后交通动脉瘤破裂的临床及形态学危险因素分析

Clinical and morphological risk factors of posterior communicating aneurysm rupture

目的研究后交通动脉瘤破裂的临床及形态学的危险因素,指导临床进行干预。方法回顾性分析徐州医科大学附属医院2015年1月—2018年5月诊治的184例后交通动脉瘤患者的临床资料。将患者分为动脉瘤破裂组(破裂组,138例)及动脉瘤未破裂组(未破裂组,46例)。用单因素和多因素分析,分析两组患者的临床和形态学指标与动脉瘤破裂的关系。在未破裂组患者中,比较伴动眼神经麻痹(oculomotor nerve paralysis,ONP)与不伴动眼神经麻痹患者之间,临床及形态学指标上的差异。结果单因素分析显示,破裂组与未破裂组高血压病(χ^2=4.174,P=0.04)、瘤高/瘤颈(aspect ratio,AR)≥1.5(χ^2=8.575,P=0.003)、瘤顶指向后下外(χ^2=17.435,P=0.01)的比率比较,差异均有统计学意义。多因素分析显示,高血压病(OR=3.443,P=0.004)、AR≥1.5(OR=1.011,P=0.047)、瘤顶指向后下外(OR=5.704,P=0.016)是后交通动脉瘤破裂的独立的危险因素。在未破裂组中,伴ONP与不伴ONP患者之间比较,AR均值(t=9.433,P=0.003)和瘤顶指向后下外(χ^2=24.840,P=0.00)的差异有统计学意义。结论AR≥1.5、高血压病史、瘤顶指向后下外是后交通动脉瘤破裂的危险因素,AR较大及瘤顶指向后下外可能是伴动眼神经麻痹的后交通动脉瘤破裂风险较高的原因。

Objective To provide clinical interventions by studying the clinical and morphological risks of the posterior communicating aneurysm rupture.Methods Patients with posterior communicating artery aneurysm,hospitalized in the Affiliated Hospital of Xuzhou Medical University,were analyzed retrospectively.All cases were divided into two groups,i.e.the unruptured aneurysm group and the ruptured aneurysm group.The morphological and clinical features of each group were analyzed as well as their relationships with the danger of rupture.Furthermore,the unruptured group was divided into oculomotor nerve paralysis and without oculomotor nerve paralysis to compare the clinical and morphological characteristics and to detect the distinctions if any.Results In the ruptured and unruptured groups,univariate analysis showed that there were significant differences in hypertension(χ^2=4.174,P=0.04),aneurysm height/neck(aspect AR)≥1.5(χ^2=8.575,P=0.003),and the apex of the aneurysm points to the posterior-inferior-lateral(χ^2=17.435,P=0.01).Multivariate analysis showed that hypertension(OR=3.443,P=0.004)、AR≥1.5(OR=1.011,P=0.047)and the apex of the aneurysm pointing to the posterior and inferior(OR=5.704,P=0.016)were independent risks of the rupture of the posterior communicating aneurysm.In the unruptured group,the univariate analysis showed that the(t=9.433,P=0.00)and the apex of the aneurysm directed to posterior-inferior-lateral(χ^2=24.840,P=0.00)were significantly higher than those of the control group.Conclusions The ratio of AR≥1.5,history of hypertension and the apical direction of posterior communicating artery aneurysm(PCoAA)are the risk factors of the rupture of posterior communicating artery aneurysm.The high AR of PCoAA with oculomotor nerve paralysis and the apex of the aneurysm points to the posterior-inferior-lateral may contribute to the rupture.