前交通动脉瘤破裂的形态学特征及临床危险因素分析

Analysis on morphological features and clinical risk factors of ruptured anterior communicating aneurysm

目的探讨前交通动脉瘤(ACo A)破裂的临床危险因素及动脉瘤形态学特征对动脉瘤破裂的影响。方法收集2013年1月~2016年11月在昆明医科大学第一附属医院就诊的138例ACo A患者,所有患者均行全脑血管造影(DSA)或颅脑磁共振血管成像(MRA)或CT血管成像(CTA)检查,入组108例。采用单因素及多因素Logistic回归方法分析患者的临床及ACo A形态学资料。结果 ACo A破裂与未破裂患者相比,血糖(P=0.038)、收缩压(P=0.036)、舒张压(P=0.046)及动脉瘤长度(P=0.013)、宽度(P=0.037)、瘤颈宽度(P=0.014)、A1/A2夹角≤100°(P=0.026)、动脉瘤有子囊(P=0.0006)之间的差异有统计学意义。多因素Logistic回归分析显示,血糖(OR 4.19,95%CI 1.615~10.899,P=0.003)、动脉瘤瘤颈宽度(OR2.14,95%CI 1.201~3.819,P=0.009)、动脉瘤有子囊(OR 12.94,95%CI 2.339~71.604,P=0.003)是ACo A破裂的独立危险因素。ROC曲线显示,瘤颈宽度的最佳预测值为3.79 mm(曲线下面积0.66,95%CI 0.534~0.786);A1-A2夹角最佳预测值为<98°(曲线下面积0.619,95%CI 0.482~0.755)。结论 ACo A瘤颈宽度>3.79 mm、是否有子囊,以及A1-A2夹角<98°为ACo A破裂的独立危险因素。

Objectives To analyze the infleunce of clinical factors and arterial aneurysm morphological feature on aneurysm rupture.Methods 138 cases with anterior communicating aneurysms that had been admitted in our hospital from January 2013 to November 2016 were included in this study and they all underwent whole cerebral Digital Subtraction Angiography （DSA） or Magnetic Resonance Angiography （MRA） imaging or CT angiography （CTA）.Anatomical data and clinical materials of anterior communicating aneurysms were collected and single factor or multiple factor logistic regression analysis were adopted.Results Blood glucose （P=0.038）,systolic pressure （P=0.036）,diastolic pressure （P=0.046）,height of arterial aneurysm （P=0.013）,width of arterial aneurysm （P=0.037）,neck diameter of aneurysm （P=0.014）,A1-A2 angle ≤100,daughter ascus （P=0.0006） of patients suffering from anterior communicating aneurysms before and after rupture had statistical differences.In multiple factor logistic regression analysis,blood glucose （P=0.003;OR 4.19,95%CI 1.615-10.899）,neck diameter of aneurysm （P=0.0089;OR,2.14;95%CI,1.201-3.819）,daughter ascus （P=0.0033;OR 12.94,95%CI 2.339-71.604） are independent risk factors of anterior communicating aneurysm rupture.ROC curve of aneurysm neck width indicated the best predicating for aneurysm rupture value was 3.79mm （area under the curve 0.66;95%CI 0.534-0.786）.A1-A2 angle ROC curve indicated the best predicating for aneurysm rupture value was less than 98 degree （area under the curve 0.619;95%CI 482-0.755）.Conclusions The neck diameter of aneurysm over 3.79 mm,daughter ascus and A1-A2 angle less than 98 degree can be indepdent risk factor of anterior communicating aneurysm rupture.