单发与多发颅内动脉瘤临床特征、治疗方式及短期预后的多中心研究  

Clinical features,treatment methods and short-term outcomes of single and multiple intracranial aneurysm s:amulticenter study

作　　者：候长凯 赵岩[1] 于建军[2] 刘振波[3] 王立群[4] 胡福广[4] 崔建忠 张中原[6] 任新亮[7] 李建华[8] 刘庆国[9] 陈镭[10] 陈实 高贻宽 王建军[13] 杨新宇[1] Hou Changkai;Zhao Yan;Yu Jianjun;Liu Zhenbo;Wang Liqun;Hu Fuguang;Cui Jianzhong;Zhang Zhongyuan;Ren Xinliang;li Jianhua;Liu Qingguo;Chen Lei;Chen Shi;Gao Yikuan;Wang Jianjun;Yang Xinyu(Department of Neurosurgery,Tianjin Medical Unitersity General Hospital,Tianjin 300052,China;Department of Neurosurgery,Linyi People's Hospital,Linyi 276000,China;Department of Neurosurgery,Xingtai People's Hospital,Xingtai 054031,China;Department of Neurosiurgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Neurosurgery,Tangshan Gongren Hospital,Tangshan 063000,China;Department of Neurosurgery.People's Hospital of Zunhua,Zunhua 064200,China;Department of Neurosurgery,Heji Hospital Afiliated to Changzhi Medical College,Changzhi 046011,China;Department of Neurosurgery,Handan First Hospital,Handan 056000,China;Department of Neurosurgery,Heping Hospital Afiliated to Changzhi Medical College,Changzhi 046000,China;Department of Neurosurgery,the Fifth Central Hospital of Tianjin,Tianjin 300457,China;Department of Neurosurger.Fuzhou Second Hospital of Xiamen UIniversity,Fuzhou 350007,China;Department of Neurosurgery,the Central Hospital of Yongzhou,Yongzhou 425000,China;Department of Neurosurgery,Erdos Central Hospital,Erdos 017000,China)

机构地区：[1]天津医科大学总医院神经外科,300052 [2]临沂市人民医院神经外科,山东276000 [3]邢台市人民医院神经外科,河北054031 [4]河北医科大学第二医院神经外科,石家庄050000 [5]唐山市工人医院神经外科,河北063000 [6]遵化市人民医院神经外科,河北064200 [7]长治医学院附属和济医院神经外科,山西046011 [8]邯郸市第一医院神经外科,河北056000 [9]长治医学院附属和平医院神经外科,山西046000 [10]天津市第五中心医院神经外科,300457 [11]厦门大学附属福州第二医院神经外科,350007 [12]永州市中心医院神经外科,湖南425000 [13]鄂尔多斯市中心医院神经外科,内蒙古自治区017000

出　　处：《中华神经外科杂志》2021年第4期331-336,共6页Chinese Journal of Neurosurgery

基　　金：天津医科大学临床研究项目(2018kylc008)。

摘　　要：目的探讨多发颅内动脉瘤(MIA)与单发颅内动脉瘤(SIA)患者的临床特征、治疗方式及短期预后.方法回顾性分析1082例颅内动脉瘤(IA)患者的临床资料,所有患者均于2017年1月至2018年12月经天津医科大学总医院等13家医院的神经外科确诊并收治,根据动脉瘤的数量将患者分为MIA组[118例(共269个动脉瘤)]和SIA组(964例).观察两组动脉瘤的一般特征,收集并比较两组患者的临床资料,将出院时改良Rankin量表评分0~2分定义为短期预后良好,3~6分定义为短期预后不良.将单因素分析中P<0.5的自变量以及临床上较为关注的自变量均纳入多因素二元logistic回归模型,进一步对MIA组和SIA组的临床资料进行1∶1倾向性评分匹配,比较匹配后的两组患者的治疗方式、住院天数及短期预后.结果MIA组动脉瘤的直径为(5.1±3.5)mm(0.2~25.0 mm),SIA组动脉瘤的直径为(5.7±3.8)mm(0.9~35.0 mm).两组性别、糖尿病史、吸烟史、饮酒史、原发性高血压病的级别、CT Fisher分级、Hunt-Hess分级、格拉斯哥昏迷评分及世界神经外科医师联盟(WFNS)分级的差异均无统计学意义(均P>0.05);与SIA组相比,MIA组患者的年龄更大,差异有统计学意义[分别为(62.4±11.7)岁、(58.8±11.6)岁,P=0.002].将年龄、性别、糖尿病史、饮酒史、吸烟史、原发性高血压的级别、入院CT Fisher分级指标纳入多因素二元logistic回归模型分析,结果显示,MIA组年龄更大,但SIA组原发性高血压(3级)患者比例更高,差异均具有统计学意义(均P<0.05).通过倾向性评分匹配,共精确匹配0对,模糊匹配118对,共计匹配成功118对.匹配后的两组患者住院时长的差异无统计学意义(P>0.05);与SIA组比较,MIA组短期预后较好(P=0.008);两组治疗方式的差异也具有统计学意义(P=0.042),其中MIA组血管内治疗更多.结论与MIA患者比较,SIA患者更易合并原发性高血压3级,但MIA患者的年龄更大,且更倾向于采用血管�Objective To explore the elinical charactristis,tratmet stratrgies and shor-term otomers of multiple intra ranial aneurysns(MIA)and single intracranial ameurysms(SIA),Methods A Tetnepoetive study Wwas conducterd o 1082 putients with MIA or SIA who were diagnoserd and treated at the noumrsungenry depurtments of 13 mrdieal centers ineluding Tanjin Medieal Universily General Hespital from January 2017 to Deenber 2018.Aoording to the number of anrurysts,the pautients were divided intn MIA group[118 eases(269 aneurysms)]and SIA group(964 eises).We obeerved the general chancteristies of aneunysms in the 2 groups.olloeted and compand the elinial dauta of the 2 groups of patientse.The mulifed Rankin scale(mRS)score of 0-2 at discharge wa defimed as a goud short-em uicome,and 3-6 points B a por shurt lerm outeoone.The inde pendent variables with P<0.5 in the uriariale analysis and the einially oncemed inodependent variables were ineluded in the multivariate binary logistie regression nodel,and the elinical data of the MIIA goup and the SIA group werr further matched with 1:1 propensity scores to comnpare the tratment methods,length of stay at hospital and bhr-term outonee of the 2 groups of putiente after matching,Results The diameter of the aneurysm in the MIA group as5.1±3.5 mn(0.2-25.0 mm).and that in the SIA goup was5.7±3.8 mm(0.9-35.0 mm).There wEs m dfrernce betmeen the 2 groups in gender,hislory of duabedes.history of smoking.history o aleohol drinking.grade of essential hypertension,CT Fsber gruole,Hunt-Hes grade,Glasgow om sore(GCS),or Ward Federatin of Neurologieal surgeons(WFNS)sale soures(all P>0.05).Cormpared with the SIA group,the patient's ag in the MIA group was older,and the dfference was saistically signifeant[(62.4±11.7)years old vs.(58.8±11.6)years old,P=0.002],The anger.grauder.histery of diabetes.history of alcobol drinking.history o smnoking.gade of essential hyperension,and CT Fisher yroale at huspital anisisii mere inclunkedl in the mulivarate hinary lgistie reressin mnlel analysis.The rsuls s

关 键 词：颅内动脉瘤 多中心研究 疾病特征 临床方案 预后 

分 类 号：R743.4[医药卫生—神经病学与精神病学]