【摘要】 目的 探讨基于主成分分析(principal component analysis, PCA)结合Logistic回归模型分析脑脊液可溶性Fas(soluble Fas, sFas)、Fas配体(soluble Fas ligand, sFasL)水平及压力参数对创伤性颅脑损伤患者术后继发脑积水的预测价值。方法 选取2018-12/2021-12月由作者医院神经外科收治的260例创伤性颅脑损伤患者作为研究对象，对其临床资料进行回顾性分析，根据术后是否发生脑积水将患者分为继发脑积水组(n=48)和无继发脑积水组(n=212)。对患者的性别、年龄、手术前后格拉斯哥昏迷量表(Glasgow coma scale, GCS)、颅脑损伤部位、手术时间、手术前后脑室系统出血、术后颅内感染、术后大面积脑梗死、手术前后中脑导水管和环池结构、术后脑脊液压力参数、术后脑脊液sFas、sFasL水平等指标进行PCA。PCA后提取主成分作为自变量，以患者术后是否出现脑积水为因变量，应用Logistic回归分析探讨相关影响因素。结果 单因素分析和PCA结果显示，脑组织损伤部位、手术前后GCS评分、脑室系统内出血、导水管和环池结构，术后颅内感染、术后大面积脑梗死、术后腰穿脑脊液置换术及术后脑脊液压力(cerebrospinal fluid pressure, CSFP)、ICP相关系数(regression of amplitude and pressure, RAP)和脑脊液sFas/sFasL水平均与患者术后继发脑积水有关(P<0.05)。PCA-Logistic回归模型显示，合并颅底损伤，手术前后GCS评分降低，脑室系统内出血，导水管和环池结构不清晰，术后合并颅内感染，大面积脑梗死，脑脊液sFas、sFasL水平升高，RAP升高和CSFP升高均是颅脑损伤患者术后继发脑水肿的独立危险因素，术后进行腰穿脑脊液置换是颅脑损伤患者术后继发脑积水的保护因素(P<0.05)。结论 术后脑脊液sFas、sFasL水平和压力参数均是创伤性颅脑损伤患者术后继发脑积水的独立影响因素，对患者术后并发脑积水有一定的预测价值。更多还原

【Abstract】 Objective To explore the predictive value of cerebrospinal fluid soluble Fas(sFas), soluble Fas ligand(sFasL) levels and pressure parameters for postoperative hydrocephalus in patients with traumatic brain injury based on principal component analysis(PCA) and Logistic regression model. Methods A total of 260 patients with traumatic brain injury admitted in neurosurgery department of author′s hospital from December 2018 to December 2021 were selected as the research objects, and their clinical data were retrospectively analyzed, and the patients were divided into secondary hydrocephalus group(n=48) and non-secondary hydrocephalus group(n=212) according to whether hydrocephalus occurred after surgery. PCA was performed on the sex, age, Glasgow coma scale(GCS), brain injury site, surgery time, intraventricular hemorrhage before and after surgery, intracranial infection after surgery, large area of cerebral infarction after surgery, structure of midbrain aqueduct and cistern before and after surgery, pressure parameters of cerebrospinal fluid after surgery, cerebrospinal fluid sFas, sFasL,etc. levels of cerebrospinal fluid after surgery. After PCA the main components were extracted as independent variables, and taking whether the patient had hydrocephalus after surgery as the dependent variable, the related influencing factors were explored by Logistic regression analysis.Results Univariate analysis and PCA results showed that the location of brain tissue injury, GCS scores before and after surgery, intraventricular hemorrhage, aqueduct and cistern structures, intracranial infection after surgery, large area of cerebral infarction after surgery, lumbar puncture cerebrospinal fluid replacement after surgery, cerebrospinal fluid pressure(CSFP) after surgery, regression of amplitude and pressure(RAP) and cerebrospinal fluid sFas, sFasL levels were all associated with secondary hydrocephalus after surgery in patients(P<0.05); PCA-Logistic regression model showed that the combination of skull base injury, decreased GCS scores before and after surgery, intraventricular hemorrhage, unclear structure of aqueduct and cistern, intracranial infection after surgery, large area of cerebral infarction, elevated cerebrospinal fluid sFas and sFasL levels, elevated RAP, elevated CSFP were independent risk factors for postoperative brain edema in patients with brain injury, while lumbar puncture cerebrospinal fluid replacement after surgery was a protective factor for postoperative secondary hydrocephalus in patients with traumatic brain injury(P<0.05).Conclusion The levels of cerebrospinal fluid sFas, sFasL and parameters of pressure are independent influencing factors of postoperative hydrocephalus in patients with traumatic brain injury, which has a certain predictive value for postoperative hydrocephalus.更多还原