颅内动脉瘤破裂的危险因素：回顾性病例系列研究

目的探讨颅内动脉瘤破裂的危险因素，为颅内动脉瘤的临床决策提供依据。方法回顾性收集颅内动脉瘤患者的人口统计学和临床资料。三维脑血管造影确定动脉瘤的部位、形态、是否存在子囊，测量瘤体长度、最大直径和瘤颈宽度，并计算瘤体长度与瘤颈宽度之比（aspectratio，AR）。结果共纳／k243例患者（289个动脉瘤），其中破裂组149例（171个动脉瘤），未破裂组94例（118个动脉瘤）。破裂组女性（71．1％对51．1％；x2=12．13，P〈0．01）、高血压（57．7％对38．3％；X2=8．69，P：0．003）、吸烟（53．0％对39．5％；X2=4．12，P=0．045）、动脉瘤存在子囊（63．7％对39．8％；x2=16．07，P〈0．01）以及最大直径〉5mm（80．7％对66．9％；x2=7．06，P〈0．01）比例显著高于未破裂组，而最大直径〉10toni（31．6％对52．5％；r=12．77，P〈0．01）比例显著低于未破裂组；破裂组动脉瘤最大直径小于未破裂组[（8．68±5．79）mln对（10．67±5．78）toni；t=-2．91，P=0．004]，而瘤体长[（8．27±4．19）mm对（6．94±4．77）mm；t=2．50，P=0．013]和AR[（2．32±1．18）对（1．42±1．21）；t=6．34，P〈0．01]长于和高于未破裂组。在289个动脉瘤中，前交通动脉瘤103个，后交通动脉瘤84个，大脑中动脉动脉瘤56个，大脑前动脉动脉瘤12个，颈内动脉动脉瘤9个，基底动脉动脉瘤25个，不同部位颅内动脉瘤破裂发生率（分别为63．1％、79．8％、41．1％、33．3％、33．3％和36．0％，P〈0．01）存在显著差异。多变量logistic回归分析显示，女性[优势比（oddsratio，OR）6．311，95％可信区间（confidenceinterval，CI）3．673～10．844；P〈0．01]、存在子囊（OR2．789，95％CI1．624～4．792；P〈0．01）以及最大直径〉5mm（OR1．866，95％CI1．012～3．437；P=0．046）为颅内动脉瘤破裂的独立危险因素。结论女性动脉瘤患者发生率和破裂率均高于男性，高血压、吸烟史、存在子囊、动脉瘤部位、动脉瘤最大直径、瘤体长度以及AR均是影响颅内动脉瘤破裂的因素，其中女性、存在子囊和最大直径〉5mm是独立危险因素。

Objective To investigate the risk factors for ruptured intracranial aneurysms in order to provide the basis for the clinical decision-making of intracranial aneurysms.Methods The demographic and clinical data of the patients with intracranial aneurysm were collected retrospectively.Three-dimensional cerebral angiography was used to identify the aneurismal location and shape,existing ascus or not,aneurysm length,maximum diameter and neck width.The aspect ratio (AR) of aneurysm was calculated.Results A total of 243 patients with intracranial aneurysms (289 aneurysms) were included,149 patients(171 aneurysms) in the ruptured aneurysm group,94 patients (118 aneurysms) in the unruptured aneurysm group.The proportions of female (71.1％ vs.51.1％ ;x2 =12.13,P ＜ 0.01),hypertension (57.7％ vs.38.3％ ;x2 =8.69,P =0.003),smoking (53.0％ vs.39.5％ ; x2 =4.12,P =0.045),existing ascus (63.7％ vs.39.8％ ; x2 =16.07,P ＜0.01),and the maximum diameter ＞ 5 mm (80.7％ vs.66.9％ ;x2 =7.06,P ＜ 0.01) in the ruptured aneurysm group were significantly higher than those in the unruptured aneurysm group,while the proportion of the maximum diameter ＞ 10 mm (31.6％vs.52.5％ ;x2 =12.77,P ＜0.01) was significantly lower than that in the unruptured aneurysm group; the maximum diameter in the ruptured aneurysm group was less than that in the unruptured aneurysm group (8.68± 5.79 mm vs.10.67± 5.78 mm; t=-2.91,P=0.004),while the aneurysm length (8.27 ± 4.19 mm vs.6.94 ± 4.77 mm; t =2.50,P =0.013) and AR (2.32 ± 1.18 vs.1.42± 1.21; t =634,P ＜ 0.01) were significantly longer and higher than that in the unruptured aneurysm group,respectively.Of the 289 aneurysms,103 were anterior communicating artery aneurysms,84 were posterior communicating artery aneurysms,56 were middle cerebral artery aneurysms,12 were anterior cerebral artery aneurysms,9 were internal carotid artery aneurysms,and 25 were basilar artery aneurysms.There were significant differences in the rupture incidence of intracranial aneurysm at different locations (63.1％,79.8％,41.1％,33.3％,33.3％,and 36.0％,respectively; P ＜0.01).Multivariate logistic regression analysis showed that the female (odds ratio [OR],6.311,95％ confidence interval [OR]3.673-10.844; P ＜ 0.01),existing ascus (OR 2.789,95％ CI 1.624-4.792; P＜0.01),and maximum diameter ＞5 mm (OR 1.866,95％ CI 1.012-3.437; P =0.046) were the independent risk factors for ruptured intracranial aneurysms.Conclusions The incidence and rupture rate in women patients with intracranial aneurysm were higher than those in men.Hypertension,history of smoking existing ascus,aneurysm location,aneurysm maximum diameter,aneurysm length and AR were all the factors that impact ruptured intracranial aneurysms,in which women,existing ascus and the maximum diameter ＞5 mm were the independent risk factors.