Hemoglobin Concentration May Affect the Effect of Atorvastin on Chronic Subdural Hematoma After Burr-Hole Drainage at High Altitude
Hemoglobin Concentration May Affect the Effect of Atorvastin on Chronic Subdural Hematoma After Burr-Hole Drainage at High Altitude
复制标题
血红蛋白浓度可能影响阿托伐斯汀治疗高海拔慢性硬膜下血肿钻孔引流术后的疗效
DOI：
10.3389/fnins.2020.00503
复制
发表时间：
2020-06-12
影响因子：
4.3
通讯作者：
Zhu, Gang
中科院分区：
文献类型：
--
作者：
Wei, Linjie;Lin, Chi;Zhu, Gang
目的慢性硬膜下血肿是一种常见病、多发病。阿托伐他汀钙可增加CSDH的吸收。然而，阿托伐他汀在高海拔地区是否能增加血肿吸收和减少复发尚不清楚。方法将慢性硬膜下血肿患者行钻孔引流后随机分为阿托伐他汀组和对照组。术后第1天、术后1个月、2个月、3个月行CT随访。计算复发率、疗效差、复发时间、手术效果差、术中复发率、CSDH量、Markwalder分级评分(MGSS)，并分析相关危险因素。结果对照组未复发与复发患者的血红蛋白浓度[176.24+/-16.43vs.194.25+/-12.34(g/L)，p<；0.01]，CT值[41.92+/-10.76vs.34.12+/-8.78(Hu)，p<；0.01]，低密度时间[3.88+/-1.04vs.5.50+/-0.87(D)，p<；0.01]。阿托伐他汀组未复发和复发患者的Hb[172.66+/-16.41vs.190.45+/-10.23(g/L)，p<；0.01]，CT值[38.91+/-7.16vs.29.50+/-8.61(Hu)，p<；0.01]，混合[2vs.4(N)，p<；低密度时间[4.09+/-0.75vs.5.45+/-1.12(D)，p<；0.01]。Logistic回归分析显示，糖化血红蛋白[优势比1.14；对照组95%可信区间1.04~1.25，优势比1.13；阿托伐他汀组95%可信区间1.03~1.23]和低密度时间(优势比3.53；对照组95%可信区间1.42~8.74)是两组患者的可能危险因素。受试者工作特征曲线显示受试者的Hb、CT值和低密度时间受试者工作特征曲线下面积分别为0.812、0.702和0.755，对照组分别为0.812、0.719和0.790，阿托伐他汀组分别为0.807、0.682和0.756。术后随访结果显示，两组在复发率、疗效差、复发时间、手术效果差、术中复发、CSDH量、MGSS等方面无明显差异。结论术后应用阿托伐他汀效果不明显。Hb和低密度时间是CSDH复发的危险因素。Hb是预测CSDH复发最特异、最敏感的指标。
Objective Chronic subdural hematoma (CSDH) is a common disease. Atorvastatin calcium can increase CSDH absorption. However, whether atorvastatin can increase hematoma absorption and reduce recurrence at high altitudes is not clear. Methods After burr-hole drainage, CSDH patients were divided into an atorvastatin group and a control group. Follow-up computed tomography (CT) was performed on day 1, months 1, 2, and 3 after surgery. Then, the recurrence rate, poor therapeutic effect, time to recurrence, poor surgical result, recurrence with operation, CSDH volume, and Markwalder grading scale score (MGSS) were calculated, and related risk factors were analyzed. Results The non-recurrent and recurrent patients in the control group differed significantly in terms of the hemoglobin concentration (HB) [176.24 +/- 16.43 vs. 194.25 +/- 12.34 (g/L),p< 0.01], CT value [41.92 +/- 10.76 vs. 34.12 +/- 8.78 (Hu),p< 0.01], and low-density time [3.88 +/- 1.04 vs. 5.50 +/- 0.87 (d),p< 0.01]. The non-recurrent and recurrent patients in the atorvastatin group differed significantly in terms of the HB [172.66 +/- 16.41 vs. 190.45 +/- 10.23 (g/L),p< 0.01], CT value [38.91 +/- 7.16 vs. 29.50 +/- 8.61 (Hu),p< 0.01], and mixed [2 vs. 4 (n),p< 0.05] and low-density time [4.09 +/- 0.75 vs. 5.45 +/- 1.12 (d),p< 0.01]. The logistic regression analysis showed that HB [odds ratio, 1.14; 95% confidence interval (CI), 1.04-1.25 in the control group, odds ratio, 1.13; 95% CI, 1.03-1.23 in the atorvastatin group] and low-density time (odds ratio, 3.53; 95% CI, 1.42-8.74 in the control group, odds ratio, 2.53; 95% CI, 1.10-5.80 in the atorvastatin group) were possible risk factors for the two groups. The receiver operating characteristic curves showed that the area under the receiver operating characteristic curve values for the HB, CT value (Hu), and low-density time were 0.812, 0.702, and 0.755 for all subjects; 0.812, 0.719, and 0.790 for the control group; and 0.807, 0.682, and 0.756 for the atorvastatin group, respectively. The postoperative follow-up results showed that there was no significant difference in the recurrence rate, poor therapeutic effect, time to recurrence, poor surgical result, recurrence with operation, CSDH volume, or MGSS between the two groups. Conclusion The effect of atorvastatin was not significant after the operation. The risk factors for CSDH recurrence were the HB and low-density time. The HB was the most specific and sensitive predictor of CSDH recurrence.