颅内动脉瘤破裂的影响因素分析

An analysis of influencing factors for intracranial aneurysm rupture

摘要:

目的 研究颅内动脉瘤（intracranial aneurysm，IA）破裂的影响因素，为临床治疗方案的制定提供参考。方法 回顾性分析2017年1月至2017年12月期间湖南省长沙市湘雅医院收治的474名颅内动脉瘤患者的临床资料，使用单因素、多因素分析等方法对性别、年龄、多发性动脉瘤、既往患病史、吸烟、饮酒、形态学特征等颅内动脉瘤破裂的可能影响因素进行了分析。结果 多因素回归分析结果提示：单发动脉瘤以及既不吸烟也不饮酒人群常见于女性（OR=2.16，95%CI：1.40，3.34）、多发性动脉瘤（OR=2.18，95%CI：1.34，3.56）以及既往既吸烟又饮酒（OR=5.01，95%CI：1.96，12.83）人群是动脉瘤破裂的危险因素。动脉瘤形态学特征自身对照配对t检验分析：动脉瘤高度、动脉瘤横径、动脉瘤高度/横径、最大瘤颈、最小瘤颈、最小瘤颈/载瘤动脉直径、动脉瘤角度、存在子囊或分叶是动脉瘤破裂的危险因素。结论 综合各类可能影响动脉瘤破裂的因素，制定最佳治疗方案以保证患者的生命安全。

Abstract:

Objective To study the influencing factors for intracranial aneurysm (IA) rupture and to provide a reference for the development of clinical treatment strategies. Methods The clinical data of 474 patients with intracranial aneurysm admitted to Xiangya Hospital in Changsha, Hunan Province, from January to December, 2017 were retrospectively analyzed. The possible influencing factors for IA rupture, such as sex, age, multiple aneurysms, previous medical history, smoking, drinking, and morphological characteristics, were analyzed by univariate and multivariate analyses. Results Multivariate analysis showed that compared with males, patients with non-multiple aneurysms, and patients who neither smoked nor drank alcohol, female sex (odds ratio[OR]=2.16, 95% confidence interval[CI]:1.40-3.34), multiple aneurysms (OR=2.18, 95%CI:1.34-3.56), and previous smoking and drinking (OR=5.01, 95%CI:1.96-12.83) were risk factors for aneurysm rupture. However, additional univariate analysis for morphological characteristics suggested that aneurysm height, aneurysm transverse diameter, aneurysm height-to-transverse diameter ratio, maximum tumor neck, minimal tumor neck, minimum tumor neck-to-parent artery diameter ratio, aneurysm angle, and the presence of ascus or lobulation were risk factors for aneurysm rupture. Conclusions Hospitals should strengthen the observation of patients with high risk of IA rupture. Treatment strategies should be developed based on the multiple factors that may lead to aneurysm rupture to ensure the safety of patients.