斜坡直至到达平台：通过腰椎内输注试验测量特发性正常压力脑积水患者的瓣膜反应的新预测指标。
Slope until reaching the plateau: a new predictor of valve response obtained by lumbar infusion test for idiopathic normal pressure hydrocephalus.
作者信息
Otero-Rodriguez Alvaro, Arandia-Guzman Daniel Angel, Pascual-Argente Daniel, Ruiz-Martin Laura, de Oca Juan-Carlos Roa-Montes, Garcia-Martin Andoni, Torres-Carretero Luis, Uriel-Lavin Rocio, Garrido-Ruiz Patricia-Alejandra, Rodriguez-Cedeño Disney, Cid-Mendes Laura
机构信息
Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain.
出版信息
Acta Neurochir (Wien). 2023 Sep;165(9):2533-2539. doi: 10.1007/s00701-023-05670-y. Epub 2023 Jun 22.
BACKGROUND
Diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is based on clinical, radiological, and hydrodynamic data of cerebrospinal fluid (CSF) obtained by invasive methods such as lumbar infusion test, which is used to determine the resistance to CSF outflow (Rout). However, Rout has limitations, and its value as predictor of valve response is questioned. Other variables can be obtained by lumbar infusion test, such as the time to reach the plateau (TRP) and the slope until reaching the plateau (SRP). The objectives were to determine if SRP could be a predictor of response to ventriculoperitoneal shunt (VPS) and what variable (Rout versus SRP) would have greater predictive value.
METHOD
Patients with probable iNPH who underwent a lumbar infusion test and were indicated for a VPS were retrospectively studied. Two groups were established, responders and non-responders. Rout, TRP (period between the start of infusion until reaching the plateau measured in seconds) and SRP ((plateau pressure-opening pressure)/TRP) were obtained. For Rout and SRP, the receiver operating curves (ROC) with its areas under the curve (AUC) were calculated.
RESULTS
One hundred ten patients were included, being 86 responders (78.20%). Shunt responders had a significantly greater Rout (17.02 (14.45-20.23) versus 13.34 (12.10-16.28) mmHg/ml/min, p = 0.002) and SRP (0.049 (0.043-0.054) versus 0.031 (0.026-0.036) mmHg/sec, p < 0.001) and smaller TRP (641.28 (584.83-697.73) versus 777.65 (654.03-901.27) sec, p = 0.028) than non-responders. The AUC for SRP was greater than the AUC for Rout (0.763 (95 % CI 0.655-0.871, p < 0.001) versus 0.673 (95 % CI 0.595-0.801, p = 0.008), respectively), but the differences were not significant (p = 0.180).
CONCLUSIONS
SRP could be considered predictor of response to VPS, and its accuracy tends to be better than Rout. So, this variable may be a useful tool to select shunt candidates among patients with probable iNPH.
背景
特发性正常压力脑积水（iNPH）的诊断基于通过腰椎穿刺等有创方法获得的脑脊液（CSF）的临床、影像学和流体动力学数据，这些数据用于确定 CSF 流出阻力（Rout）。然而，Rout 存在局限性，其作为瓣膜反应预测因子的价值受到质疑。其他变量可以通过腰椎穿刺试验获得，例如达到平台的时间（TRP）和达到平台的斜率（SRP）。本研究旨在确定 SRP 是否可以作为脑室-腹腔分流术（VPS）反应的预测因子，以及哪种变量（Rout 与 SRP）具有更大的预测价值。
方法
回顾性研究了因疑似 iNPH 而行腰椎穿刺试验并需要进行 VPS 的患者。建立了两组，即反应者和非反应者。获得 Rout、TRP（从开始输注到达到平台的时间，以秒为单位）和 SRP（（平台压力-开放压力）/TRP）。对于 Rout 和 SRP，计算了接收器工作曲线（ROC）及其曲线下面积（AUC）。
结果
共纳入 110 例患者，其中 86 例（78.20%）为反应者。分流反应者的 Rout（17.02（14.45-20.23）与 13.34（12.10-16.28）mmHg/ml/min，p=0.002）和 SRP（0.049（0.043-0.054）与 0.031（0.026-0.036）mmHg/sec，p<0.001）显著更高，TRP（641.28（584.83-697.73）与 777.65（654.03-901.27）sec，p=0.028）更小。SRP 的 AUC 大于 Rout 的 AUC（0.763（95%CI 0.655-0.871，p<0.001）与 0.673（95%CI 0.595-0.801，p=0.008）），但差异无统计学意义（p=0.180）。
结论
SRP 可作为 VPS 反应的预测因子，其准确性似乎优于 Rout。因此，该变量可能是选择疑似 iNPH 患者分流候选者的有用工具。
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