02);Evans指数与前角指数呈正相关(r=0.23,P=0.03)。单因素和多因素logistic回归分析显示,入院时脑萎缩指数≥7.15%、CAS为中度萎缩和重度萎缩会增加老年头部创伤患者CSDH发生风险(P<0.05)。结论CAS和脑萎缩指数可预测老年头部创伤患者CSDH发生。
Objective To study the value of CAS and brain atrophy index(BAI)in predicting CSDH in elderly patients.Methods Two hundred and sixty-eight elderly head trauma patients were divided into CSDH group(n=40)and CSDH-free group(n=228).Their CSF volume,intracranial volume,brain volume,ventricular volume,subarachnoid space volume were measured by MR scanning,their BAI,Evans index,FHI,CAS score and clinical data such as gender and age were recorded,their clinical data and laboratory parameters were compared.Relationship between different factors in elderly CSDH patients was analyzed.The risk factors for CSDH in head trauma patients were analyzed by univariate and multivariate logistic regression analysis.Results The BAI and CAS score of moderate and severe brain atropy were significantly higher in CSDH group than in CSDH-free group(P<0.01).Correlation analysis showed that BAI was negatively related with brain volume and positively related with ventricular volume and subarachnoid space volume,ventriclular volume was positively related with subarachnoid space volume and Evans index,subarachnoid space volume was positively related with Evans index(r=0.35,P=0.02),Evans index was positively related with FHI(r=0.23,P=0.03).Univariate and multivariate logistic regression analysis showed that BAI≥7.15% on admission and CAS score of moderate and severe brain atrophy increased the risk of CSDH in elderly head trauma patients(P<0.05).Concluson CAS score and BAI can predict the occurrence of CSDH in elderly head trauma patients.
Objective To study the value of CAS and brain atrophy index(BAI)in predicting CSDH in elderly patients.Methods Two hundred and sixty-eight elderly head trauma patients were divided into CSDH group(n=40)and CSDH-free group(n=228).Their CSF volume,intracranial volume,brain volume,ventricular volume,subarachnoid space volume were measured by MR scanning,their BAI,Evans index,FHI,CAS score and clinical data such as gender and age were recorded,their clinical data and laboratory parameters were compared.Relationship between different factors in elderly CSDH patients was analyzed.The risk factors for CSDH in head trauma patients were analyzed by univariate and multivariate logistic regression analysis.Results The BAI and CAS score of moderate and severe brain atropy were significantly higher in CSDH group than in CSDH-free group(P<0.01).Correlation analysis showed that BAI was negatively related with brain volume and positively related with ventricular volume and subarachnoid space volume,ventriclular volume was positively related with subarachnoid space volume and Evans index,subarachnoid space volume was positively related with Evans index(r=0.35,P=0.02),Evans index was positively related with FHI(r=0.23,P=0.03).Univariate and multivariate logistic regression analysis showed that BAI≥7.15% on admission and CAS score of moderate and severe brain atrophy increased the risk of CSDH in elderly head trauma patients(P<0.05).Concluson CAS score and BAI can predict the occurrence of CSDH in elderly head trauma patients.
引文
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[2]Ohba S,Kinoshita Y,Nakagawa T,et al.The risk factors for recurrence of chronic subdural hematoma[J].Neurosurg Rev,2013,36(1):145-149.DOI:10.1007/s10143-012-0396-z.
[3]Ju MW,Kim SH,Kwon HJ,et al.Comparision between brain atrophy and subdural volume to predict chronic subdural hematoma:volumetric CT imaging analysis[J].Korean J Neurotrauma,2015,11(2):87-92.DOI:10.13004/kjnt.2015.11.2.87.
[4]Akgun B,Cakin H,Ozturk S,et al.Evaluation of cortical brain parenchyma by diffusion and perfusion MRI before and after chronic subdural hematoma surgery[J].Turk Neurosurg,2017,27(5):1019-1028.DOI:10.5137/1019-5149.JTN.19968-17.1.
[5]Gonzales MM,Insel PS,Nelson C,et al.Cortical atrophy is associated with accelerated cognitive decline in mild cognitive impairment with subsyndromal depression[J].Am J Geriatr Psychiatry,2017,25(9):980-991.DOI:10.1016/j.jagp.2017.04.011.
[6]Arpín EC,Sobrino TG,Vivero CD,et al.Changes in brain atrophy indices in patients with relapsing-remitting multiple sclerosis treated with natalizumab[J].Neurodegener Dis Manag,2016,6(1):5-12.DOI:10.2217/nmt.15.53.
[7]Jeong EO,Choi SW,Lim JW,et al.Effectiveness of cortical atrophy scale and indirect indices of brain atrophy to predict chronic subdural hematoma in older patients[J].Korean J Neurotrauma,2016,12(2):112-117.DOI:10.13004/kjnt.2016.12.2.112.
[8]Lee L,Ker J,Ng HY,et al.Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians:a multicenter study[J].J Neurosurg,2016,124(2):546-551.DOI:10.3171/2014.12.JNS142053.
[9]盖延廷,贺子建.钻孔引流术与钻孔冲洗术治疗慢性硬膜下血肿疗效的Meta分析[J].中国临床神经外科杂志,2015,20(5):293-295.DOI:10.13798/j.issn.1009-153X.2015.05.012.
[10]肖爵贤,程世奇,邹轶群,等.阿托伐他汀治疗慢性硬膜下血肿的疗效分析[J].临床外科杂志,2015,23(2):159-160.DOI:10.3969/j.issn.1005-6483.2015.02.032.
[11]Thotakura AK,Marabathina NR.Nonsurgical treatment of chronic subdural hematoma with steroids[J].World Neurosurg,2015,84(6):1968-1972.DOI:10.1016/j.wneu.2015.08.044.
[12]Leroy HA,Abouka6s R,Reyns N,et al.Predictors of functional outcomes and recurrence of chronic subdural hematomas[J].J Clin Neurosci,2015,22(12):1895-1900.DOI:10.1016/j.jocn.2015.03.064.
[13]Yang AI,Balser DS,Mikheev A,et al.Cerebral atrophy is associated with development of chronic subdural haematoma[J].Brain Inj,2011,26(13-14):1731-1736.DOI:10.3109/02699052.2012.698364.
[14]Koedam EL,Lehmann M,van der Flier WM,et al.Visual assessment of posterior atrophy development of a MRI rating scale[J].Eur Radiol,2011,21(12):2618-2625.DOI:10.1007/s00330-011-2205-4.
[15]Steenwijk MD,Geurts JJ,Daams M,et al.Cortical atrophy patterns in multiple sclerosis are non-random and clinically relevant[J].Brain,2016,139(1):115-126.DOI:10.1093/brain/awv337.
[16]Tatsumi H,Yamamoto M,Yasui K,et al.Clinical significance of cognitive rehabilitation and psychoeducational intervention for family caregivers of patients with posterior cortical atrophy:a longitudinal study[J].Psychogeriatrics,2018,18(1):77-78.DOI:10.1111/psyg.12284.
[17]Zivadinov R,Cerza N,Hagemeier J,et al.Humoral response to EBV is associated with cortical atrophy and lesion burden in patients with MS[J].Neurol Neuroimmunol Neuroinflamm,2016,3(1):e190.DOI:10.1212/NXI.0000000000000190.
[18]Suárez-González A,Crutch SJ,Franco-Macías E,et al.Neuropsychiatric symptoms in posterior cortical atrophy and Alzheimer disease[J].J Geriatr Psychiatry Neurol,2016,29(2):65-71.DOI:10.1177/0891988715606229.
[19]Ferreira D,Verhagen C,Hernández-Cabrera JA,et al.Distinct subtypes of Alzheimer's disease based on patterns of brain atrophy:longitudinal trajectories and clinical applications[J].Sci Rep,2017,7:46263.DOI:10.1038/srep46263.