后交通段动脉瘤破裂的危险因素分析及预测模型的建立

Analysis of risk factors of posterior communicating segment aneurysm rupture and establishment of prediction model

目的分析后交通段动脉瘤破裂的危险因素,并建立预测模型。方法选取枣庄市立医院神经外科2017年7月—2019年12月诊治的后交通段动脉瘤患者,分为破裂组及未破裂组。测量入组动脉瘤的形态学参数,包括瘤体直径(D)、纵横比(AR)、尺寸比(SR)、体颈比(DN),入射角(IA)及瓶颈指数(BN)。统计血流动力学参数,包括低壁面切应力面积(LSA)、剪切振荡指数(OSI)和归一化壁面切应力(NWSS)。对两组动脉瘤的基础资料、形态学及血流动力学参数进行单因素分析,将有显著性差异的参数进行受试者工作特征曲线(ROC)分析,对有统计学意义的参数行多因素logistic回归分析其内在关联,建立风险评估的回归方程,比较各方程曲线下面积(AUC)。结果共纳入后交通段动脉瘤124处,其中破裂组84处,未破裂组40处。单因素分析结果显示,两组基础资料无统计学差异(P>0.05),形态学参数D、AR、SR、DN、IA差异有统计学意义(P<0.05);血流动力学参数NWSS及LSA差异有统计学意义(P<0.05)。对上述参数进行logistic回归分析建立方程,形态学:ln(R/1-R)=0.334D+0.279IA-2.252;血流动力学:ln(R/1-R)=-0.238NWSS+1.805;联合:ln(R/1-R)=0.431IA-0.329LSA-2.107,R为破裂发生率。AUC形态学0.757,血流动力学0.659,联合0.773,与0.5比较均有统计学意义(P≤0.05)。结论后交通段动脉瘤的破裂与形态学及血流动力学相关,通过形态学与血流动力学分析建立logistic回归预测模型可为医务人员提供诊断和决策依据。

Objective To analyze the risk factors of rupture of posterior communicating segment aneurysms and establish a prediction model.Methods Patients with posterior communicating segment aneurysms from 2017 to 2019 were divided into ruptured group and unruptured group.Morphological parameters including diameter(D),aspect ratio(AR),size ratio(SR),body neck ratio(DN),incidence angle(IA)and bottleneck index(BN)were measured.The hemodynamic parameters including low wall shear stress area(LSA),shear oscillation index(OSI)and normalized wall shear stress(nwss)were analyzed.The basic data,morphological and hemodynamic parameters of the two groups were analyzed by univariate analysis.The parameters with significant differences were analyzed by receiver operating characteristic curve(ROC).The multivariate logistic regression analysis was used to analyze the internal correlation of the parameters with statistical significance.The regression equation of risk assessment was established and the area under the curve(AUC)of each equation was compared.Results A total of 124 posterior communicating segment aneurysms were included,including 84 ruptured aneurysms and 40 unruptured aneurysms.Univariate analysis showed that there was no significant difference in basic data between the two groups(P>0.05),but there was significant difference in morphological parameters D,AR,Sr,DN and IA between the two groups(P<0.05);There were significant differences in hemodynamic parameters of nwss and LSA(P<0.05).Logistic regression analysis was used to establish the equation.ln(R/1-R)=0.334 D+0.279 IA-2.252;Hemodynamics:ln(R/1-R)=-0.238 NWSS+1.805;Combined:ln(R/1-R)=0.431 IA-0.329 LSA-2.107,R is the rupture rate.AUC morphology 0.757,hemodynamics 0.659,combined 0.773,compared with 0.5 were statistically significant(P≤0.05).Conclusion The rupture of posterior communicating segment aneurysms is related to morphology and hemodynamics.The establishment of logistic regression prediction model based on morphology and hemodynamics analysis can provide diagnosis and decision-making basis for medical staff.