CAJ | 학술논문

目的：评价Spetzler-Martin补充分级法是否能更好地筛选手术患者、提高术后预判的准确性。方法回顾性分析我院手术治疗的221例脑动静脉畸形，记录改良Rankin量表评分以及相关临床、影像学资料。建立两种不同Logistic模型，比较不同模型的ROC（receiver operating characteristic curve)曲线下面积并进行统计学分析。结果 Spetzler-Martin补充分级模型ROC曲线下面积（0.901），Spetzler-Martin评分系统模型ROC曲线下面积为（0.774），两者间的差异有统计学意义（P＝0.0362)。结论 Spetzler-Martin补充分级法能有效地进一步把患者根据手术风险进行细化分组，更加准确地评估手术风险。当Spetzler-Martin补充分级小于或者等于5分时（敏感性：70%，特异性：88.24%），患者手术风险较低，可以作为是否手术治疗的一个重要参考依据。
목적：평개Spetzler-Martin보충분급법시부능경호지사선수술환자、제고술후예판적준학성。방법회고성분석아원수술치료적221례뇌동정맥기형，기록개량Rankin량표평분이급상관림상、영상학자료。건립량충불동Logistic모형，비교불동모형적ROC（receiver operating characteristic curve)곡선하면적병진행통계학분석。결과 Spetzler-Martin보충분급모형ROC곡선하면적（0.901），Spetzler-Martin평분계통모형ROC곡선하면적위（0.774），량자간적차이유통계학의의（P＝0.0362)。결론 Spetzler-Martin보충분급법능유효지진일보파환자근거수술풍험진행세화분조，경가준학지평고수술풍험。당Spetzler-Martin보충분급소우혹자등우5분시（민감성：70%，특이성：88.24%），환자수술풍험교저，가이작위시부수술치료적일개중요삼고의거。
Objective We evaluate if supplementary grading system can refine patient selection and accurately predict neurological outcome in BAVM. Methods We retrospectively study 221 BAVM patients who were treated micro?surgically by our hospital. The score of pre and post operation mRS and relative clinical, radiology data were collected. Two different logistic models (Spetzler-Martin, Supplementary Spetzler-Martin grading model) were constructed to com?pare the area under ROC. Results Some factors are significant different between worse outcome patients and good out?come patients:Non-hemorrhagic presentations prior surgery, AVM bigger than 3cm, diffuse shape of AVM and the elder patients. Predictive accuracy was higher for the supplementary model (ROC area, 0.91), than the Spetzler-Martin model (ROC area, 0.774). So the predictive accuracy of supplementary model was significantly better than that of the Spet?zler-Martin model (P=0.0362). Conclusions Supplementary Spetzler-Martin model can improve preoperative risk pre?diction and subgroup the patients more efficiently. When the score less than 5(including 5) in supplementary Spet?zler-Martin patients seem to have lower risk relative to surgery.