基底尖动脉瘤破裂的相关因素分析  

Analysis of relevant factors for rupture of basilar tip aneurysms

作　　者：葛润泽 冯欣 黄驰 黄梦诗 黄际万 李灿 苏世星[1] 张炘[1] 李西锋[1] 段传志[1] Ge Runze;Feng Xin;Huang Chi;Huang Mengshi;Huang Jiwan;Li Can;Su Shixing;Zhang Xin;Li Xifeng;Duan Chuanzhi(Department of Cerebrovascular Disease Surgery,Zhujiang Hospital of Southern Medical University,National Clinical Key Specialty,Engineering Research Center of Cerebrovascular Disease Diagnosis and Treatment of Ministry of Education,Key Laboratory of Brain Function Repair and Regeneration of Guangdong Ordinary Colleges and Universities,Guangdong Institute of Neurosurgery,Guangzhou 510282,China)

机构地区：[1]南方医科大学珠江医院神经外科中心脑血管病外科、国家临床重点专科、脑血管病诊断与治疗教育部工程研究中心、广东省普通高校脑功能修复与再生重点实验室、广东神经外科研究所,广州510282

出　　处：《中华外科杂志》2025年第3期227-232,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(82201427);国家卫生健康委能力建设和继续教育中心课题(CWJJ2022100102);广州市科技计划项目(2023A04J2426)。

摘　　要：目的探讨基底尖动脉瘤破裂的相关因素。方法本研究为回顾性队列研究。回顾性收集2008年7月到2023年2月于南方医科大学珠江医院接受脑血管数字减影造影检查并证实为基底尖动脉瘤的101例患者的临床及影像学资料。男性45例,女性56例,年龄(57.5±10.2)岁(范围:36~76岁);基底尖动脉瘤最大径[M(IQR)]为6.85(5.79)mm(范围:1.28~27.48 mm)。依据基底尖动脉瘤是否发生破裂将患者分为破裂组(37例,36.6%)和未破裂组(64例,63.4%)。收集并比较患者的一般资料、动脉瘤及载瘤动脉的形态学数据。采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法对数据进行分析,并通过Logistic回归分析探讨基底尖动脉瘤破裂的相关因素。采用方差膨胀因子法进行共线性分析。结果单因素分析结果显示,破裂组与未破裂组患者的瘤颈宽度、基底动脉直径、平均载瘤动脉直径、瘤颈宽度与平均载瘤动脉直径之比(NRP)、动脉瘤宽度、动脉瘤最大径的差异均有统计学意义(P值均<0.05)。多因素分析结果显示,基底动脉直径(OR=0.347,95%CI:0.176~0.687,P=0.002)、NRP(OR=0.366,95%CI:0.192~0.696,P=0.002)是基底尖动脉瘤发生破裂的独立相关因素。共线性分析中,NRP和基底动脉直径之间没有多重共线性(VIF=1)。结论基底动脉直径和NRP是基底尖动脉瘤发生破裂的独立相关因素。基底动脉直径和NRP越小,基底尖动脉瘤破裂的风险越高。ObjectiveTo investigate the relevant factors for rupture of basilar tip aneurysms.MethodsThis is a retrospective cohort study.Patients who underwent cerebrovascular digital subtraction angiography at Department of Cerebrovascular Disease Surgery,Zhujiang Hospital of Southern Medical University from July 2008 to February 2023 and were confirmed to have basilar tip aneurysms were retrospectively analyzed.There were 45 males and 56 females,aged(57.5±10.2)years(range:36 to 76 years);the maximum diameter of the basilar tip aneurysm(M(IQR))was 6.85(5.79)mm(range:1.28 to 27.48 mm).Finally,101 basilar tip aneurysms were included,and divided into two groups based on whether the basilar tip aneurysm ruptured or not.There were 37 cases(36.6%)in the ruptured group and 64 cases(63.4%)in the unruptured group.Data were analyzed using independent t-test,Mann-Whitney U test,chi-square test,or Fisher′s exact test,as appropriate,and predictive factors for rupture of basilar tip aneurysms were explored by Logistic regression analysis.Variance inflation factors was used for analysis of collinearity.ResultsThe univariate results showed statistically significant differences between the ruptured and unruptured groups in terms of aneurysm neck width,basilar artery diameter,mean diameter of the parental artery,the ratio of neck width to parent artery diameter,aneurysm width and maximum diameter of the aneurysm(all P<0.05).In multivariate analysis,basilar artery diameter(OR=0.347,95%CI:0.176 to 0.687,P=0.002),and NRP(OR=0.366,95%CI:0.192 to 0.696,P=0.002)were predictive factors for rupture of aneurysms occurring at the basilar tip.There was no multiple covariance between NRP and basilar artery diameter in the analysis of covariance(VIF=1).ConclusionSmaller basilar artery diameter and smaller NRP are relevant factors for rupture of basilar tip aneurysms.

关 键 词：颅内动脉瘤 基底动脉 破裂基底尖动脉瘤 基底动脉直径 NRP 相关因素 

分 类 号：R65[医药卫生—外科学]