颅内动静脉畸形血管构筑特征与出血的相关性分析  

Study of angioarchitectural factors and their correlation with bleeding risk of intracranial arteriove-nous malformations

作　　者：方兵[1] 李铁林[1] 段传志[1] 王义荣[2] 汪求精[1] 何旭英[1] 赵庆平[1] 陈光忠[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282 [2]浙江大学附属邵逸夫医院神经外科

出　　处：《中国脑血管病杂志》2005年第8期342-347,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颅内动静脉畸形(AVM)首次出血相关的血管构筑特征。 方法 回 顾性研究277例颅内AVM患者(281个颅内畸形团)的临床表现,其中出血组畸形团167个 (59．4％),非出血组114个(40．6％),分析、比较两组患者脑血管造影的血管构筑特征,采用 单因素和多因素分析模式对其进行统计学分析。 结果 单因素统计分析表明,小畸形团 (<30mm)、幕下畸形、深部畸形、单支深静脉引流、单支静脉引流、引流静脉直径／供血动脉直 径r≤2与出血表现具有相关性;引流静脉扩张、狭窄及合并颅内动脉瘤与畸形出血无关。当采 用多因素回归分析时,只有小畸形团(OR:3．72;95％ CI:1．76～7．85)、幕下畸形(OR: 6．54;95％ CI:2．07～20．72)、r≤2(OR:2．55;95％ CI:1．32—4．94)与出血表现相关(P< 0．01),当r≤1．5时,OR为7．08(95％ CI:2．90～17．27,P<0．001)。 结论 位于幕下、小 畸形团、引流静脉直径／供血动脉直径r≤2是颅内AVM出血的高危因素,当r≤1．5时,颅内 AVM出血的风险更大。Objective To study the correlation between angioarchitectural features of brain arteriovenous malformations （AVM） with subsequent risk of hemorrhage, the behavior of AVM and therefore guiding management. Methods The initial clinical presentation of 277 consecutive patients with brain AVM were analyzed, and the angioarehitectural features between the hemorrhagic group and non-hemorrhagic group were compared. All possible factors were analyzed by univariate analyses, then the significant factors from univariate analyses were used to construct a multivariate model relating the above features to the occurrence of hemorrhage. The multivariate model was done by Binary Logistic Regression with SPSS10. 0 statistical software package.Results By univariate analysis,analysis,maximal size of AVM〈30mm,infratentorial AVM,deep location,exclusively deep draining veins,single draining vein,and the ratio of the diameter between main draining vein and main feeding artery （r=V/F） was≤2 predicted hemorrhagic presentation.The presence of intranidal aneurysm,venous ectasia and venous stenosis were not correlated with hemorrhagic presentation.When we used stepwise multiple logistic regression analysis,only AVM maximum diamete 〈30mm （OR：3.72;95% CI：1.76-7.85）,infratentorial AVM（OR：6.54;95% CI： 2.07-20.72）,and the ratio of r ≤2（OR： 2.55;95% CI：1.32-4.94） were independent predictors （P〈0.01） of hemorrhagic presentation;when the ratio betwwen the diameter of main draining vein and the diameter of main feeding artery was ≤1.5,the odds ratio was 7.08（95% CI：2.90-17.27）（P〈0.001）,Conclusion Small siged AVM（〈30mm）,infratentorial VAM and the ratio r ≤2 are most powerful risk predictors for hemorrhagic AVM presentaion,When the ratio of r≤1.5 ,the bleeding risk is the highest,In contrast with many previous reports,intranidal aneurysm,venous ectasia and venous stenosis are not associated with hemorrhage in our study.

关 键 词：颅内动静脉畸形 颅内出血 血管构筑 畸形团 临床表现 

分 类 号：R743[医药卫生—神经病学与精神病学]