肾血管平滑肌脂肪瘤自发性破裂危险因素  

Risk factors of spontaneous rupture of renal angiomyolipoma

作　　者：刘泽川 吕天石[1] 曹守金 姚航 武思彤 范思源 姚子平 宋莉[1] 邹英华[1] 王健[1] LIU Zechuan;LYU Tianshi;CAO Shoujin;YAO Hang;WU Sitong;FAN Siyuan;YAO Ziping;SONG Li;ZOU Yinghua;WANG Jian(Department of Interventional and Vascular Surgery,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院介入血管外科,北京100034

出　　处：《中国介入影像与治疗学》2023年第8期454-458,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：北京医学奖励基金(YXJL-2021-0072-0111)。

摘　　要：目的观察肾血管平滑肌脂肪瘤(RAML)自发性破裂的危险因素。方法纳入151例接受超选择性栓塞的RAML患者,根据治疗前CT或血管造影是否可见对比剂外溢将其分为破裂组(n=45)及未破裂组(n=106);比较组间患者基本资料及肿瘤影像学表现的差异,以多因素logistic回归分析观察RAML破裂的独立危险因素,构建风险预测模型并以列线图可视化;绘制受试者工作特征(ROC)曲线,评价以各危险因素及模型判断RAML破裂的效能。结果组间肿瘤最大径、瘤内动脉瘤最大径>5 mm占比差异均有统计学意义(P均<0.05)。ROC曲线分析结果显示,以6.32 cm为截断值,根据肿瘤最大径判断RAML破裂的曲线下面积(AUC)为0.684。多因素logistic分析显示,单发肿瘤、直径较大及瘤内动脉瘤最大径≥5 mm(OR=0.37、1.14、5.69,P均<0.05)是RAML破裂的独立危险因素;以之构建的预测RAML破裂风险模型预测RAML破裂的AUC为0.776,且模型校准曲线与理想曲线的重合度尚可。结论单发病灶、肿瘤较大且存在≥5 mm的瘤内动脉瘤是RAML自发性破裂的独立危险因素。Objective To observe the risk factors of spontaneous rupture of renal angiomyolipoma(RAML).Methods Totally 151 patients with RAML who underwent superselective arterial embolization(SAE)were enrolled and divided into rupture group(n=45)and unrupture group(n=106)based on contrast agent overflow showed on CT before treatment or angiography.The patients'basic information and imaging manifestations of RAML were compared between groups.Multivariate logistic analysis was adopted to explore the independent risk factors of spontaneous rupture of RAML,and a predicting model was built and visualized as nomogram.The receiver operating characteristic(ROC)curve was drawn to assess the predictive efficacy of risk factors and the model.Results Significant differences of the maximum diameters of RAML and the proportions of aneurysms with a maximum diameter≥5 mm were found between groups(both P<0.05).ROC curve showed that taken 6.32 cm as the cut-off value of the maximum dimeter of RAML,the area under the curve(AUC)for predicting spontaneous rupture of RAML was 0.684.Multivariate logistic analysis showed that single lesion,larger diameter and intratumoral aneurysm≥5 mm were all independent risk factors of spontaneous rupture of RAML(OR=0.37,1.14,5.69,all P<0.05),AUC of this model for predicting spontaneous rupture of RAML was 0.776,and the calibration curve was roughly coincident with the ideal curve.Conclusion Single lesion,with larger diameter and intratumoral aneurysm≥5 mm were independent risk factors of spontaneous rupture of RAML.

关 键 词：肾肿瘤 血管肌脂瘤 破裂 栓塞 治疗性 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]