颈内动脉眼段至交通段高曲度与后交通动脉动脉瘤形成的关系  

The association between the high tortuosity of internal carotid artery from ophthalmic to posterior communicating segment and posterior communicating artery aneurysms

作　　者：杨磊 张栋梁 韩永丰 苏现辉 金文才 张学敬 Yang Lei;Zhang Dongliang;Han Yongfeng;Su Xianhui;Jin Wencai;Zhang Xuejing(Department of Neurosurgery,Shijazhuang People's Hospital,Shijiazhuang 05001l,China;Center of Medical Research,Shijiazhuang People's Hospital,Shijiazhuang 050011,China)

机构地区：[1]石家庄市人民医院神经外科,石家庄050011 [2]石家庄市人民医院科研中心,石家庄050011

出　　处：《中华神经外科杂志》2025年第2期138-144,共7页Chinese Journal of Neurosurgery

基　　金：河北省医学科学研究重点课题(20191459);河北省重点研发计划(22377753D)。

摘　　要：目的探讨颈内动脉(ICA)眼段至交通段高曲度与后交通动脉(PCoA)动脉瘤形成的关系,以及血管曲度与血流动力学参数的相关性。方法回顾性对比分析2017年1月至2020年4月于石家庄市人民医院神经外科行数字减影血管造影(DSA)检查的PCoA动脉瘤患者(动脉瘤组,43例)与无颅内动脉瘤患者(对照组,78例)的临床资料。基于血管中心线,以ICA-PCoA交界点为P_(0)点,ICA上游距离P_(0)点3、5 mm的位点分别定义为P_(Up3)和P_(Up5),下游的相应位点分别定义为P_(Dw3)和P_(Dw5),测量P_(Up3)与P_(Up5)处的平均ICA直径和横截面面积(分别为D Up和S Up)及下游的相应参数(D_(Dw)和S Dw);测量P_(Up3)至P_(Dw3)、P_(Up5)至P_(Dw5)的曲度(分别为T_((Up+Dw)3)和T_((Up+Dw)5),及P_(0)至ICA上游3、5 mm(分别为T_(Up3)和T Up5)和下游3、5 mm(分别为T_(Dw3)和T_(Dw5))的曲度。采用多因素logistic回归模型(逐步回归法)和受试者工作特征(ROC)曲线分析ICA眼段至交通段曲度对PCoA动脉瘤形成的影响及其临床预测价值。设计7种不同曲度的血管模型模拟P_(0)及其上游和下游的ICA,利用计算流体动力学分析血管曲度与血流动力学参数的相关性。结果与对照组比较,动脉瘤组女性、有原发性高血压病史者占比均较高,T_((Up+Dw)3)、T(Up+Dw)5、T_(Up3)、T_(Dw3)及T_(Dw5)均较大(均P<0.05)。多因素logistic回归模型分析结果显示,女性(OR=5.54,95%CI:2.20~13.50,P<0.001)和T_((Up+Dw)3)增大(OR=5.42,95%CI:2.24~13.13,P<0.001)均为PCoA动脉瘤形成的危险因素。ROC曲线分析显示,T_((Up+Dw)3)预测PCoA动脉瘤形成的曲线下面积为0.81,具有中等预测价值。计算流体动力学分析显示,血管模型曲度与壁面平均剪切力、压力和涡流强度均呈直线正相关关系(r值分别为0.94、0.92和0.94,均P<0.01)。结论PCoA动脉瘤形成可能与女性、ICA眼段至交通段高曲度有关;血管曲度增加时,壁面平均剪切力、压力和涡流强度均相应增大。ObjectiveTo investigate the relationship between the high tortuosity of internal carotid artery(ICA)from ophthalmic artery(OA)to posterior communicating artery(PCoA)and the formation of PCoA aneurysms and the correlation between the tortuosity of the vessel and hemodynamic parameters.MethodsThe clinical data of patients with PCoA aneurysm(aneurysm group,43 cases)and without intracranial aneurysm(control group,78 cases)who underwent digital subtraction angiography(DSA)examination in the Department of Neurosurgery,Shijiazhuang People′s Hospital from January 2017 to April 2020 were retrospectively analyzed and compared.The ICA-PCoA bifurcation apex was termed P_(0),and the points located at the upstream of ICA,and 3 and 5 mm away from P_(0) were named P_(Up3) and P_(Up5),respectively.The corresponding points located at the downstream were termed P_(Dw3) and P_(Dw5),respectively.The diameter and cross section area of upstream(D Up and S Up)and downstream(D_(Dw) and S Dw)of ICA,the tortuosity from upstream to downstream(T_((Up+Dw)3) and T_((Up+Dw)5),respectively),from P_(0) to P_(Up3) and P_(Up5)(T_(Up3) and T Up5,respectively)and to P_(Dw3) and P_(Dw5)(T_(Dw3) and T_(Dw5),respectively)were measured based on the centerlines.Multivariate logistic regression and receiver operator characteristic(ROC)analysis were performed to identify the factors that associated with PCoA aneurysm presence and their predictive value.Seven vascular models with different tortuosity were designed to simulate the P_(0) and its upstream and downstream of ICA segments,and to analyze the relationship between tortuosity and hemodynamic stresses based on the computational fluid dynamics(CFD).ResultsFemale and primary hypertension ratios,T_((Up+Dw)3),T_((Up+Dw)5),T_(Up3),T_(Dw3) and T_(Dw5) of aneurysm group were significantly larger than control group(all P<0.05).The multivariate logistic regression analysis revealed that the female(OR=5.54,95%CI:2.20-13.50,P<0.001)and T_((Up+Dw)3)(OR=5.42,95%CI:2.24-13.13,P<0.001)were risk factors for the pres

关 键 词：颅内动脉瘤 血流动力学 后交通动脉 颈内动脉 曲度 

分 类 号：R74[医药卫生—神经病学与精神病学]