论文部分内容阅读
目的探讨颅内动脉瘤破裂的危险因素。方法收集4所三甲医院2008-01~2014-03经手术或CTA诊断为动脉瘤的2 361例患者(2 674个动脉瘤)。依据CT平扫时蛛网膜下隙出血类型或者手术结果将动脉瘤二分为破裂组和未破裂组。纳入研究的镜像动脉瘤形态学参数包括瘤颈宽度、瘤体大小及形状、瘤体深度与瘤颈宽度的比值(aspect ratio,AR)、瘤体深度与载瘤动脉直径的比值(size ratio,SR)、高度瘤体之比(height-width ratio,HWR)、动脉瘤面积与瘤颈处载瘤动脉面积的比值(area ratio)。采用单变量和多变量条件Logistic回归分析动脉瘤破裂的独立危险因素。结果本研究共纳入34例镜像动脉瘤患者(29例女性),平均年龄为(62.2±10.2)岁。单变量统计分析显示动脉瘤的大小,AR,SR,面积比值和不规则的瘤壁在破裂组和未破裂组中具有显著差异。以不规则的瘤壁作为调节变量,多变量分析显示动脉瘤的大小≥4.55 mm(AOR 9.233,95%CI 2.023-42.144),AR≥1.114(AOR 8.438,95%CI 1.730-41.160),SR≥1.869(AOR 16.709,95%CI 2.112-132.200)和面积比≥1.531(AOR 34.722,95%CI 2.503-481.649)是动脉瘤破裂的重要预测因素。结论动脉瘤的大小≥4.55 mm,AR≥1.114,SR≥1.869和面积比≥1.531是独立于不规则瘤壁和人口学特征的破裂危险因素。这些动脉瘤的形态学参数在评估、预测、预防动脉瘤破裂风险中具有一定的价值。
Objective To investigate the risk factors of ruptured intracranial aneurysms. Methods Totally 2 361 patients (2 674 aneurysms) diagnosed as aneurysms by surgery or CTA were enrolled in 4 top-three hospitals from January 2008 to March 2014. Aneurysm was divided into rupture group and non-rupture group according to the type of subarachnoid hemorrhage or the result of CT scan. The morphological parameters of the aneurysm studied included the width of the tumor, the size and shape of the tumor, the ratio of the depth of the tumor to the width of the tumor (AR), the ratio of the depth of the tumor to the diameter of the parent artery (size ratio, SR), height-width ratio (HWR), aneurysm area and tumor neck area. Univariate and multivariate conditional Logistic regression analysis of aneurysm rupture of independent risk factors. Results A total of 34 patients with MIRA (29 women) were included in this study, with an average age of (62.2 ± 10.2) years. Univariate statistical analysis showed that aneurysm size, AR, SR, area ratio, and irregular wall were significantly different between ruptured and ruptured groups. Multivariate analysis showed aneurysm size ≥4.55 mm (AOR 9.233, 95% CI 2.023-42.144), AR ≥1.114 (AOR 8.438, 95% CI 1.730-41.160), and SR≥ 1.869 (AOR 16.709, 95% CI 2.112-132.200) and area ratio ≧ 1.531 (AOR 34.722, 95% CI 2.503-481.649) are important predictors of aneurysm rupture. Conclusions The size of aneurysm≥4.55 mm, AR≥1.114, SR≥1.869 and area ratio≥1.531 are the risk factors of rupture independent of irregular tumor wall and demography. The morphological parameters of these aneurysms in the assessment, prediction, prevention of aneurysm rupture risk has a certain value.