颅内微小动脉瘤破裂的危险因素分析  

Analysis of Risk Factors for Rupture of Very Small Intracranial Aneurysms

作　　者：谢仁华 李泽奇 苏平 刘博虎 岑键昌 李俊彦 XIE Ren-hua;LI Ze-qi;SU Ping;LIU Bo-hu;CEN Jian-chang;LI Jun-yan(Department of Cerebrovascular,the First People's Hospital of Zhaotong,Zhaotong 657000,Yunnan,China;Department of Neurosurgery,the First People's Hospital of Yibin,Yibin 644000,Sichuan,China;Department of Neurosurgery,Calmette Hospital Affiliated to Kunming Medical University,Kunming 650100,Yunnan,China)

机构地区：[1]昭通市第一人民医院脑血管科,云南昭通657700 [2]宜宾市第一人民医院神经外科,四川宜宾644000 [3]昆明医科大学附属甘美医院神经外科,云南昆明650100

出　　处：《医学信息》2023年第24期51-56,共6页Journal of Medical Information

基　　金：云南省卫生科技计划项目(编号:2017NS086)。

摘　　要：目的探讨颅内微小动脉瘤(VSIA)破裂的相关危险因素,为颅内未破裂微小动脉瘤的临床管理提供指导。方法连续纳入昆明医科大学附属甘美医院2016年1月-2021年11月99例单发颅内微小动脉瘤,根据是否破裂分为破裂组(48例)和未破裂组(51例)。回顾性分析患者临床特征、瘤体位置、外形和形态学参数。使用独立样本t检验或χ2检验分析这些因素的显著性,对单因素分析中有统计学意义的因素进一步行多因素Logistic回归分析,采用受试者工作特征曲线分析各参数预测微小动脉瘤破裂的最佳阈值。结果破裂组与未破裂组患者动脉瘤位置、形态、入射角、动脉瘤角、纵横比、体积瘤颈面积比、长宽比、尺寸比、高血压病史和吸烟史比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,吸烟史、入射角、长宽比、体积瘤颈面积比和外形是微小动脉瘤破裂的独立危险因素(P<0.05);ROC曲线显示,入射角的曲线下面积最大为0.864,其评估VSIA是否破裂最准确。结论微小动脉瘤瘤体有较大的入射角、长宽比、体积瘤颈面积比、瘤体不规则以及位于前交通动脉,可视该动脉瘤具有高的破裂风险,如条件允许,建议积极手术干预;有高血压病史、有吸烟史的患者,建议控制好血压、戒烟,定期行数字减影血管造影复查,若动脉瘤形态发生变化应及时行手术干预。Objective To explore the related risk factors of rupture of very small intracranial aneurysms(VSIA),and to provide guidance for the clinical management of unruptured intracranial microaneurysms.Methods A total of 99 patients of single very small intracranial aneurysms at Calmette Hospital Affiliated to Kunming Medical University from January 2016 to November 2021 were continuously included in the study.They were divided into ruptured group(n=48)and non-ruptured group(n=51)according to whether or not they ruptured.The clinical features,tumor location,shape and morphological parameters of the patients were retrospectively analyzed.Independent sample t test orχ2 test was used to analyze the significance of these factors.Multivariate logistic regression analysis was further performed on the statistically significant factors in the univariate analysis.The receiver operating characteristic curve was used to analyze the optimal threshold of each parameter to predict the rupture of microaneurysms.Results There were significant differences in aneurysm location,morphology,inflow angle,aneurysm angle,aspect ratio,volume to neck ratio,diameter-width ratio,size ratio,hypertension history and smoking history between the ruptured group and the non-ruptured group(P<0.05).Multivariate Logistic regression analysis showed that smoking history,inflow angle,diameter-width ratio,volume to neck ratio and shape were independent risk factors for rupture of microaneurysms(P<0.05).The ROC curve showed that the maximum area under the curve of the inflow angle was 0.864,which was the most accurate to evaluate whether the VSIA was ruptured.Conclusion Very small intracranial aneurysm with large inflow angles,diameter-width ratio,volume to neck ratio,irregularities in the aneurysm,and location in the anterior communicating artery are considered to be at high risk of rupture,and aggressive surgical intervention is recommended if conditions warrant.For patients with a history of hypertension and smoking,it is recommended to control blood pressur

关 键 词：颅内动脉瘤 微小动脉瘤 破裂 

分 类 号：R651.1[医药卫生—外科学]