脑动静脉畸形破裂出血影响因素分析

Analysis of influencing factors of cerebral arteriovenous malformation rupture and bleeding

目的脑出血为脑动静脉畸形患者最为严重的一种并发症,具有较高的致残率及病死率。本研究分析脑动静脉畸形破裂出血影响因素,为脑动静脉畸形破裂出血临床评估及治疗提供参考依据。方法选取南阳市第一人民医院2018-03-01-2019-06-30收治的80例脑动静脉畸形患者为研究对象,通过自行设计的一般调查问卷收集患者临床资料。通过影像学陈旧性出血证据和病理学含铁血黄素普鲁士蓝染色,判断患者是否合并静息态病灶内微出血。将其中存在影像学陈旧性出血证据即存在脑动静脉畸形破裂出血的39例患者作为病例组,无脑动静脉畸形破裂出血的42例患者作为对照组。通过多因素Logistic回归分析法分析脑动静脉畸形患者破裂出血影响因素。结果病例组血管团破裂出血例数为34例,高于对照组的19例,χ2=17.459,P<0.001;病例组多支供血动脉例数为7例,低于对照组的22例,χ2=9.956,P=0.001;普鲁士蓝染色阳性例数为36例,高于对照组的14例,χ2=32.092,P<0.001。Logistic回归分析结果显示,供血动脉数量(OR=0.265,95%CI为0.089~0.792,P=0.018)、深静脉引流(OR=6.196,95%CI为2.845~17.496,P<0.001)、陈旧性出血(OR=3.864,95%CI为1.658~9.014,P=0.014)、普鲁士蓝染色(OR=5.112,95%CI为1.983~13.052,P=0.006)是脑动静脉畸形患者破裂出血影响因素。结论供血动脉数量多、深静脉引流、陈旧性出血、普鲁士蓝染色阳性患者更容易发生脑动静脉急性破裂出血。

OBJECTIVE Cerebral hemorrhage is the most serious complication of patients with cerebral arteriovenous malformations,and it has a higher morbidity and mortality.This study analyzes the influencing factors of patients with ruptured cerebral arteriovenous malformation and provides a reference for clinical evaluation and treatment of ruptured cerebral arteriovenous malformation.METHODS A total of 80 patients with cerebral arteriovenous malformations admitted to Nanyang First People’s Hospital from March 1,2018 to June 30,2018 were selected as the research object,and the clinical data of patients were collected through a self-designed general questionnaire.Based on the old imaging bleeding evidence and the pathological hemosiderin Prussian blue staining,it was determined whether the patient had microbleeds in the resting lesion.39 cases with an evidence of old imaging bleeding,that was rupture of cerebral arteriovenous malformation were used as the case group,and 42 patients without cerebral arteriovenous malformation and bleeding were the control group.Multifactor logistic regression analysis was used to analyze the influencing factors of rupture and bleeding in patients with cerebral arteriovenous malformation.RESULTS The number of cases of vascular mass rupture and bleeding in the case group was 34,which was higher than that of the control group(19 cases),χ~2=17.459,P<0.001.The number of cases of multiple blood supply arteries in the case group was 7 cases,which was lower than that of the control group(22 cases),χ~2=9.956,P=0.001.The number of positive cases of Prussian blue staining was 36,which was higher than that of the control group(14 cases),χ~2=32.092,P<0.001.Logistic regression analysis showed that the number of blood supply arteries(OR=0.265,95%CI:0.08-0.792,P=0.018),deep venous drainage(OR=6.196,95%CI:2.84-17.496,P<0.001),hemorrhage(OR=3.864,95%CI:1.658-9.014,P=0.014),Prussian blue staining(OR=5.112,95%CI:1.893-13.052,P=0.006)were the influencing factors of rupture and bleeding in patients with cerebral arteriovenous malformations.CONCLUSION Patients with a large number of blood supply arteries,deep vein drainage,old bleeding,and positive Prussian blue staining were more prone to acute cerebral arteriovenous bleeding.