脑动静脉畸形合并出血相关影响因素分析

Correlated factors of bleeding in patients with cerebral arteriovenous malformation

目的通过全脑DSA造影检测脑动静脉畸形血管构筑特征，分析探讨脑动静脉畸形合并出血的相关影响因素。方法回顾性分析珠江医院神经外科收治的199例脑动静脉畸形患者的影像学资料，其中出血组107例，非出血组92例。采用单因素和多因素Logistic回归分析方法，分析畸形血管团大小、位置，供血动脉数目、位置，引流静脉数目、引流方向，合并动脉瘤数目、大小、与动脉瘤的位置关系，有无合并瘤样改变等因素与畸形血管团破裂出血的关系。结果单因素分析表明微型（0．5～1．0cm）和小型（1．0-2．0cm）畸形血管团、深部畸形血管团、深部供血动脉、1～2支引流静脉、深部引流静脉、合并多个动脉瘤、合并小动脉瘤（〈5mm）和位于供血动脉端动脉瘤是畸形血管团破裂出血的危险因素，合并瘤样变则降低出血的风险，供血动脉数目与出血无关。多因素Logistic回归分析发现畸形血管团破裂出血独立危险因素是微型和小型畸形血管团，深部引流静脉及合并供血动脉端动脉瘤。结论微型、小型畸形血管团，深部引流静脉，供血动脉端动脉瘤与畸形血管团破裂出血密切相关。

Objective To explore the influencing factors of bleeding in patients with cerebral arteriovenous malformation （AVM） through observing the angioarchitecture of AVM with cerebral DSA. Methods The clinical and imaging data of 199 patients with AVM, including 107 with bleeding and 92 without bleeding, were retrospectively analyzed. The relationships between bleeding and such factors as the site and size of masses, the type and site of supplying arteries, the number and pathway of venous drainage, having vascular tumor-like changes or not, the relation between AVM and aneurysm in terms of location, and the number and size of concurrent aneurysms were determined by univariate analyses and Binary logistic regression with SPSS13.0. Results Univariate analysis indicated that such factors as micro-sized （0.5-1.0 cm） and small-sized （1.0-2.0 cm） masses ofAVM, AVM under deep location, having exclusively deep draining veins, fewer draining veins and deep feeding arteries, concurrent small aneurysms （〈5 mm）, aneurysms at the end of the blood-supply artery were positively correlated to hemorrhagic presentation. The number of feeding arteries and the number of concurrent aneurysms were not correlated with hemorrhagic presentation. Having vascular tumor-like changes can decreased the risk of bleeding. When stepwise multiple logistic regression analysis was employed, only micro-sized and small-sized masses of AVM, having deep feeding arteries, and aneurysms at the end of the blood-supply artery were dependent predictors of hemorrhagic presentation. Conclusion Micro-sized and small-sized masses of AVM, having deep draining veins and aneurysms at the end of the blood-supply artery are the most powerful risk predictors for hemorrhagic AVM presentation.