基于CT血管造影的形态学特征预测后交通囊状动脉瘤破裂出血的危险因素  

Prediction of Risk Factors for Bleeding After Rupture of Posterior Communicating Cystic Aneurysms Based on Morphological Features of CT Angiography

作　　者：李松 沈龙山[2] 罗宏[2] 仝贺 王震寰 LI Song;SHEN Longshan;LUO Hong;TONG He;WANG Zhenhuan(School of Graduate,Bengbu Medical College,Bengbu Anhui 233000,China;Department of Radiology,The 2nd Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233017,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233030 [2]蚌埠医学院第二附属医院放射科,安徽蚌埠233017

出　　处：《中国医疗设备》2022年第8期128-131,146,共5页China Medical Devices

基　　金：安徽省跨世纪学术和技术带头人后备人选科研资助项目(2002HBL26);数字医学与智慧健康安徽普通高校重点实验室项目(AHCM2002W002);蚌埠医学院自然科学重点项目(2020byzd188,2021byzd185)。

摘　　要：目的比较分析破裂与未破裂后交通囊状动脉瘤临床指标和形态学特征,评估后交通动脉瘤破裂出血的风险因素。方法回顾性分析2017年1月至2022年2月收治于蚌埠医学院第二附属医院的后交通囊状动脉瘤患者131例。根据动脉瘤破裂出血与否分为破裂组和未破裂组,利用单因素比较分析临床基本资料和动脉瘤形态学特征,通过Logistic回归分析评估后交通囊状动脉瘤的破裂风险因素,建立破裂出血风险的预测模型。结果破裂组与未破裂组在性别、动脉瘤顶指向、是否伴有子囊、瘤体最大径、瘤体宽度、瘤体高度、纵横比、尺寸比、长宽比以及入射角度方面差异有统计学意义(P<0.05);多因素Logistic回归显示动脉瘤顶指向外下方(OR=29.526,95%CI:3.205~271.987,P=0.003)、入射角度(OR=1.038,95%CI:1.002~1.077,P=0.014)、纵横比(OR=4.979,95%CI:1.046~23.712,P=0.044)、尺寸比(OR=6.233,95%CI:1.432~27.135,P=0.015)为影响后交通囊状动脉瘤破裂出血的独立危险因素。构建的临床后交通囊状动脉瘤破裂风险的预测模型,用预测模型的工作特征曲线分析的曲线下面积(95%CI)为0.877(0.815~0.939),存在统计学差异(P<0.001)。结论后交通动脉瘤顶指向外下方、入射、纵横比和尺寸比是形态学预测破裂的独立危险因素,可用于预测后交通囊状动脉瘤破裂的风险。Objective To compare the clinical indicators and morphological features of ruptured and unruptured posterior communicating cystic aneurysms and evaluate the risk factors of ruptured and bleeding of the communicating cystic aneurysms. Methods A total of 131patients with posterior communicating cystic aneurysms treated in the 2nd Affiliated Hospital of Bengbu Medical College from January 2017 to February 2022 were retrospectively and consecutively included. The patients were divided into the ruptured and unruptured groups according to whether the aneurysm ruptured or not. The clinical data and morphological features were compared and analyzed by monofactor analysis and the risk factors of rupture of posterior communicating cystic aneurysm were evaluated by binary multivariate Logistic regression analysis and the risk prediction model of rupture bleeding was established. Results There were statistically significant differences between the ruptured group and the unruptured group in gender, apex direction of aneurysm, whether accompanied by ascus, maximum diameter of tumor,tumor width, tumor height, aspect ratio, size ratio, diameter-widthratio, inflow angle of aneurysmal dome(P<0.05). Multivariate Logistic regression showed that the independent risk factors for posterior communicating artery aneurysm rupture were the lateral direction of the aneurysmal dome(OR=29.526, 95%CI: 3.205-271.987, P=0.003), incidence angle(OR=1.038, 95%CI: 1.002-1.077, P=0.014), aspect ratio(OR=4.979, 95%CI: 1.046-23.712, P=0.044), and size ratio(OR=6.233, 95%CI: 1.432-27.135, P=0.015). The prediction model of rupture risk of postclinical communicating cystic aneurysm was constructed. The area under the curve analyzed by receiver operator characteristic curve of the prediction model(95%CI) was 0.877(0.815-0.939) and there was a statistical difference(P<0.001). Conclusion The lateral direction of the aneurysmal dome, aspect ratio, size ratio and inflow angle of posterior communicating artery aneurysm are independent risk factors for morpholog

关 键 词：后交通囊状动脉瘤 形态学 危险因素 CT血管造影成像 

分 类 号：R739.41[医药卫生—肿瘤]