Steroid-Associated Acute Clinical Worsening and Poor Outcome in Patients With Spinal Dural Arteriovenous Fistulas A Prospective Cohort Study
Steroid-Associated Acute Clinical Worsening and Poor Outcome in Patients With Spinal Dural Arteriovenous Fistulas A Prospective Cohort Study
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DOI：
10.1097/brs.0000000000003370
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发表时间：
2020-06-01
期刊：
影响因子：
3
通讯作者：
Zhang, Hongqi
中科院分区：
文献类型：
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作者：
Ma, Yongjie;Hong, Tao;Zhang, Hongqi
研究设计.前瞻性队列研究。Objective.我们进行了一项前瞻性队列研究，以确定类固醇和临床恶化之间的关系，并比较术前使用和不使用类固醇的患者的结局。背景数据总结。硬脊膜动静脉瘘（SDAVF）患者常被误诊并使用类固醇治疗，导致急性恶化。方法. 2013年3月至2014年12月期间，在两个转诊中心连续招募了经血管造影证实的SDAVF患者。我们回顾了所有患者的病史，以确定那些在排除瘘管前接受类固醇治疗的患者。采用改良Aminoff & Logue评分法（mALS）评价激素治疗前后、手术前、术后1年随访时脊髓功能。采用配对t检验评估不同时间点类固醇给药患者的mALS。未配对t检验和Pearson卡方检验用于评估使用和不使用类固醇的患者之间的差异。结果本研究纳入了18例（18.2%）和81例（81.8%）未使用类固醇的患者。基线时，两组患者在年龄、性别、病程、瘘管位置、治疗和术前mALS方面无差异。然而，根据1年随访时的mALS，未使用类固醇的患者具有统计学显著更好的结局（P < 0.05）。结论类固醇给药可诱导SDAVF患者的急性临床恶化，尽管瘘成功闭塞，但这种恶化仍可能持续，因此应避免。
Study Design. A prospective cohort study. Objective. We conducted a prospective cohort study to identify the association between steroids and clinical worsening and compare outcomes between patients with and without preoperative steroid administration. Summary of Background Data. Patients with spinal dural arteriovenous fistulas (SDAVFs) often were misdiagnosed and treated with steroids which led to acute worsening. Methods. Patients with angiographically confirmed SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centers. We reviewed the history of all the patients to identify those patients who were treated with steroids before exclusion of the fistulas. Modified Aminoff & Logue scale (mALS) was used to evaluate the spinal cord function at different time points: before and after steroid administration, before operation, and at 1-year follow-up. Pairedttests were used to assess the mALS of patients with steroid administration at different time points. Unpairedttests and Pearson chi-square test were used to assess differences between patients with and without steroid administration. Results. Eighteen patients with (18.2%) and 81 patients without (81.8%) steroid administration were included in this study. At baseline, there were no difference between both patient groups, in regards to age, sex, duration, location of fistula, treatment, and preoperative mALS. Patients without steroid administration, however, had statistically significant better outcome according to their mALS at 1-year follow-up (P < 0.05). Conclusion. Steroid administration can induce acute clinical worsening in patients with SDAVFs that may persist despite successful obliteration of the fistula and should thus be avoided.