颅内镜面动脉瘤破裂的危险因素及预测研究  

Exploration of rupture risk factors and their clinical prediction accuracy for intracranial mirror aneurysms

作　　者：吴政俊 刘宏[1] 涂小龙 何明方[1] Wu Zhengjun;Liu Hong;Tu Xiaolong(Department of Cerebrovascular Disease,Guangyuan Central Hospital,Guangyuan628099)

机构地区：[1]四川省广元市中心医院脑血管病科,628099

出　　处：《卒中与神经疾病》2023年第1期55-58,共4页Stroke and Nervous Diseases

摘　　要：目的 探讨颅内镜面动脉瘤破裂的危险因素及预测指标。方法 回顾性纳入2016年1月-2021年12月于本院诊治颅内镜面动脉瘤患者共62例124个,根据动脉瘤是否破裂分为破裂组(60个)和未破裂组(64个);比较2组一般资料、电子计算机断层扫描(Computed tomography, CT)表现及血流动力学指标,采用Logistic回归模型分析颅内镜面动脉瘤破裂的独立危险因素,描绘受试者工作特征(Receiver operating characteristic, ROC)曲线评价上述独立危险因素的临床预测效能。结果 破裂组CT扫描动脉瘤最大径、颈宽、尺寸比、壁切应力变异系数、平均壁切应力均值变异系数、平均壁切应力绝对值变异系数、壁切应力梯度变异系数及平均壁切应力梯度变异系数均显著多于未破裂组(P<0.05);破裂组压力变异系数显著少于未破裂组(P<0.05);将单因素分析有统计学意义指标纳入Logistic回归模型行多因素分析显示,壁切应力变异系数和壁切应力梯度变异系数均是颅内镜面动脉瘤破裂的独立危险因素(P<0.05);ROC曲线分析显示,壁切应力变异系数联合壁切应力梯度变异系数用于颅内镜面动脉瘤破裂的预测临床效能优于两者单用(P<0.05)。结论 存在高壁切应力变异系数和高壁切应力梯度变异系数的颅内镜面动脉瘤患者具有更高破裂风险,同时上述两类指标联合具有更佳的预测效能。Objective To investigate rupturerisk factors and their clinical prediction accuracy for intracranial mirror aneurysms in order to provide information for the plan of clinical personalized intervention. Methods 62 patients with 124 intracranial mirror aneurysms were retrospectively selected during the period from January 2016 to December 2021. All patients were divided into ruptured group(60 cases) and unruptured group(64 cases) based on the ocurrence of aneurysm rupture or not. The general data, CT scan morphology and hemodynamic indexes of 2 groups were compared. Logistic regression model was used to analyze the independent risk factors of intracranial mirror aneurysm rupture, and Receiver Operating Characteristic(ROC) curve was used to evaluate the clinical prediction accuracy of above independent risk factors. Results The maximum diameter, cervical width, size ratio, coefficient of variation of MST, mean value of MST, absolute value of MST, coefficient of variation of MST, and coefficient of variation of MST gradient of ruptured group were all significantly higher than those in unruptured group(P<0.05). The pressure variation coefficient of ruptured group was significantly lower than that of unruptured group(P<0.05). Multivariate analysis was performed by integrating the statistically significant indexes of univariate analysis into the Logistic regression model. The results showed that the coefficient of variation of MST and the coefficient of variation of MST gradient were independent risk factors for rupture of intracranial mirror aneurysms(P<0.05). Results of ROC curve analysis showed that the clinical accuracy of coefficient of variation of wall shear stress combined with coefficient of variation of wall shear stress gradient was better than any index alone in predicting the rupture risk of intracranial mirror aneurysms(P<0.05).Conclusion Both high coefficient of variation of wall shear stress and high coefficient of variation of wall shear stress gradient may increase the risk of intracranial mirror aneur

关 键 词：镜面动脉瘤 破裂 危险因素 电子计算机断层扫描 预测 

分 类 号：R743.9[医药卫生—神经病学与精神病学]