破裂动静脉畸形脑出血量相关因素分析

Factors for the volume of cerebral hemorrhage due to ruptured brain arteriovenous malformation

摘要:

目的 筛选与脑动静脉畸形（brain arteriovenous malformation，BAVM）破裂后出血量相关的因素，为治疗策略制定提供参考。方法 回顾性分析2014年1月至2016年6月就诊于中南大学湘雅医院神经外科的破裂BAVM患者，采用改良Rankin量表评价出血后的预后，应用线性回归筛选与出血量相关的因素。结果 入组106例患者，26例病变位于后颅窝，57例位于脑室周围。后颅窝、非后颅窝BAVM平均出血量分别为8.81±5.12ml及15.00±10.00ml，脑室周围、非脑室周围BAVM平均出血量分别为15.28±8.78ml及10.00±14.00ml，多因素线性回归提示后颅窝（P=0.002）、脑室周围（P=0.04）病变与出血量相关联，卡方检验提示后颅窝（P=0.041）及脑室周围（P=0.042）病变出血后预后更差。结论 脑室周围BAVM破裂出血量较多，后颅窝病变破裂出血量较少，两者出血后预后均更差，可用于指导未破裂患者治疗的选择。

Abstract:

Objective To investigate the factors for intracerebral hemorrhage (ICH) volume after rupture of brain arteriovenous malformation (BAVM), and to provide a reference for developing therapeutic strategies.Methods A retrospective analysis was performed for the clinical data of patients with ruptured BAVM who visited Department of Neurosurgery, Xiangya Hospital of Central South University, from January 2014 to June 2016. The modified Rankin Scale (mRS) was used to evaluate prognosis after ICH, and a linear regression analysis was used to screen out the factors associated with ICH volume.Results A total of 106 patients were enrolled, among whom 26 had lesions in the posterior cranial fossa and 57 had lesions in the periventricular region. The mean volumes of hemorrhage due to BAVM in the posterior cranial fossa and other regions were 8.81±5.12 ml and 15.00±10.00 ml, respectively, and the mean volumes of hemorrhage due to BAVM in the periventricular region and the non-periventricular region were 15.28±8.78 ml and 10.00±14.00 ml, respectively. The multivariate linear regression analysis showed that lesion in the posterior cranial fossa (P=0.002) and lesion in the periventricular region (P=0.04) were associated with ICH volume, and the chi-square test showed that patients with ICH due to lesions in the posterior cranial fossa and the periventricular region had poorer prognosis (P=0.041 and 0.042, respectively).Conclusions Ruptured BAVM in the periventricular region causes a higher ICH volume than that in the posterior cranial fossa, and patients with ICH due to ruptured BAVM in these two regions tend to have poor prognosis, which can be used to guide the treatment of patients with unruptured BAVM.