脑动脉狭窄伴未破裂颅内动脉瘤的临床特征分析

Clinical features of cerebral artery stenosis with unruptured intracranial aneurysms

摘要:

目的 分析脑动脉狭窄伴或不伴未破裂颅内动脉瘤的患者临床特征的差异。方法 回顾性收集西安交通大学第二附属医院神经内科2018年1月至2019 年12月进行数字减影血管造影检查确诊的脑动脉狭窄患者的资料。根据患者是否伴未破裂颅内动脉瘤，分为病例组（伴未破裂颅内动脉瘤）和对照组（仅存在动脉狭窄），并对2组患者的临床特征进行比较。结果 共纳入了877例脑动脉狭窄患者，其中病例组76例（8.7%）。2组高血压病史、甘油三酯、高密度脂蛋白、颅内动脉狭窄等指标的比较差异具有统计学意义（P<0.05）。2组血管炎症指标（中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值、单核细胞/淋巴细胞比值、单核细胞与高密度脂蛋白比值）水平的比较差异无统计学意义（P>0.05）。病例组中动脉瘤平均大小为（3.18±1.66）mm，常位于颈内动脉，以狭窄后动脉瘤最多见。多因素Logistic回归分析显示高血压（P=0.014）和颅内动脉狭窄（P=0.028）是脑动脉狭窄患者中出现未破裂颅内动脉瘤的危险因素。结论 患有高血压的颅内动脉狭窄患者更容易出现未破裂颅内动脉瘤。较小且无症状的未破裂颅内动脉瘤不会引起显著的炎症反应。

Abstract:

Objective To investigate the differences in clinical features between the cerebral artery stenosis patients with or without unruptured intracranial aneurysms.Methods A retrospective analysis was performed for the data of patients who were diagnosed with cerebral artery stenosis by digital subtraction angiography in the Department of Neurology， The Second Affiliated Hospital of Xi'an Jiaotong University， from January 2018 to December 2019. According to the presence or absence of unruptured intracranial aneurysms， the patients were divided into case group （with unruptured intracranial aneurysms） and control group （without unruptured intracranial aneurysms）， and clinical features were compared between the two groups.Results A total of 877 patients with cerebral artery stenosis were enrolled， among whom 76 patients （8.7%） were enrolled in the case group. There were significant differences between the two groups in hypertension history， triglyceride， high-density lipoprotein， and intracranial artery stenosis （P<0.05）. There were no significant differences between the two groups in vascular inflammatory markers （neutrophil-to-lymphocyte ratio， platelet-to-lymphocyte ratio， monocyte-to-lymphocyte ratio， and monocyte-high-density lipoprotein ratio）（P>0.05）. The mean diameter of aneurysms was （3.18±1.66） mm in the case group， and most aneurysms were located in the internal carotid artery， with post-stenosis aneurysms as the most common type. The multivariate Logistic regression analysis showed that hypertension （P=0.014） and intracranial artery stenosis （P=0.028） were risk factors for unruptured intracranial aneurysms in patients with cerebral artery stenosis.Conclusions Hypertensive patients with intracranial arterial stenosis are more likely to develop unruptured intracranial aneurysms， and small and asymptomatic unruptured intracranial aneurysms do not cause significant inflammatory response.