动脉瘤倾斜角对颅内单发动脉瘤破裂出血的影响研究  

Multivariate predictors of intracranial aneurysm rupture and hemorrhage by regression analysis with emphasis on aneurysm angle

作　　者：尹家和[1] 张炘[1] 段传志[1] 李西锋[1] 何旭英[1] Yin Jiahe;Zhang Xin;Duan Chuanzhi;Li Xifeng;He Xuying(Department of Neurosurgery,Zhujiang Hospital of Southern Medical University,National Key Clinical Specialty,Engineering Technology Research Center of Ministry of Education,Guangdong Institute of Neurosurgery,Guangdong Key Laboratory of Brain Function Repair and Regeneration,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院神经外科,国家临床重点专科,教育部工程技术研究中心,广东神经外科研究所,广东省脑功能修复与再生重点实验室,广州510282

出　　处：《中华神经医学杂志》2019年第7期692-699,共8页Chinese Journal of Neuromedicine

基　　金：南方医科大学科研研究启动计划项目(QD2018N022);南方医科大学临床研究启动计划项目(LC2016ZD024).

摘　　要：目的探讨动脉瘤倾斜角对颅内单发动脉瘤破裂出血的影响。方法对南方医科大学珠江医院神经外科自2010年1月至2018年4月收治的2064例颅内单发动脉瘤患者(1086例未破裂出血,978例破裂出血),采用数字减影血管造影(DSA)检查及三维重建方法对其动脉瘤进行形态学评估,参数包括动脉瘤大小、位置、形态、倾斜角、血管角、瘤体与瘤颈比以及长轴与载瘤动脉直径比等。采用单因素分析及多因素分析筛选影响动脉瘤破裂出血的危险因素,并采用二分段线性回归模型及平滑曲线拟合分析动脉瘤倾斜角影响动脉瘤破裂出血的饱和阈值效应,进一步通过分层分析明确在各类分层因素(脑微出血、糖尿病、高脂血症等)存在的情况下动脉瘤倾斜角变化对动脉瘤破裂出血的风险的影响。结果动脉瘤倾斜角是动脉瘤破裂出血的独立危险因素[风险比(HR)=1.02,95%CI:1.01~1.03,P=0.000]。动脉瘤倾斜角>106.3°时,动脉瘤破裂出血的风险逐渐增大;动脉瘤倾斜角每增加1度,动脉瘤破裂出血的风险增加3%。动脉瘤倾斜角每增加1度,合并脑微出血的患者比不合并脑微出血的患者的动脉瘤破裂出血的风险多增加7%,空腹血糖正常的糖尿病患者和空腹血糖偏高的糖尿病患者分别比无糖尿病的患者的动脉瘤破裂出血的风险多增加2%和4%,有高脂血症的患者比无高脂血症的患者的动脉瘤破裂出血的风险增加3%。结论动脉瘤倾斜角与颅内单发动脉瘤破裂出血密切相关,准确测量动脉瘤倾斜角对于评估动脉瘤破裂出血的风险有着重要的临床意义。Objective To evaluate the influence of aneurismal inclination angle in the intracranial aneurysm rupture and hemorrhage. Methods A total of 2064 patients with intracranial aneurysms (1086 without rupture and hemorrhage, and 978 with rupture and hemorrhage), admitted to our hospital from January 2010 to April 2018, were chosen in our study. DSA examination and three-dimensional reconstruction were used for morphological evaluation of aneurysms, including aneurysm size, location, morphous feature, aneurismal inclination angle, vessel angle, aspect ratio (AR) and size ratio (SR). Risk factors of intracranial aneurysm rupture were analyzed by univariate and multivariate regression models;two-piecewise linear regression model and smooth curve fitting were used to analyze the saturation threshold effect of aneurismal inclination angle on aneurysm rupture and hemorrhage to evaluate the correlation between aneurismal inclination angle and aneurysm rupture and hemorrhage. Stratified analysis was conducted to clarify the influence of aneurismal inclination angle changes in risk of aneurysm rupture and hemorrhage in presence of various stratified factors (cerebral microbleeds [CMBs], diabetes, and hyperlipidemia). Results Aneurysm inclination angle was an independent risk factor for aneurysm rupture and hemorrhage (HR=1.02, 95%CI: 1.01-1.03, P=0.000). Risk of aneurysm rupture and hemorrhage increased when aneurismal inclination angle was more than 106.3 degrees for each additional degree;each degree of increase in aneurysm inclination increased the risk of aneurysm rupture and hemorrhage by 3%. As compared with patients without CMBs, risk of aneurysm rupture and hemorrhage increased extra 7% in patients with CMBs for each additional degree of aneurismal inclination angle;as compared with patients without diabetes mellitus MD, for each additional degree of aneurismal inclination angle, risk of aneurysm rupture and hemorrhage increased extra 2% in diabetes patients with fasting blood-glucose (FBG)≤6.0 mmol/L, and increased

关 键 词：颅内动脉瘤 动脉瘤倾斜角 破裂出血 

分 类 号：R743[医药卫生—神经病学与精神病学]