摘要
目的探讨颅内小动脉瘤破裂的危险因素,为颅内未破裂小动脉瘤干预与否提供依据。方法收集2010—2013年接受介入治疗、有详细影像资料和临床资料的单发性颅内小动脉瘤(≤5 mm)患者180例,其中破裂出血149例,未破裂31例。比较两组患者动脉瘤形态学参数之入射角、动脉瘤瘤体高度与瘤颈长度之比值(AR)、瘤体最大瘤深与近端载瘤动脉直径之比值(SR)、动脉瘤形状、位置和子囊,以及临床危险因素之年龄、性别、高血压、蛛网膜下腔出血史。采用单因素两独立样本t检验(或秩和检验)和卡方检验,以及多变量Logistic回归分析确定两组差异的显著性。结果单因素分析显示破裂的小动脉瘤多位于前交通动脉(OR=0.166,P=0.023)及基底动脉末端(OR=0.006,P<0.001),表明前交通部位与基底动脉末端的动脉瘤更易破裂。180例颅内小动脉瘤患者中破裂组与未破裂组动脉瘤部位、子囊、AR值(1.76±0.72对1.35±0.48)、SR值(1.90±0.81对1.31±0.67)、入射夹角(123.9°±23.21°对95.96°±20.2°)均存在明显的统计学差异(P<0.05),而两组动脉瘤形态、动脉瘤最大直径以及临床危险因素中年龄、性别、高血压、蛛网膜下腔出血史均无统计学意义(P>0.05)。多变量Logistic回归分析显示动脉瘤部位(OR=1.347,P=0.002)、入射夹角(OR=1.057,P<0.001)、SR值(OR=2.726,P=0.047)为颅内小动脉瘤破裂的独立危险因素。结论前交通动脉和基底动脉末端部位、SR值>1.90±0.81、入射角度>123.9°±23.21°为颅内≤5 mm动脉瘤破裂的独立危险因素,可以作为颅内未破裂小动脉瘤干预与否的参考依据。
Objective To explore the risk factors related to the rupture of small（≤ 5 mm）intracranial aneurysms in order to provide scientific basis to make decision as whether it is necessary to adopt intervention for unruptured intracranial aneurysms. Methods A total of 180 patients with small（≤5 mm）solitary intracranial aneurysms, who were admitted to authors＇ hospital during the period form 2010 to 2013 to receive interventional therapy and had detailed clinical records as well as complete imaging materials, were enrolled in this study. Among the 180 cases, ruptured aneurysms were detected in 146（ruptured group） and unruptured aneurysms were seen in 31（unruptured group）. Imaging features, including inflow angle, AR value（Height/Neck）, SR value（Dmax/L）, shape, location and asci of aneurysm, and clinical risk factors（age, sex, hypertension, history of subarachnoid hemorrhage） were recorded, and the results were compared between the two groups. The differences between the two groups was statistically evaluated by using single factor and two-independent samples t test（or rank sum test）, chi-squared test and multi-variable logistic regression analysis. Results Single factor analysis showed that the ruptured aneurysms mainly located at the anterior communicating artery（OR = 0.166, P = 0.023） or at the distal end of basilar artery（OR = 0.006, P =0.001）, indicating that the aneurysms located at these sites were more easily to be ruptured. Statistically significant differences in the location, asci of aneurysm, AR value（1.76 ± 0.72 vs. 1.35 ± 0.48, P =0.001）, SR value（1.90 ± 0.81 vs. 1.31 ± 0.67, P = 0.001） and inflow angle（123.9° ± 23.21° vs. 95.96° ±20.2°, P 0.001） existed between the two groups（P 0.05）; while the differences in the clinical risk factors, including age（P = 0.70）, sex（P = 0.24）, hypertension（P = 0.53） and history of subarachnoid hemorrhage（P = 0.83）, between the two groups were not significant（P 0.05）. Multi-variable logistic regression analysis indicated that the location of aneurysms（OR = 1.347, P = 0.002）, the inflow angle（OR =1.057, P 0.001） and SR（OR = 2.726, P = 0.047） were independent risk factors for the rupture of intracranial aneurysms. Conclusion The independent risk factors for the rupture of ≤ 5 mm intracranial aneurysms include lesion＇s location at the anterior communicating artery and the distal end of the basilar artery, SR value 1.90 ± 0.81 and inflow angle 123.9° ± 23.21°, which can be used as a reference to take preventive intervention for unruptured intracranial aneurysms.
出处
《介入放射学杂志》
CSCD
北大核心
2015年第2期97-101,共5页
Journal of Interventional Radiology
关键词
颅内动脉瘤
破裂
危险因素
intracranial aneurysm
rupture
risk factor
