颅内动脉瘤破裂危险因素分析

Risk factors for rupture of intracranial aneurysm

目的 探讨颅内动脉瘤破裂出血的危险因素,为临床防治措施的制定提供理论依据.方法 回顾性分析2010年1月到2013年12月我院收治的脑动脉瘤患者278例的临床资料,其中发生颅内动脉瘤破裂患者122例（破裂组）,未发生颅内动脉瘤破裂患者156例（未破裂组）.收集两组患者的各项临床资料,通过单因素分析和多因素logistic回归分析探讨颅内动脉瘤破裂出血的危险因素.结果 破裂组女性、有嗜烟史、有高血压病史、颅内动脉粥样硬化的比例显著高于未破裂组[70.5％ （86/122）与59.0％ （92/156）,42.6％（52/122）与29.5％ （46/156）,63.9％（78/122）与51.9％（81/156）,69.7％（85/122）与51.3％ （80/156）,χ2值分别为3.943、5.175、4.034和4.319,均P＜0.05];破裂组患者动脉瘤颈宽度（5.1±2.3）mm、动脉瘤体直径（4.8±2.1）mm,均显著低于未破裂组[（8.5±5.5）和（8.4±6.7）mm,t值为5.642和6.383,均P＜0.01];瘤体直径＜5、5～8、＞8 mm者的动脉瘤破裂率[63.4％ （64/101）、40.9％（38/93）、25.0％ （21/84）]依次显著降低（Z=27.180,P=0.000）;瘤颈宽度＜4 mm的颅内动脉瘤破裂率为67.3％（66/98）,显著高于瘤颈宽度≥4 mm的颅内动脉瘤[31.1％（56/180）,χ2=33.832,P=0.000];多因素logistic回归分析显示,动脉瘤体直径是颅内动脉瘤破裂的独立危险因素（OR=3.759,95％CI：1.638～6.897,P=0.000）.结论 瘤体直径为颅内动脉瘤破裂出血的独立危险因素,临床上应综合患者的病史、影像学检查等各项资料制定相应的诊疗方案,降低颅内动脉瘤破裂出血的风险.

Objective To investigate the risk factors of rupture of intracranial aneurysms.Methods Two hundred and seventy eight patients with cerebral aneurysms admitted from January 2000 to December 2013 were enrolled in study,including 122 cases with ruptured intracranial aneurysm （rupture group） and 156 cases without rupture （non-rupture group）.The clinical data were collected from two groups,risk factors of aneurysm rupture were studied by univariate analysis and multivariate logistic regression analysis.Results The rates of female gender,smoking history,hypertension and atherosclerosis in rupture group were significantly higher than those in non-rupture group [70.5% （86/122） vs.59.0% （92/156）,42.6% （52/122） vs.29.5% （46/156）,63.9% （78/122） vs.51.9% （81/156） and 69.7% （85/122） vs.51.3% （80/156）;χ2 =3.943,5.175,4.034 and 4.319,respectively,all P 〈 0.05];the width of aneurysm neck and diameter of aneurysm in rupture group were significantly lower than those in non-rupture group （all P 〈 0.05）.In addition,the rates of aneurysm rupture in patients with aneurysm diameter of 〈 5 mm,5-8 mm and 〉8 mm were 63.4% （64/101）,40.9% （38/93）,25.0% （20/84）,respectively,Z =27.180,P =0.000;the rates of aneurysm rupture in patients with aneurysm neck width of 〈4 mm was higher than that with width ≥ 4 mm [67.3% （66/98） vs.31.1% （56/180）,χ2 =33.832,P =0.000].Multivariate logistic regression analysis showed that aneurysm diameter is an independent risk factor for rupture of intracranial aneurysm （OR =3.759,95CI：1.638-6.879,P =0.001）.Conclusions The diameter of intracranial aneurysm in an independent risk factor for aneurysm rupture.Female gender,history of smoking,underlying hypertension and atherosclerosis,and the width of aneurysm neck may also related to the rupture of intracranial aneurysms.