南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (03): 382-.

• • 上一篇    下一篇

动脉瘤性蛛网膜下腔出血后慢性脑积水与TGF-β1的关系及相关多因素分析

刘飞,袁文,廖达光,张天一,王知非   

  • 出版日期:2013-03-20 发布日期:2013-03-20

Association of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage with transforming growth factor-β1 levels and other risk factors

  • Online:2013-03-20 Published:2013-03-20

摘要: 目的探讨脑脊液中转化生长因子-β1(TGF-β1)浓度及其他临床因素在成年动脉瘤性蛛网膜下腔出血(aSAH)后慢性脑积
水形成中的作用。方法根据患者是否并发慢性脑积水分为非脑积水组和脑积水组。首先比较不同时间点两组间脑脊液中
TGF-β1浓度的差异性;再通过回顾性分析,筛选可能导致慢性脑积水的临床危险因素;最后以多因素Logistic回归分析加以确
定。结果(1)16例患者(12.4%)并发慢性脑积水,诊断慢性脑积水的平均时间为31.6±17.0 d;(2)在第13天脑积水组的TGF-β1
浓度显著性增高(P<0.05);(3)通过回顾性分析,两组间在高血压病史、SAH次数和首诊时Hunt-Hess分级、脑室扩大、动脉瘤位
置、Fisher分级、脑室脑池积血分布计分及术后颅内感染存在显著性差异(P<0.05);(4)多因素分析显示首诊时脑室扩大、动脉瘤
位置、Fisher分级、脑室脑池积血分布计分和术后颅内感染为临床危险因素(P<0.05)。结论对于成年aSAH患者,首诊时脑室
扩大、动脉瘤位置、Fisher分级、脑室脑池积血Graeb评分和术后颅内感染是慢性脑积水形成的危险因素;对预测慢性脑积水的
发生,它们较脑脊液中TGF-β1浓度更具有实际意义。

Abstract: Objective To study the role of transforming growth factor-β1 (TGF-β1) levels and other risk factors in the occurrence
of chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). Methods Patients treated for aSAH in our
hospital between January, 2007 and June, 2012 were divided into non-hydrocephalus group and hydrocephalus group. TGF-β1
levels in the cerebrospinal fluid (CSF) were compared between the two groups at different time points. A retrospective analysis
was conducted to identify the potential risk factors for chronic hydrocephalus, which were subsequently confirmed by Logistic
regression analysis. Results Of the 129 patients enrolled, 16 (12.4% ) developed chronic hydrocephalic with an average
diagnosis time of 31.6±17.0 days. In patients with chronic hydrocephalus, TGF-β1 level in the CSF increased significantly on the
13th day following aSAH (P<0.05). Retrospective analysis showed that the patients with hydrocephalus and those without had
significant differences in history of hypertension, times of SAH, Hunt-Hess classification, ventricular expansion, aneurysm
position, Fisher classification, ventricular hemorrhage score and intracranial infections (P<0.05). Logistic regression analysis
identified ventricular expansion, aneurysm position, Fisher classification, ventricular hemorrhage score and postoperative
intracranial infections as significant risk factors for the occurrence of chronic hydrocephalus (P<0.05). Conclusions In adult
patients with aSAH, the risk factors for chronic hydrocephalus include ventricular expansion, aneurysm position, Fisher
classification, ventricular hemorrhage score and postoperative intracranial infections. These risk factors can have greater
clinical value than TGF-β1 levels in the CSF in predicting the occurrence of chronic hydrocephalus following aSAH.