动脉瘤性蛛网膜下腔出血患者发生急性脑积水的危险因素分析

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[中图分类号] R651. 1 [文献标志码] A

ABSTRACT Objective：To explore the risk factors associated with aneurysmal subarachnoid haemorrhage （aSAH）complicated with acute hydrocephalus （aHCP），and to provide the clinical reference for the early identification and intervention of these patients.Methods：The clinical data and laboratory indexes of 175 patients with aSAH were retrospectively analysed，and the patients were divided into aHCP group （ n=56 ）and non-aHCP group （ n=119 ）according to whether they presented with aHCP after the onset of the disease.Univariate analysis and binary logistic regresson were applied to identify the risk factors for the aHCP in aSAH patients，and receiver operating characteristic （ROC） curve analysis with area under the curve （AUC） was used to evaluate the predictive value of these factors. Results：A total of 56 （ 32.0% ）out of 175 aSAH patients included developed aHCP after the onset of the disease. Compared with non-aHCP group，the levels of neutrophil count，blood glucose，neutrophil-albumin ratio （NAR），platelet-lymphocyte ratio（PLR），neutrophil-lymphocyte ratio （NLR），monocyte-lymphocyte ratio （MLR），systemic immuneinflammatory index （SII），systemic inflammatory response index （SIRI），and systemic inflammation composite index （AISI） of the patients in aHCP group were significantly increased（ P<0.05 ），the level of lymphocyte count was significantly decreased .-0.05 ），theHunt-Hess grade and modified Fisher grade were higher （ P<0.05 ），and the incidence of ventricularhaematochezia wasmore high （ P<0.05 ）.ThebinaryLogistic regression analysis results showed that the elevated levels of NAR（OR .=2.237 ， 95% CI： 1.063-4.708 ， P=0.034 ）andNLR（OR ⋅=1.210 ， 95% CI： 1.095-1.337 ， P<0.01 ）were the independent risk factors for the development of aHCP after aSAH. The ROC curve analysis showed that the AUC of NAR was 0.812（ 95% CI： 0.745-0.878 ， P<0.001 ），theAUCofNLRwasO.844（ 95% CI： 0.785-0.903 ， P< 0.001），and the combined AUC of NAR and NLR was O.854（ 95% CI： 0.798-0.910 ， P<0.001 ） Conclusion：NAR and NLR are independent risk factors for the development of aHCP in aSAH patients.

KEYWORDS Aneurysmal subarachnoid hemorhage；Acute hydrocephalus；Neuroinflammatory response；Risk factor

动脉瘤性蛛网膜下腔出血（aneurysmalsubarachnoidhemorrhage，aSAH）是出血性卒中发病率和死亡率均较高的亚型，占所有卒中类型的5% ，全球年发病率约为 6.1/10 万，院前死亡率可达 22%～26% ，院内死亡率可达 13% [1-3]。（剩余10849字）