Diagnostic value of computed tomography angiography combined with IL-6 and TNF-α in intracranial aneurysms
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摘要:
目的 探讨采用计算机体层血管成像（CTA）与白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）联合检测对颅内动脉瘤的诊断鉴别价值。 方法 选取本院2019年3月~2022年3月收治的108例颅内动脉瘤疑似病例，采用CTA联合IL-6、TNF-α检测分析其对颅内动脉瘤的诊断价值。 结果 108例疑似患者经数字减影血管造影检测发现93例确诊为颅内动脉瘤，CTA诊断为87例，CTA诊断的Kappa值为0.669，准确性为90.74%，敏感度为0.914，特异性为0.867；颅内动脉瘤患者机体血清IL-6、TNF-α水平高于非颅内动脉瘤患者（P < 0.05）；Spearman相关性分析显示：IL-6、TNF-α与患者颅内动脉瘤的发生呈正相关关系（r=0.377、0.453，P < 0.05）；ROC曲线显示，CTA与IL-6、TNF-α联合诊断指标曲线下面积为0.974，高于各单项指标曲线下面积（P < 0.05）。 结论 CTA联合IL-6、TNF-α检测对颅内动脉瘤具有较高的诊断价值。 Abstract:Objective To evaluate the diagnostic value of computed tomography angiography (CTA) combined with interleukin (IL-6) and tumor necrosis factor-α (TNF-α) in intracranial aneurysms. Methods A total of 108 suspected cases of intracranial aneurysm admitted to our hospital from March 2019 to March 2022 were selected. The diagnostic value of CTA combined with IL-6 and TNF-α were analyzed. Results Among 108 suspected patients, 93 were diagnosed as intracranial aneurysm by DSA and 87 were diagnosed by CTA. The Kappa value of CTA was 0.669, accuracy was 90.74%, sensitivity was 0.914 and specificity was 0.867. The serum levels of IL-6 and TNF-α in patients with intracranial aneurysm were significantly higher than those in patients without intracranial aneurysm (P < 0.05). Spearman correlation analysis showed that IL-6 and TNF-α were positively correlated with the occurrence of intracranial aneurysm (r=0.377, 0.453, P < 0.05). ROC curve showed that the area under the curve of CTA combined with IL-6 and TNF-α was 0.974, which was significantly higher than the area under the curve of each single index (P < 0.05). Conclusion CTA combined with IL-6 and TNF-α has high diagnostic value for intracranial aneurysm. -
图 1 患者男，53岁，因突发剧烈头痛伴呕吐6 h急诊入院，头颅CTA提示右侧大脑中动脉分叉处动脉瘤
Figure 1. A 53-year-old male patient was admitted to the emergency department with sudden severe headache and vomiting for 6 hours. Cranial CTA showed aneurysm at the bifurcation of the right middle cerebral artery.
图 2 患者男，55岁，因突发剧烈头颈部疼痛8 h急诊入院，头颅CTA提示前交通复合体动脉瘤
Figure 2. A 55-year-old male patient was admitted to the emergency department due to sudden severe head and neck pain for 8 hours. Cranial CTA showed anterior communicating complex aneurysm.
图 3 CTA联合IL-6、TNF-α对颅内动脉瘤的诊断效能
Figure 3. Diagnostic efficacy of intracranial aneurysm by CTA combined with IL-6 and TNF-α.
表 1 CTA诊断颅内动脉瘤的一致性分析
Table 1. Consistent analysis of intracranial aneurysms diagnosed by CTA
项目 CTA(n) DSA(n) 敏感度 特异性 阳性预测值 阴性预测值 Kappa值 阳性 87 93 0.914 0.867 0.977 0.619 0.669 阴性 21 15 合计 108 108 CTA: 计算机体层血管成像; DSA: 数字减影血管造影. 
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表 2 IL-6、TNF-α水平比较
Table 2. Comparison of IL-6, TNF-α levels (pg/mL, Mean±SD)
组别 IL-6 TNF-α 颅内动脉瘤（n=93） 41.32±9.54 26.54±7.53 非颅内动脉瘤（n=15） 30.74±6.17 15.60±5.77 t 4.152 5.367 P < 0.001 < 0.001 IL-6: 白介素-6; TNF-α: 肿瘤坏死因子-α.
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表 3 CTA联合IL-6、TNF-α对颅内动脉瘤的诊断效能
Table 3. Diagnostic efficacy of CTA combined with IL-6 and TNF-α for intracranial aneurysms
指标 曲线下面积 最佳截断值 敏感度 特异性 95% CI 约登指数 CTA 0.896* - 0.925 0.867 0.791~1.000 0.792 IL-6 0.814* 35.38 pg/mL 0.710 0.933 0.716~0.913 0.643 TNF-α 0.878* 19.21 pg/mL 0.849 0.733 0.794~0.962 0.582 联合 0.974 - 0.957 0.933 0.934~1.000 0.890 *P < 0.05 vs联合诊断.
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