动脉瘤形态学特征对胼周动脉瘤破裂的影响因素分析  

Effect of morphological characteristics of aneurysms on the rupture of pericallosal artery aneurysms

作　　者：翟晓东[1] 李传捷 于嘉兴 任健[1] 张鸿祺[1] Zhai Xiaodong;Li Chuanjie;Yu Jiaxing;Ren Jian;Zhang Hongqi(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]北京市顺义区医院神经外科

出　　处：《中国脑血管病杂志》2019年第5期225-230,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家重点研发计划重大慢性非传染性疾病防控重点专项(2016YFC1300800)

摘　　要：目的探讨胼周动脉瘤(PAAs)的形态学特征,并分析PAAs破裂的形态学影响因素。方法回顾性连续纳入2013年1月至2017年5月首都医科大学宣武医院神经外科收治的PAAs患者40例,于术前经全脑血管DSA确诊。根据PAAs是否破裂,将40例患者分为破裂组(22例,共22个动脉瘤)和未破裂组(18例,共23个动脉瘤)。采用二维或三维旋转造影的动脉瘤数数据计算形态学参数,包括动脉瘤的直径、高度、宽度、瘤颈宽度,载瘤动脉直径以及流入角度等,并进一步计算每个动脉瘤的纵横比、尺寸比和长宽比(动脉瘤直径/动脉瘤宽度)。纵横比分别采用动脉瘤高度/瘤颈宽度和动脉瘤直径/瘤颈宽度计算,尺寸比分别采用动脉瘤高度/载瘤动脉直径和动脉瘤直径/载瘤动脉直径计算。比较两组PAAs形态学参数的差异,并进行多因素Logistic回归分析,初步探讨PAAs破裂的形态学影响因素。结果 (1)两组患者年龄及男性、多发动脉瘤和心脑血管疾病危险因素的差异均无统计学意义(均P> 0.05)。(2)破裂组不规则动脉瘤比例、长宽比均高于未破裂组,组间差异均有统计学意义[90.9%(20/22)比39.1%(9/23),χ~2=8.01;(1.35±0.36)比(1.01±0.22),t=-3.85;均P <0.01];两组动脉瘤直径、高度、宽度、载瘤动脉直径、纵横比、入射角度、瘤颈、尺寸比的差异均无统计学意义(均P> 0.05)。(3) 45个动脉瘤中,A3前段分叉处动脉瘤比例为53.3%(24个),其中破裂组和未破裂组A3前段分叉动脉瘤数比例分别为68.2%(15/22)和39.1%(9/23),组间差异无统计学意义(χ~2=0.381,P=0.051)。(4) 45个PAAs长宽比均值为1.18,以此为界定值将长宽比转换为二分类变量,以PAAs破裂为因变量,将形态学参数的单因素分析中长宽比(>1.18)、不规则动脉瘤纳入多因素Logistic回归分析,结果显示,长宽比值> 1.18(OR=1.84,95%CI:1.42～28.11,P=0.016)、不规则动脉瘤(OR=2.06,95%CI:1.66～37.11,P=0.009)为PAAs破裂的独立危险�Objectives To investigate the morphological characteristics of pericallosal artery aneurysms (PAAs) and to analyze the morphological influence factor of PAA rupture. Methods From January 2013 to May 2017A,40 consecutive patients with PAA admitted to the Department of Neurosurgery,Xuanwu Hospital, Capital Medical University were enrolled retrospectively.They were diagnosed by whole brain vascular DSA before treatment.Forty patients were divided into ruptured group ( n =22 with 22 aneurysms) and the unruptured group ( n =18 with 23 aneurysms).The morphological parameters of the number of aneurysms in two-dimensional or three-dimensional rotational angiography included diameter,height,width,aneurysm neck width,diameter of parent arteries,and inflow angle of aneurysms,and the aspect ratio,size ratio and length-width ratio (aneurysm diameter/aneurysm width) of each aneurysm were further calculated.The aspect ratio was calculated using aneurysm height/aneurysm neck width and aneurysm diameter/aneurysm neck width,respectively,and the size ratio was calculated using aneurysm height/parent artery diameter and aneurysm diameter/parent artery diameter,respectively.The differences of morphological parameters of PAAs were compared and multivariate logistic regression analysis was performed to preliminarily investigate the morphology of influencing factors of PAA rupture. Results (1) There were no significant differences in age,male,multiple aneurysms,and risk factors for cardiocerebrovascular diseases between the two groups (all P >0.05).(2) The proportion of irregular aneurysms and the length-width ratio of aneurysms in the rupture group were higher than those in the unruptured group.The difference between the groups was statistically significant (90.9%[20/22] vs .39.1%[9/23],χ^ 2=8.01);1.35±0.36 vs .1.01±0.22, t =-3.85;all P <0.01).There were no significant differences in aneurysm diameter,height,width,diameter of parent artery ,aspect ratio,inflow angle,aneurysm neck,and size ratio between the two groups (all P >0.05).(

关 键 词：颅内动脉瘤 胼周动脉瘤 动脉瘤 破裂 形态学参数 

分 类 号：R743[医药卫生—神经病学与精神病学]