背景:分流梗阻是脑室-腹腔分流术(VPS)失败的一种。脑脊液(CSF)参数的变化是否会影响分流结果尚有争议。
方法:在本研究中,我们回顾性纳入2013年11月至2021年9月在中国不同省份的6家综合医院接受VPS的成人脑积水患者.纳入标准:纳入来自中国不同省份的6家综合医院的所有病因均接受分流手术的脑积水患者。排除标准:1.18岁以下患者;2.曾进行过分流手术的患者;3.分流失败的其他因素;4.患者死于其他原因;5.患者数据不完整。分流患者的CSF已在分流插入时进行了分析。当植入分流器时,收集和分析CSF样品。分析脑脊液参数与1年内分流梗阻发生率的关系。
结果:共纳入6家医院的717名合格患者,其中59人(8.23%)出现梗阻。多因素logistic回归分析确定蛋白质水平(比值比[OR]1.161,95%CI1.005~1.341,p=0.043),血糖水平降低(<2.5mmol/L)(比值比3.784,95%置信区间1.872〜7.652,p=0.001)和蛋白质水平升高(>0.45g/L)(比值比3.653,95%置信区间1.931〜6.910,p=0.001)是分流梗阻的独立危险因素。
结论:这项研究表明,脑脊液中蛋白质水平升高(>0.45g/L)和葡萄糖水平降低(<2.5mmol/L)表明脑积水患者分流梗阻的风险增加。因此,当CSF葡萄糖和蛋白质异常时,应更仔细地考虑分流手术。
BACKGROUND: Shunt obstruction is a type of ventriculoperitoneal shunt (VPS) failure. Whether changes in cerebrospinal fluid (CSF) parameters can influence shunt outcomes or not is debatable.
METHODS: In this study, we retrospectively included adult hydrocephalus patients who received VPS from 6 general hospitals in different provinces of
China from November 2013 to September 2021. The inclusion criteria: Patients with hydrocephalus of all etiologies underwent shunt surgery from 6 general hospitals in different provinces of
China were included in the study. The exclusion criteria: 1.Patients under the age of 18; 2.Patients who had previous shunt surgery; 3. Shunt failure from other factors; 4.Patients died from other causes; 5. Patients with incomplete data. The CSF of shunt patients had been analyzed at the time of shunt insertion. The CSF samples were collected and analyzed when the shunt was implanted. The relationship between CSF parameters and the incidence rate of shunt obstruction in one year was analyzed.
RESULTS: A total of 717 eligible patients from 6 hospitals were included, of whom 59(8.23%) experienced obstruction. Multivariate logistic regression analysis identified that protein level(odds ratio [OR] 1.161, 95% CI 1.005 ~ 1.341, p = 0.043), decreased glucose level(< 2.5 mmol/L)(odds ratio 3.784, 95% confidence interval 1.872 ~ 7.652, p = 0.001) and protein level increase(> 0.45 g/L) (odds ratio 3.653, 95% confidence interval 1.931 ~ 6.910, p = 0.001)were independent risk factors of shunt obstruction.
CONCLUSIONS: This study suggested that increased protein level (> 0.45 g/L) and decreased glucose level (< 2.5 mmol/L) in CSF indicated an increased risk of shunt obstruction in a patient with hydrocephalus. Thus, shunt surgery should be more carefully considered when the CSF glucose and protein were abnormal.