WFNS I级动脉瘤性蛛网膜下腔出血患者的预后因素

目的：探讨导致世界神经外科联盟分级（WFNS）I级的动脉瘤性蛛网膜下腔出血（aSAH）患者预后不良的相关因素。方法：回顾性分析2007年12月至2016年1月温州医科大学附属第一医院收治的407例前交通动脉（ACoA）动脉瘤破裂后形成蛛网膜下腔出血的WFNS?I级患者。用出院时的格拉斯哥预后（GOS）评分来评估患者的临床预后，并将GOS 1～3分定义为预后不良。对患者的年龄、性别、治疗方式、高血压史、吸烟史、血管痉挛、脑梗死、Fisher分级和动脉瘤形态（动脉瘤大小、瘤颈、AR、SR、动脉瘤角度、血管角度、血流角度、动脉瘤朝向、A1段形态学、子囊）等进行单因素及多因素logistic回归分析，得到与预后不良的相关因素；再用ROC曲线评估相关因素的预测效能。结果：在407例WFNS?I级的患者中仅30例（7.4%）出现预后不良。多因素logistic回归分析显示，高龄（OR=1.038，95%CI=1.003～1.075，P=0.033）、Fisher分级＞3（OR=5.109，95%CI=1.806～14.457，P=0.002）、治疗方式（栓塞 vs. 保守治疗，OR=0.200，95%CI=0.068～0.588，P=0.003）和子囊（OR=4.957，95%CI=1.730～14.207，P=0.003）与预后不良密切相关。ROC曲线结果显示，年龄、Fisher分级、治疗方式、子囊和联合诊断AUC值分别为0.691（95%CI=0.586～0.796）、0.687（95%CI=0.597～0.778）、0.658（95%CI=0.543～0.773）、0.574（95%CI=0.457～0.691）和0.817（95%CI=0.739～0.896）。结论：较大年龄、动脉瘤子囊形成及Fisher分级＞3是WFNS?I级aSAH患者预后不良的危险因素，栓塞治疗后的患者预后相对较好。

Prognostic factors of aneurysmal subarachnoid hemorrhage in patients with WFNS grade I

Objective: To investigate the risk factors of unfavourable outcome of World Federation of Neurosurgical Societies (WFNS) grade I aneurysmal subarachnoid haemorrhage (aSAH) patients. Methods: Totally 407 patients with WFNS grade I aSAH caused by rupture of anterior communicating artery (ACoA) aneurysms, who were admitted to the First Affiliated Hospital of Wenzhou Medical University between December 2007 and January 2016, were retrospectively analyzed. Glasgow outcome scale (GOS) was used to measure clinical outcome at discharge. Unfavourable outcome was defined as a GOS score of 1~3. Univariate and multivariate logistic regression analysis were adopted to compare the patients in age, sex, treatment, medical history (hypertension, smoke), angiographic vasospasm, Fisher grade, Cerebral infarction, aneurysm morphology (aneurysm size, neck size, aspect ratio, size ratio, aneurysm angle, vessel angle, flow angle, aneurysm orientation, A1 segment types, and daughter sac). Receiver operating characteristic curve (ROC curve) was used to evaluate the predictive performance of factors related to poor prognosis. Results: Of the 407 WFNS I patients, only 30 (7.4%) had a poor prognosis. Multivariate logistic regression analysis showed that older age (OR=1.038, 95%CI=1.003-1.075, P=0.033), Fisher grade>3(OR=5.109, 95%CI=1.806-14.457, P=0.002), treatment (Coil vs. Conservative, OR=0.200, 95%CI=0.068-0.588, P=0.003) and daughter sac (OR=4.957, 95%CI=1.730-14.207, P=0.003) were independently associated with poor prognosis. In the ROC curve, the AUC in age, Fisher grade>3, treatment, daughter sac and combined diagnosis were respectively 0.691 (95%CI=0.586-0.796), 0.687 (95%CI=0.597-0.778), 0.658 (95%CI=0.543-0.773), 0.574 (95%CI=0.457-0.691) and 0.817 (95%CI=0.739-0.896). Conclusion: Older age, daughter sac, and Fisher grade >3 are the risk factors for poor prognosis of WFNS grade I aSAH patients. In addition, patients who choose embolization have better prognosis.