PDF(Pubmed)
Abstract：
Purpose: With advances in medical technology, the average lifespan has increased, leading to a growing significance of idiopathic normal pressure hydrocephalus (iNPH), particularly in the elderly population. Most patients with iNPH have been treated either with ventriculo-peritoneal shunts (VPS) or conservative measures. However, lumbo-peritoneal shunts (LPS) have emerged as an alternative treatment option for iNPH in recent decades, extensive research still lacks comparing outcomes with LPS to those with VPS or non-surgical treatment. The aim of the resent study is to disclose the long-term therapeutic outcomes of LPS, VPS, and non-shunting in patients with iNPH. Methods: We used the National Health Insurance Research Database in Taiwan to assess the long-term outcomes of these treatment options. We enrolled 5,537 iNPH patients who received shunting surgery, of which 5,254 were VPS and 283 were LPS. To compare the difference between each group, matching was conducted by propensity score matching using a 1:1 ratio based on LPS patients. Primary outcomes included death and major adverse cardiovascular events (MACEs) Results: Our findings show that VPS resulted in significantly more MACEs than non-surgical treatment (Odds ratio: 1.83, 95% confidence interval: 1.16-2.90). In addition, both VPS and LPS groups had significantly lower overall mortality rates than non-shunting group. Moreover, LPS had lower overall mortality but similar MACEs rates to VPS. Conclusions: Based on these findings, we propose that the LPS is preferable to the VPS, and surgical treatment should be considered the primary choice over conservative treatment unless contraindications are present.
摘要：
目的：随着医疗技术的进步，平均寿命增加了，导致特发性正常压力脑积水（iNPH）的重要性日益增加，尤其是老年人。大多数iNPH患者都接受了脑室-腹膜分流术（VPS）或保守措施的治疗。然而,腰-腹膜分流术（LPS）已成为近几十年来iNPH的替代治疗选择，广泛的研究仍然缺乏比较LPS与VPS或非手术治疗的结果.最新研究的目的是揭示LPS的长期治疗结果，VPS,iNPH患者不分流。方法：我们使用台湾的国家健康保险研究数据库来评估这些治疗方案的长期结果。我们招募了5,537名接受分流手术的iNPH患者，其中5,254为VPS，283为LPS。为了比较各组之间的差异，采用基于LPS患者的1:1比例,通过倾向评分匹配进行匹配.主要结果包括死亡和主要不良心血管事件（MACEs）。结果：我们的发现表明，VPS导致的MACEs明显多于非手术治疗（赔率比：1.83，95％置信区间：1.16-2.90）。此外,VPS组和LPS组的总死亡率均显著低于非分流组.此外，LPS的总死亡率较低，但MACE发生率与VPS相似。结论：基于这些发现，我们认为LPS优于VPS，除非存在禁忌症，否则手术治疗应被视为保守治疗的主要选择。
