Junkkari A, Häyrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto A M, Roine R P, Viinamäki H, Soininen H, Luikku A, Jääskeläinen J E, Leinonen V
Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
Eur J Neurol. 2017 Jan;24(1):58-66. doi: 10.1111/ene.13130. Epub 2016 Sep 19.
This prospective study explored the factors affecting the health-related quality-of-life (HRQoL) outcome in patients with idiopathic normal-pressure hydrocephalus (iNPH) 1 year after the installation of the cerebrospinal fluid shunt.
The HRQoL outcome was evaluated using a 15D instrument, in which the minimum clinically significant change/difference has been estimated to be ±0.015. The follow-up data (15D, Mini-Mental State Examination, Beck Depression Inventory, iNPH Grading Scale), frontal cortical biopsy, Charlson Age Comorbidity Index and body mass index of 145 patients diagnosed with iNPH by clinical and radiological examination were analyzed.
At 1-year follow-up, 63 (43%) patients had experienced a clinically significant improvement in HRQoL. Multivariate binary logistic regression analysis indicated that the absence of amyloid-β and hyperphosphorylated tau pathology in the frontal cortical biopsy (53% vs. 33%; absolute risk difference, 20%; adjusted odds ratio, 2.27; 95% confidence interval, 1.07-4.84; P < 0.05) and lower body mass index (adjusted odds ratio, 0.90, 95% confidence interval, 0.82-0.98; P < 0.05) predicted favorable HRQoL outcome 1 year after the shunting.
Less than half of the patients with iNPH experienced clinically significant favorable HRQoL outcome, partly explained by the patient's characteristics and comorbidities. The HRQoL approach reveals aspects that are important for the patient's well-being, but may also improve the quality of the outcome assessment of cerebrospinal fluid shunting. Study results may help clinicians to estimate which patients will benefit shunt surgery.
本前瞻性研究探讨了特发性正常压力脑积水（iNPH）患者在脑脊液分流术后1年影响健康相关生活质量（HRQoL）结果的因素。
使用15D工具评估HRQoL结果，其中最小临床显著变化/差异估计为±0.015。分析了145例经临床和影像学检查诊断为iNPH患者的随访数据（15D、简易精神状态检查表、贝克抑郁量表、iNPH分级量表）、额叶皮质活检、查尔森年龄合并症指数和体重指数。
在1年随访时，63例（43%）患者的HRQoL有临床显著改善。多变量二元逻辑回归分析表明，额叶皮质活检中不存在淀粉样β蛋白和过度磷酸化tau病理（53%对33%；绝对风险差异，20%；调整优势比，2.27；95%置信区间，1.07 - 4.84；P < 0.05）以及较低的体重指数（调整优势比，0.90，95%置信区间，0.82 - 0.98；P < 0.05）预测分流术后1年HRQoL结果良好。
不到一半的iNPH患者经历了临床显著的良好HRQoL结果，部分原因可由患者特征和合并症解释。HRQoL方法揭示了对患者幸福感重要的方面，但也可能改善脑脊液分流结果评估的质量。研究结果可能有助于临床医生估计哪些患者将从分流手术中获益。
