颅内动脉瘤%动脉瘤,破裂%蛛网膜下腔出血%危险因素
顱內動脈瘤%動脈瘤,破裂%蛛網膜下腔齣血%危險因素
로내동맥류%동맥류,파렬%주망막하강출혈%위험인소
Intracranial Aneurysm%Aneurysm,Ruptured%Subarachnoid Hemorrhage%Risk Factors
目的 探讨颅内动脉瘤破裂的危险因素,为颅内动脉瘤的临床决策提供依据.方法 回顾性收集颅内动脉瘤患者的人口统计学和临床资料.三维脑血管造影确定动脉瘤的部位、形态、是否存在子囊,测量瘤体长度、最大直径和瘤颈宽度,并计算瘤体长度与瘤颈宽度之比(aspect ratio,AR).结果 共纳入243例患者(289个动脉瘤),其中破裂组149例(171个动脉瘤),未破裂组94例(118个动脉瘤).破裂组女性(71.1％对51.1％;x2=12.13,P＜ 0.01)、高血压(57.7％对38.3％；x2=8.69,P=0.003)、吸烟(53.0％对39.5％; x2=4.12,P=0.045)、动脉瘤存在子囊(63.7％对39.8％；x2=16.07,P＜0.01)以及最大直径＞5 mm(80.7％对66.9％；x2 =7.06,P＜0.01)比例显著高于未破裂组,而最大直径＞ 10 mm(31.6％对52.5％；x2=12.77,P＜0.01)比例显著低于未破裂组；破裂组动脉瘤最大直径小于未破裂组[(8.68 ±5.79)mm对(10.67±5.78)mm;t=-2.91,P=0.004],而瘤体长[(8.27±4.19)mm对(6.94±4.77) mm;t=2.50,P=0.013]和AR[(2.32±1.18)对(1.42± 1.21)；=6.34,P＜0.01]长于和高于未破裂组.在289个动脉瘤中,前交通动脉瘤103个,后交通动脉瘤84个,大脑中动脉动脉瘤56个,大脑前动脉动脉瘤12个,颈内动脉动脉瘤9个,基底动脉动脉瘤25个,不同部位颅内动脉瘤破裂发生率(分别为63.1％、79.8％、41.1％、33.3％、33.3％和36.0％,P＜0.01)存在显著差异.多变量logistic回归分析显示,女性[优势比(odds ratio,OR)6.311,95％可信区间(confidence interval,CI)3.673 ～ 10.844;P＜0.01]、存在子囊(OR2.789,95％ CI 1.624 ～4.792；P＜0.01)以及最大直径＞5mm(OR 1.866,95％ CI 1.012～3.437；P=0.046)为颅内动脉瘤破裂的独立危险因素.结论 女性动脉瘤患者发生率和破裂率均高于男性,高血压、吸烟史、存在子囊、动脉瘤部位、动脉瘤最大直径、瘤体长度以及AR均是影响颅内动脉瘤破裂的因素,其中女性、存在子囊和最大直径＞5 mm是独立危险因素.
目的 探討顱內動脈瘤破裂的危險因素,為顱內動脈瘤的臨床決策提供依據.方法 迴顧性收集顱內動脈瘤患者的人口統計學和臨床資料.三維腦血管造影確定動脈瘤的部位、形態、是否存在子囊,測量瘤體長度、最大直徑和瘤頸寬度,併計算瘤體長度與瘤頸寬度之比(aspect ratio,AR).結果 共納入243例患者(289箇動脈瘤),其中破裂組149例(171箇動脈瘤),未破裂組94例(118箇動脈瘤).破裂組女性(71.1％對51.1％;x2=12.13,P＜ 0.01)、高血壓(57.7％對38.3％；x2=8.69,P=0.003)、吸煙(53.0％對39.5％; x2=4.12,P=0.045)、動脈瘤存在子囊(63.7％對39.8％；x2=16.07,P＜0.01)以及最大直徑＞5 mm(80.7％對66.9％；x2 =7.06,P＜0.01)比例顯著高于未破裂組,而最大直徑＞ 10 mm(31.6％對52.5％；x2=12.77,P＜0.01)比例顯著低于未破裂組；破裂組動脈瘤最大直徑小于未破裂組[(8.68 ±5.79)mm對(10.67±5.78)mm;t=-2.91,P=0.004],而瘤體長[(8.27±4.19)mm對(6.94±4.77) mm;t=2.50,P=0.013]和AR[(2.32±1.18)對(1.42± 1.21)；=6.34,P＜0.01]長于和高于未破裂組.在289箇動脈瘤中,前交通動脈瘤103箇,後交通動脈瘤84箇,大腦中動脈動脈瘤56箇,大腦前動脈動脈瘤12箇,頸內動脈動脈瘤9箇,基底動脈動脈瘤25箇,不同部位顱內動脈瘤破裂髮生率(分彆為63.1％、79.8％、41.1％、33.3％、33.3％和36.0％,P＜0.01)存在顯著差異.多變量logistic迴歸分析顯示,女性[優勢比(odds ratio,OR)6.311,95％可信區間(confidence interval,CI)3.673 ～ 10.844;P＜0.01]、存在子囊(OR2.789,95％ CI 1.624 ～4.792；P＜0.01)以及最大直徑＞5mm(OR 1.866,95％ CI 1.012～3.437；P=0.046)為顱內動脈瘤破裂的獨立危險因素.結論 女性動脈瘤患者髮生率和破裂率均高于男性,高血壓、吸煙史、存在子囊、動脈瘤部位、動脈瘤最大直徑、瘤體長度以及AR均是影響顱內動脈瘤破裂的因素,其中女性、存在子囊和最大直徑＞5 mm是獨立危險因素.
목적 탐토로내동맥류파렬적위험인소,위로내동맥류적림상결책제공의거.방법 회고성수집로내동맥류환자적인구통계학화림상자료.삼유뇌혈관조영학정동맥류적부위、형태、시부존재자낭,측량류체장도、최대직경화류경관도,병계산류체장도여류경관도지비(aspect ratio,AR).결과 공납입243례환자(289개동맥류),기중파렬조149례(171개동맥류),미파렬조94례(118개동맥류).파렬조녀성(71.1％대51.1％;x2=12.13,P＜ 0.01)、고혈압(57.7％대38.3％；x2=8.69,P=0.003)、흡연(53.0％대39.5％; x2=4.12,P=0.045)、동맥류존재자낭(63.7％대39.8％；x2=16.07,P＜0.01)이급최대직경＞5 mm(80.7％대66.9％；x2 =7.06,P＜0.01)비례현저고우미파렬조,이최대직경＞ 10 mm(31.6％대52.5％；x2=12.77,P＜0.01)비례현저저우미파렬조；파렬조동맥류최대직경소우미파렬조[(8.68 ±5.79)mm대(10.67±5.78)mm;t=-2.91,P=0.004],이류체장[(8.27±4.19)mm대(6.94±4.77) mm;t=2.50,P=0.013]화AR[(2.32±1.18)대(1.42± 1.21)；=6.34,P＜0.01]장우화고우미파렬조.재289개동맥류중,전교통동맥류103개,후교통동맥류84개,대뇌중동맥동맥류56개,대뇌전동맥동맥류12개,경내동맥동맥류9개,기저동맥동맥류25개,불동부위로내동맥류파렬발생솔(분별위63.1％、79.8％、41.1％、33.3％、33.3％화36.0％,P＜0.01)존재현저차이.다변량logistic회귀분석현시,녀성[우세비(odds ratio,OR)6.311,95％가신구간(confidence interval,CI)3.673 ～ 10.844;P＜0.01]、존재자낭(OR2.789,95％ CI 1.624 ～4.792；P＜0.01)이급최대직경＞5mm(OR 1.866,95％ CI 1.012～3.437；P=0.046)위로내동맥류파렬적독립위험인소.결론 녀성동맥류환자발생솔화파렬솔균고우남성,고혈압、흡연사、존재자낭、동맥류부위、동맥류최대직경、류체장도이급AR균시영향로내동맥류파렬적인소,기중녀성、존재자낭화최대직경＞5 mm시독립위험인소.
Objective To investigate the risk factors for ruptured intracranial aneurysms in order to provide the basis for the clinical decision-making of intracranial aneurysms.Methods The demographic and clinical data of the patients with intracranial aneurysm were collected retrospectively.Three-dimensional cerebral angiography was used to identify the aneurismal location and shape,existing ascus or not,aneurysm length,maximum diameter and neck width.The aspect ratio (AR) of aneurysm was calculated.Results A total of 243 patients with intracranial aneurysms (289 aneurysms) were included,149 patients(171 aneurysms) in the ruptured aneurysm group,94 patients (118 aneurysms) in the unruptured aneurysm group.The proportions of female (71.1％ vs.51.1％ ;x2 =12.13,P ＜ 0.01),hypertension (57.7％ vs.38.3％ ;x2 =8.69,P =0.003),smoking (53.0％ vs.39.5％ ; x2 =4.12,P =0.045),existing ascus (63.7％ vs.39.8％ ; x2 =16.07,P ＜0.01),and the maximum diameter ＞ 5 mm (80.7％ vs.66.9％ ;x2 =7.06,P ＜ 0.01) in the ruptured aneurysm group were significantly higher than those in the unruptured aneurysm group,while the proportion of the maximum diameter ＞ 10 mm (31.6％vs.52.5％ ;x2 =12.77,P ＜0.01) was significantly lower than that in the unruptured aneurysm group; the maximum diameter in the ruptured aneurysm group was less than that in the unruptured aneurysm group (8.68± 5.79 mm vs.10.67± 5.78 mm; t=-2.91,P=0.004),while the aneurysm length (8.27 ± 4.19 mm vs.6.94 ± 4.77 mm; t =2.50,P =0.013) and AR (2.32 ± 1.18 vs.1.42± 1.21; t =634,P ＜ 0.01) were significantly longer and higher than that in the unruptured aneurysm group,respectively.Of the 289 aneurysms,103 were anterior communicating artery aneurysms,84 were posterior communicating artery aneurysms,56 were middle cerebral artery aneurysms,12 were anterior cerebral artery aneurysms,9 were internal carotid artery aneurysms,and 25 were basilar artery aneurysms.There were significant differences in the rupture incidence of intracranial aneurysm at different locations (63.1％,79.8％,41.1％,33.3％,33.3％,and 36.0％,respectively; P ＜0.01).Multivariate logistic regression analysis showed that the female (odds ratio [OR],6.311,95％ confidence interval [OR]3.673-10.844; P ＜ 0.01),existing ascus (OR 2.789,95％ CI 1.624-4.792; P＜0.01),and maximum diameter ＞5 mm (OR 1.866,95％ CI 1.012-3.437; P =0.046) were the independent risk factors for ruptured intracranial aneurysms.Conclusions The incidence and rupture rate in women patients with intracranial aneurysm were higher than those in men.Hypertension,history of smoking existing ascus,aneurysm location,aneurysm maximum diameter,aneurysm length and AR were all the factors that impact ruptured intracranial aneurysms,in which women,existing ascus and the maximum diameter ＞5 mm were the independent risk factors.
