抗血小板药与颅内动脉瘤破裂的相关性  

Correlation between antiplatelet agents and ruptured intracranial aneurysms

作　　者：傅俊婷 张维杰[2] 邢成名[2] 王鸿雁[2] 张汉哲[2] 甄超 于谭方[2] 王新[2] Fu Junting;Zhang Weijie;Xing Chengming;Wang Hongyan;Zhang Hanzhe;Zhen Chao;Yu Tanfang;Wang Xin(Weifang Medical University,Weifang 261053,China;Department of Neurology,East Hospital Area of Qingdao Municipal Hospital,Qingdao 266071,China)

机构地区：[1]潍坊医学院,261053 [2]青岛市市立医院东院区神经内一科,266071

出　　处：《国际脑血管病杂志》2020年第7期510-515,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨抗血小板药与颅内动脉瘤破裂风险的相关性。方法回顾性选择青岛市市立医院东院区2018年6月至12月期间收治的颅内动脉瘤患者,收集患者以及颅内动脉瘤特征基线资料。通过单变量分析以及多变量logistic回归分析确定抗血小板药与颅内动脉瘤破裂风险的独立相关性。结果共纳入90例颅内动脉瘤患者。男性31例(34.44%),女性59例(65.56%),最大动脉瘤直径中位数为4 mm。有46例患者在诊断颅内动脉瘤前服用抗血小板药,其中36例服用阿司匹林,3例服用氯吡格雷,7例服用阿司匹林+氯吡格雷。破裂动脉瘤共31例(34.44%),未破裂动脉瘤共59例(65.56%)。破裂组年龄<60岁(P<0.05)、糖尿病(P<0.1)、缺血性心脏病(P<0.05)、既往卒中或短暂性脑缺血发作史(P<0.1)、颈内动脉动脉瘤(P<0.01)、前交通动脉动脉瘤(P<0.05)、后交通动脉动脉瘤(P<0.01)以及诊断前服用抗血小板药(P<0.1)的患者比例与未破裂组差异有统计学意义。多变量logistic回归分析显示,年龄<60岁[优势比(odds ratio,OR)4.116,95%可信区间(confidence interval,CI)1.337~12.673;P=0.014)、前交通动脉动脉瘤(OR 5.015,95%CI 1.155~22.559;P=0.032)和后交通动脉动脉瘤(OR 68.796,95%CI 6.762~699.951;P<0.001)是颅内动脉瘤破裂的独立危险因素,而服用抗血小板药是颅内动脉瘤破裂的独立保护因素(OR 0.320,95%CI 0.104~0.992;P=0.048)。结论服用抗血小板药尤其是阿司匹林不会增高颅内动脉瘤破裂风险,而可能是颅内动脉瘤破裂的保护因素。对于具有明确适应证的患者,未破裂动脉瘤并非抗血小板治疗的禁忌证。Objective To investigate the correlation between antiplatelet agents and the risk of ruptured intracranial aneurysm.Methods Patients with intracranial aneurysm admitted to the Department of Neurology, East Hospital Area of Qingdao Municipal Hospital from June to December 2018 were selected retrospectively. The baseline data of patients and the characteristics of intracranial aneurysms were collected. The independent correlation between antiplatelet agents and the risk of ruptured intracranial aneurysm was identified by the univariable analysis and multivariate logistic regression analysis.Results A total of 90 patients with intracranial aneurysm were included in the study. There were 31 males (34.44%) and 59 females (65.56%). The median diameter of the aneurysm was 4 mm. Forty-six patients taking antiplatelet agents before being diagnosed with intracranial aneurysm, of which 36 taking aspirin, 3 taking clopidogrel, and 7 taking aspirin+ clopidogrel. There were 31 patients (34.44%) with ruptured aneurysm and 59 (65.56%) with unruptured aneurysm. There were statistical differences in the proportion of patients with age <60 years (P<0.05), diabetes (P<0.1), ischemic heart disease (P<0.05), history of previous stroke or transient ischemic attack (P<0.01), internal carotid artery aneurysm (P<0.01), anterior communicating artery aneurysm (P<0.05), posterior communicating artery aneurysm (P<0.01) and taking antiplatelet agents before diagnosis (P<0.1) between the ruptured group and the unruptured group. Multivariate logistic regression analysis showed that age <60 years (odds ratio[OR] 4.116, 95% confidence interval [CI] 1.337-12.673;P=0.014), anterior communicating artery aneurysm (OR 5.015, 95% CI 1.155-22.559;P=0.032) and posterior communicating artery aneurysm (OR 68.796, 95% CI 6.762-699.951;P<0.001) were the independent risk factors for ruptured intracranial aneurysm, and taking antiplatelet agents was an independent protective factor for ruptured intracranial aneurysm (OR 0.320, 95% CI 0.104-0.992;P=0.048).Conclu

关 键 词：颅内动脉瘤 动脉瘤 破裂 抗血小板聚集药 阿司匹林 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]