尺寸比及子囊形成对颅内镜像动脉瘤破裂的影响  

Roles of size ratio and bleb formation in the rupture of intracranial mirror aneurysms

作　　者：唐晓宇 文立利[1] 吴琪[1] 张鑫[1] TANG Xiao-yu;WEN Li-li;WU Qi;ZHANG Xin(Department of Neurosurgery,Nanjing General Hospital,Nanjing Military Region of the People′s Liberation Army,Jiangsu Province,Nanjing 210002,China)

机构地区：[1]中国人民解放军南京军区南京总医院神经外科,江苏南京210002

出　　处：《河北医科大学学报》2023年第2期167-172,共6页Journal of Hebei Medical University

基　　金：国家自然科学基金面上项目(82071328);江苏省自然基金面上项目(BK20191231)。

摘　　要：目的探讨颅内镜像动脉瘤的形态学及血流动力学特征及其对动脉瘤破裂的影响。方法回顾性分析颅内镜像动脉瘤46例92枚动脉瘤的数字减影血管造影资料,采用计算流体动力学模拟。收集动脉瘤15个形态学参数和5个血流动力学参数。比较破裂动脉瘤与未破裂动脉瘤各参数的差异,采用多因素Logistic回归分析法确定动脉瘤破裂的危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析各参数预测动脉瘤破裂的曲线下面积(area under curve,AUC)和阈值。结果破裂组动脉瘤形状不规则、子囊形成发生率多于未破裂组,最大径、高度、宽度、最大深度、瓶颈因子(bottle neck factor,BNF)、纵横比(aspect ratio,AR)、尺寸比(size ratio,SR)、高宽比(height/width,H/W)、深宽比(Hmax/width,Hmax/W)大于未破裂组,平均壁面剪切力、标准化壁面剪切力小于未破裂组,差异有统计学意义(P<0.05);2组位于分叉部、瘤颈宽度、载瘤动脉直径(diameter of parent vessel,DV)、流入角、最大壁面剪切力、平均震荡剪切指数、载瘤动脉壁面剪切力差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,SR和子囊形成是动脉瘤发生破裂的危险因素。ROC分析结果显示,最大径、高度、最大深度和SR具有较高的AUC值分别为0.841、0.820、0.847和0.873。结论破裂的颅内镜像动脉瘤更多见于不规则形态与子囊形成的动脉瘤,并具有较大的最大径、高度、宽度、最大深度、AR、SR、H/W、Hmax/W与较小的平均壁面剪切力、标准化壁面剪切力,其中SR及子囊形成是颅内镜像动脉瘤破裂的危险因素。Objective To investigate the morphological and hemodynamic characteristics of intracranial mirror aneurysm and their effect on aneurysm rupture.Methods The data of 92 aneurysms in 46 patients with intracranial mirror aneurysms by digital subtraction angiography were analyzed retrospectively.Fifteen morphological parameters and 5 hemodynamic parameters of aneurysms were collected by computational fluid dynamics simulation.The difference of parameters between ruptured and unruptured aneurysms was compared,and the risk factors for ruptured aneurysms were determined by multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was used to analyze each parameter to predict the area under ROC curve(AUC)and threshold of aneurysm rupture.Results The incidence of irregular shape and bleb formation in ruptured group were higher than that in unruptured group.Maximum diameter,height,width,maximum height(Hmax),bottle neck factor(BNF),aspect ratio(AR),size ratio(SR),height/width(H/W)and Hmax/width(Hmax/W)were higher than those in the unruptured group,and the average wall shear stress(WSS)and normalized wall shear stress(NWSS)were lower than those in the unruptured group,with statistical significance(P<0.05).There were no significant differences in the bifurcation,tumor neck width,diameter of parent vessel(DV),inflow angle,maximum wall shear stress(MWSS),average oscillatory shear index(OSI)and wall shear stress of parent artery(PTWSS)between two groups(P>0.05).Multiple Logistic regression analysis showed that SR and bleb formation were risk factors for aneurysm rupture.ROC analysis results showed that the maximum diameter,height,Hmax and SR had high AUC values of 0.841,0.820,0.847 and 0.873,respectively.Conclusion Ruptured intracranial mirror aneurysms are more common in aneurysms with irregular shape and bleb formation,and have larger maximum diameter,height,width,Hmax,AR,SR,H/W,Hmax/W,and smaller WSS and NWSS.SR and bleb formation are independent risk factors for the rupture of intracranial mirror a

关 键 词：颅内动脉瘤 形态学 血流动力学 

分 类 号：R743.9[医药卫生—神经病学与精神病学]