颅内动脉瘤血管内栓塞术后复发的影响因素分析  

Analysis of influencing factors of recrudescence after endovascular embolization of intracranial aneurysms

作　　者：王驰[1] 曹伟[1] 左乔[1] 吕楠[1] 冯政哲[1] 刘建民[1] 黄清海[1] 

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433

出　　处：《中国脑血管病杂志》2016年第3期113-117,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：上海市教育委员会项目(14ZZ081)

摘　　要：目的探讨影响颅内动脉瘤血管内栓塞术后复发的危险因素,建立回归模型以预测特定颅内动脉瘤患者经血管内栓塞治疗后的复发风险。方法回顾性连续纳入2012年5月至2014年5月第二军医大学长海医院脑血管病治疗中心经血管内栓塞治疗且有符合纳入标准的颅内囊状动脉瘤患者429例（共计动脉瘤441个）,多发动脉瘤均按每个动脉瘤单独计算例数。根据动脉瘤是否复发,分为复发组（66例）和未复发组（375例）。比较两组临床特征、治疗技术及材料、动脉瘤解剖学等共计11项因素的差异,采用Logistic回归分析颅内动脉瘤血管内栓塞术后复发的危险因素,并评价其预测复发的有效性。结果复发组与未复发组的动脉瘤大小（χ2=46.352,P〈0.01）、破裂与否（χ2=4.198,P=0.040）、是否使用支架（χ2=9.554,P=0.002）、术后即刻栓塞结果（χ2=10.397,P=0.003）的差异均有统计学意义。多因素Logistic回归分析结果显示,非支架辅助栓塞（OR=4.076,95%CI：2.147～7.736,P〈0.01）、RaymondⅡ级（OR=4.222,95%CI：1.537～11.579,P=0.005）、RaymondⅢ级（OR=4.467,95%CI：1.600～12.470,P=0.004）、大型动脉瘤（〉10～25 mm,OR=4.914,95%CI：2.277～10.604,P〈0.01）和巨大型动脉瘤（〉25 mm,OR=35.743,95%CI：3.511～363.837,P=0.003）是动脉瘤栓塞术后复发的危险因素。回归模型预测复发的有效性检验结果显示,复发预测模型的曲线下面积为73.5%,Raymond分级为56.6%,非支架栓塞为60.1%,动脉瘤大小为40.3%,利用Z检验计算复发评分与非支架栓塞、Raymond分级、动脉瘤大小的ROC曲线下面积差异,Z值分别为2.662、3.513、6.308,P值分别为0.007、0.004、0.001。结论大型或巨大型动脉瘤、非支架辅助栓塞、术后即刻栓塞不全与颅内动脉瘤血管内栓塞术后复发有关,所建立的回归模型可反映患者术后复发风险大小。Objectives To study the risk factors for influencing recrudescence after endovascular embolization of intracranial aneurysms and to establish a regression model to predict the risk of recrudescence in patients with specific intracranial aneurysm after endovascular embolization. Methods From May 2012 to May 2014,429 patients（ a total of 441 aneurysms） with intracranial saccular aneurysm who met the inclusion criteria and treated with endovascular embolization at the Cerebrovascular Treatment Center,Changhai Hospital,the Second Military Medical University were analyzed retrospectively. Multiple aneurysms were calculated separately according to per aneurysm. The aneurysms were divided into either a recurrent group（ n = 66） or an unrecurrent group（ n = 375） according to whether they had recrudescence or not. The differences of 11 factors such as clinical features,treatment technology and materials,and aneurysm anatomy of both groups were compared. Logistic regression was used to analyze the risk factors for recrudescence after endovascular embolization of intracranial aneurysms,and its effectiveness of predicting recrudescence was evaluated. Results There were significant differences in the size of aneurysms（ χ2= 46. 352,P〈 0. 01）,rupture or not（ χ2= 4. 198,P = 0. 040）,using stents or not（ χ2= 9. 554,P = 0. 002）,and results of immediate postoperative embolization（ χ2= 10. 397,P = 0. 003）. The results of multivariate logistic regression analysis showed that non-stent-assisted embolization（ OR,4. 076,95% CI 2. 147- 7. 736,P〈 0. 01）,Raymond grade Ⅱ（ OR,4. 222,95% CI 1. 537- 11. 579,P = 0. 005）,Raymond grade Ⅲ（ OR,4. 467,95% CI 1. 600-12. 470,P = 0. 004）,large aneurysms（ 〉10-25 mm）（ OR,4. 914,95% CI 2. 277-10. 604,P〈 0. 01）,and giant aneurysms（ 〉25 mm）（ OR,35. 743,95% CI 3. 511-363. 837,P = 0. 003）were the risk factors for recrudescence after aneurysm embolization. The effective test results of the regression model in predicting recrudescence showe

关 键 词：颅内动脉瘤 栓塞 治疗性 血管内治疗 复发 危险因素 

分 类 号：R739.41[医药卫生—肿瘤]