颅内动脉瘤介入术后认知功能障碍的因素探讨:基于PSM法

doi:10.3969/j.issn.1004-583X.2025.04.004

摘要/Abstract

摘要：

目的基于倾向性评分匹配(propensity score matching,PSM)法探讨颅内动脉瘤介入术后认知功能障碍的影响因素。方法回顾性分析2016年1月-2023年11月濮阳市安阳地区医院收治的行介入术治疗的颅内动脉瘤患者392例,根据术后认知功能障碍发生情况将其分为认知障碍组(n=58)与非认知障碍组(n=334)。采用PSM法对两组性别、年龄、学历等进行1∶1匹配,比较匹配前后两组临床资料。采用单因素及多因素logistic回归分析法探索颅内动脉瘤介入术后认知功能障碍的影响因素。结果采用PSM法进行1∶1匹配后,共有52对匹配成功。匹配后,两组性别、年龄、学历、吸烟史、饮酒史比较差异无统计学意义(P>0.05);匹配后,认知障碍组入院时Hunt-Hess分级Ⅲ级、入院时计算机断层扫描(computed tomography,CT) Fisher分级≥Ⅲ级、入院时世界神经外科学会联合会(world federation of neurosurgical societies,WFNS)分级≥Ⅲ级、入院至手术时间≥3 d、动脉瘤最长径>10 mm、动脉瘤破裂、手术耗时>60 min、术后脑缺血占比均高于非认知障碍组(P<0.05);多因素logistic回归分析显示,入院时Hunt-Hess分级Ⅲ级、入院时CT Fisher分级≥Ⅲ级、入院时WFNS分级≥Ⅲ级、动脉瘤破裂、手术耗时>60 min、术后脑缺血均是颅内动脉瘤介入术后并发认知功能障碍的危险因素(P<0.05)。结论基于PSM法,入院时Hunt-Hess分级、入院时CT Fisher分级、入院时WFNS分级、动脉瘤破裂、手术耗时、术后脑缺血均是颅内动脉瘤介入术后并发认知功能障碍的影响因素。

关键词: 颅内动脉瘤, 介入治疗, 认知功能, 影响因素, 倾向性评分匹配

Abstract:

Objective To explore the influencing factors for cognitive dysfunction after intracranial aneurysm intervention based on the propensity score matching (PSM) method. Methods The clinical data of 392 patients with intracranial aneurysms treated with intervention surgery in Anyang District Hospital, Puyang City from January 2016 to November 2023 were retrospectively analyzed, and they were divided into the cognitive dysfunction group (n=58) and non-cognitive dysfunction group (n=334) based on the occurrence of postoperative cognitive dysfunction. Gender, age and education level of patients in the two groups were matched by using the PSM method at a 1∶1 ratio. The clinical data of the two groups of patients before and after PSM were compared. The influencing factors for cognitive dysfunction after intracranial aneurysm intervention surgery was explored by univariate and multivariate logistic regression analyses. Results After PSM at a 1∶1 ratio, a total of 52 pairs of patients were successfully matched. After matching, there were no significant differences in the gender, age, education level, smoking history and drinking history between the two groups of patients (P>0.05). After matching, the proportions of Hunt-Hess grade Ⅲ on admission, computed tomography (CT) Fisher grade≥Ⅲ on admission, world federation of neurosurgical societies (WFNS) grade≥Ⅲ on admission, time from admission to surgery ≥3 d, longest diameter of aneurysm>10 mm, aneurysm rupture, surgery time>60 min and postoperative cerebral ischemia in the cognitive dysfunction group were significantly higher than those of the non-cognitive dysfunction group (P<0.05). Multivariate logistic regression analysis showed that Hunt-Hess grade Ⅲ at admission, CT Fisher grade≥Ⅲ on admission, WFNS grade≥Ⅲ on admission, aneurysm rupture, surgery time>60 min and postoperative cerebral ischemia were all risk factors for cognitive dysfunction after intracranial aneurysm intervention (P<0.05). Conclusion Based on the PSM method, Hunt-Hess grade on admission, CT Fisher grade on admission, WFNS grade on admission, aneurysm rupture, surgery time and postoperative cerebral ischemia are all influencing factors for cognitive dysfunction after intracranial aneurysm intervention.

Key words: intracranial aneurysm, interventional therapy, cognitive function, influencing factors, propensity score matching

中图分类号:

R743.9

赵世亮, 牛艳国, 赵燕民, 李俊青, 洪丽, 王献. 颅内动脉瘤介入术后认知功能障碍的因素探讨:基于PSM法[J]. 临床荟萃, 2025, 40(4): 320-324.

Zhao Shiliang, Niu Yanguo, Zhao Yanmin, Li Junqing, Hong Li, Wang Xian. Factors influencing cognitive dysfunction after interventional surgery for intracranial aneurysms: A PSM study[J]. Clinical Focus, 2025, 40(4): 320-324.

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链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.04.004

https://lchc.magtechjournal.com/CN/Y2025/V40/I4/320

图/表 5

表1 匹配前两组基线资料比较

Tab. 1 Baseline data of patients between two groups before and after PSM

组别	例数	性别[例(%)]		年龄 (岁)	学历[例(%)]			吸烟史 [例(%)]	饮酒史 [例(%)]
组别	例数	男	女	年龄 (岁)	小学/初中	高中/中专	大专及以上	吸烟史 [例(%)]	饮酒史 [例(%)]
匹配前认知障碍组	58	30(51.7)	28(48.3)	56.85±11.32	20(34.5)	28(48.3)	10(17.2)	24(41.4)	19(32.8)
匹配前非认知障碍组	334	186(55.7)	148(44.3)	54.24±10.69	61(18.3)	201(60.2)	72(21.6)	116(34.7)	93(27.8)
统计值		χ²=0.314		$t$ =1.701	χ²=7.930			χ²=0.952	χ²=0.585
P值		0.575		0.090	0.019			0.329	0.444

表1 匹配前两组基线资料比较

Tab. 1 Baseline data of patients between two groups before and after PSM

组别	例数	性别[例(%)]		年龄 (岁)	学历[例(%)]			吸烟史 [例(%)]	饮酒史 [例(%)]
组别	例数	男	女	年龄 (岁)	小学/初中	高中/中专	大专及以上	吸烟史 [例(%)]	饮酒史 [例(%)]
匹配前认知障碍组	58	30(51.7)	28(48.3)	56.85±11.32	20(34.5)	28(48.3)	10(17.2)	24(41.4)	19(32.8)
匹配前非认知障碍组	334	186(55.7)	148(44.3)	54.24±10.69	61(18.3)	201(60.2)	72(21.6)	116(34.7)	93(27.8)
统计值		χ²=0.314		$t$ =1.701	χ²=7.930			χ²=0.952	χ²=0.585
P值		0.575		0.090	0.019			0.329	0.444

表2 匹配后两组基线资料比较

Tab. 2 Baseline data of patients between the two groups

组别	例数	性别[例(%)]		年龄 (岁)	学历[例(%)]			吸烟史 [例(%)]	饮酒史 [例(%)]
组别	例数	男	女	年龄 (岁)	小学/初中	高中/中专	大专及以上	吸烟史 [例(%)]	饮酒史 [例(%)]
匹配后认知障碍组	52	26(50.0)	26(50.0)	56.41±10.69	17(32.7)	27(51.9)	8(15.4)	20(38.5)	16(30.8)
匹配后非认知障碍组	52	28(53.8)	24(46.2)	55.18±10.33	15(28.8)	28(53.8)	9(17.3)	19(36.5)	14(26.9)
统计值		χ²=0.154		$t$ =0.597	χ²=1.830			χ²=0.041	χ²=0.187
P值		0.695		0.552	0.401			0.839	0.665

表2 匹配后两组基线资料比较

Tab. 2 Baseline data of patients between the two groups

组别	例数	性别[例(%)]		年龄 (岁)	学历[例(%)]			吸烟史 [例(%)]	饮酒史 [例(%)]
组别	例数	男	女	年龄 (岁)	小学/初中	高中/中专	大专及以上	吸烟史 [例(%)]	饮酒史 [例(%)]
匹配后认知障碍组	52	26(50.0)	26(50.0)	56.41±10.69	17(32.7)	27(51.9)	8(15.4)	20(38.5)	16(30.8)
匹配后非认知障碍组	52	28(53.8)	24(46.2)	55.18±10.33	15(28.8)	28(53.8)	9(17.3)	19(36.5)	14(26.9)
统计值		χ²=0.154		$t$ =0.597	χ²=1.830			χ²=0.041	χ²=0.187
P值		0.695		0.552	0.401			0.839	0.665

表3 匹配后单因素分析[例(%)]

Tab. 3 Univariate analysis after PSM

组别	例数		高血压		糖尿病		入院时Hunt-Hess 分级Ⅲ级		入院时CT Fisher 分级≥Ⅲ级		入院时WFNS 分级≥Ⅲ级		入院至手术时间≥3 d
认知障碍组	52		21(40.4)		13(25.0)		20(38.5)		22(42.3)		24(46.2)		27(51.9)
非认知障碍组	52		17(32.7)		11(21.2)		10(19.2)		11(21.2)		12(23.1)		17(32.7)
χ²值			0.663		0.217		4.685		5.371		6.118		3.939
P值			0.415		0.642		0.030		0.020		0.013		0.047
组别	动脉瘤多发			前循环动脉瘤			动脉瘤最长径 >10 mm		瘤体形态不规则		宽颈动脉瘤		动脉瘤破裂
认知障碍组	28(53.8)			38(73.1)			19(36.5)		30(57.7)		21(40.4)		18(34.6)
非认知障碍组	25(48.1)			39(75.0)			10(19.2)		24(46.2)		31(59.6)		8(15.4)
χ²值	0.346			0.050			3.873		1.387		3.846		5.128
P值	0.556			0.823			0.049		0.239		0.050		0.024
组别		手术耗时 >60 min		支架辅助治疗		术后脑血管痉挛		术后脑出血		术后脑积水		术后颅内感染		术后脑缺血
认知障碍组		29(55.8)		32(61.5)		5(9.6)		4(7.7)		2(3.8)		1(1.9)		11(21.2)
非认知障碍组		16(30.8)		36(69.2)		4(7.7)		1(1.9)		1(1.9)		0(0.0)		3(5.8)
χ²值		6.620		0.680		0.000		0.840		0.000		0.000		5.283
P值		0.010		0.410		1.000		0.359		1.000		1.000		0.022

表4 变量赋值

Tab. 4 Variable assignment

变量	赋值
入院时Hunt-Hess分级	<Ⅲ级=0,Ⅲ级=1
入院时CT Fisher分级	<Ⅲ级=0,≥Ⅲ级=1
入院时WFNS分级	<Ⅲ级=0,≥Ⅲ级=1
入院至手术时间	<3 d=0,≥3 d=1
动脉瘤最长径	≤10 mm=0,>10 mm=1
动脉瘤破裂	无=0,有=1
手术耗时	≤60 min=0,>60 min=1
术后脑缺血	无=0,有=1
认知功能障碍	无=0,有=1

表5 介入术后并发认知功能障碍多因素logistic回归分析

Tab. 5 Multivariate logistic regression analysis of cognitive dysfunction after interventional surgery

指标	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
指标	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
入院时Hunt-Hess分级Ⅲ级	0.885	0.368	5.784	0.042	2.423	1.178	4.984
入院时CT Fisher分级≥Ⅲ级	0.918	0.349	6.919	0.029	2.504	1.264	4.963
入院时WFNS分级≥Ⅲ级	0.946	0.337	7.880	0.019	2.575	1.330	4.985
入院至手术时间≥3 d	0.583	0.298	3.827	0.059	1.791	0.999	3.213
动脉瘤最长径>10 mm	0.567	0.293	3.745	0.060	1.763	0.993	3.131
动脉瘤破裂	0.896	0.354	6.406	0.035	2.450	1.224	4.903
手术耗时>60 min	0.959	0.341	7.909	0.018	2.609	1.337	5.090
术后脑缺血	0.908	0.352	6.654	0.033	2.479	1.244	4.943
常数项	-3.011	1.046	8.286		0.049

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