颅内动脉瘤的大小和部位与破裂的关系

Relationship between the size and location of intracranial aneurysms and the risk of rupture

目的探讨颅内动脉瘤的基本特征、大小和部位与动脉瘤破裂出血的关系。方法回顾性分析698例颅内动脉瘤患者的临床及脑血管造影资料,包括性别、年龄、Hunt-Hess分级、破裂诱因、Fisher分级、动脉瘤大小、部位等。结果①698例平均发病年龄为53岁,男女比例为1:1.21,其中557例发生破裂出血,21.0%(117/557)存在破裂诱因;141例未破裂。多发性动脉瘤比例为13.8%(96/698),大部分位于同侧的颈内动脉或对称的镜像部位。②共有动脉瘤814个。764个囊状动脉瘤中,破裂的有539个(最大径的中位数为5.63 mm,范围1.39～32.04 mm);未破裂的有225个(最大径的中位数为4.46 mm,范围1.30～44.88 mm)。在囊状破裂动脉瘤中,5.2%(28/539)≤2.5 mm,42.7%(230/539)≤5 mm,70.3%(379/539)≤7 mm,90.2%(486/539)≤10 mm;体颈比≥1.5者破裂比例较高(P<0.001);相对于瘤径≤5 mm组,>5～10 mm组破裂发生的危险明显增加(OR=2.83,95%CI:1.95～4.10),而>15～25 mm组(OR=0.29,95%CI:0.13～0.64)和>25 mm组(OR=0.14,95%CI:0.04～0.50)危险性降低。③在破裂动脉瘤中,以前交通动脉动脉瘤最为常见(35.2%,190/539),其次为后交通动脉动脉瘤(29.3%,158/539)、大脑中动脉瘤(12.1%,65/539);而在未破裂动脉瘤中,以眼动脉段最为常见(31.6%,71/225),其次为后交通动脉(24.4%,55/225)和颈内动脉硬膜外段(19.1%,43/225)。以后交通动脉动脉瘤的破裂发生为基准,前交通动脉动脉瘤发生破裂的危险较高(OR=7.35,95% CI:3.52～15.34),而眼动脉段(OR=0.15,95%CI:0.09～0.25)和颈内动脉硬膜外段(OR=0.02,95%CI:0.00～0.07)动脉瘤的破裂危险较低。结论位于前交通动脉、直径>5～10mm、体颈比≥1.5的动脉瘤更容易破裂出血;而位于颈内动脉硬膜外段或眼动脉段、直径≤2.5mm、无瘤颈或体颈比<1.5的动脉瘤出血概率较低。

Objective To investigate the relationship between the size and location of intracranial aneurysm and the risk of rupture. Methods The clinical and cerebral angiography data of 698 patients with intracranial aneurysm including sex and age of the patients, Hunt-Hess grading, inducing factors of rupture, Fishers grading, size and location of aneurysms were analyzed retrospectively. Results ① The mean age of onset of symptoms in 698 patients was 53 years （ male ： female ratio 1 ： 1.21 ）. Of those, the aneurysms of 557 patients were ruptured, and 141 did not ruptured; 21.0% of patients （117/557） had inducement of rupture. The proportion of muhiple aneurysms was 13.8% （96/698） , and most of them were situated in the ipsilateral internal carotid artery or the symmetrical mirror sites. ②There were a total of 814 aneurysms in 698 patients. Of the 764 saccular aneurysms, 539 were ruptured （ median maximum diameter 5.63 mm, range 1.39 to 32.04 ram）; 225 aneurysms did not ruptured （median maximum diameter 4.46 mm, range 1.30 to 44. 88 ram）; of the ruptured aneurysms, 5.2% （28/539） was ≤2.5 mm, 42.7% （230/539） was ≤5 mm, 70.3% （379/539） was ≤7 mm, and 90.2% （486/539） was ≤10 mm. The rupture rate of aneurysms with body/neck ratio i〉 1.5 was higher （ P 〈 0. 001 ） ; The risk of rupture increased significantly in the 5 - 10 him group （OR =2. 83; 95% CI, 1.95 -4. 10） , and the risk of rupture in the 15 -25 mm group （OR =0. 29; 95% CI, 0. 13 -0. 64） and in the 〉25 mm group（OR = 0. 14; 95% CI, O. 04 -0. 50） decreased compared to the aneurysm diameter ≤5 mm group. ③Among the ruptured aneurysms, anterior communicating artery aneurysm was most common （35.3%, 190/539）, then posterior communicating artery aneurysm （29.3%, 158/539）, and middle cerebral artery aneurysm （12. 1% , 65/539） ; and among the unruptured aneurysms, the ophthalmic artery segment aneurysms was most common （31.6%, 71/225）, then posterior communicating artery aneurysms（24. 4%, 55/225）, and the extradural segment of internal carotid artery aneurysms （19. 1%, 43/225 ）; the occurrence of posterior communicating artery aneurysm rupture was used as a benchmark, the risk of anterior communicating artery aneurysm rupture was higher （ OR =7. 35 ; 95% CI, 3.52 - 15.34） , and the risk of aneurysm rupture of the ophthalmic artery segment （ OR = 0.15 ; 95 % CI, 0. 09 - 0. 25 ） and the extradural segment of internal carotid artery （ICA） （OR=0.02; 95% CI, 0.00-0.07） were lower. Conclusions The aneurysms located in anterior communicating artery, with 5 -10 mm in diameter, and body/neck ratio ≥ 1.5 are more likely to rupture ; whereas the probability of aneurysm bleeding in the extradural segment of internal carotid artery or ophthalmic artery segment, and ≤2. 5 mn in diameter, no aneurysm neck or body/neck ratio 〈 1.5 was lower.