大脑前动脉A1段发育不全与脑出血关系研究

The correlation between the hypoplasia of A1 segment of anterior cerebral artery and the cerebral hemorrhage

目的探索大脑前动脉A1段发育不全与脑出血的关系,为脑出血临床防治提供参考。方法采用成组设计的病例对照研究方法,回顾性连续收集248例诊断为脑出血患者作为脑出血组,248例无脑出血的中医科住院患者按性别匹配作为对照组。A1段发育不全定义为一侧A1段明显增粗,对侧A1段未显影或直径小于优势侧1/2。采用SPSS软件25.0版进行单因素和多因素logistic回归分析,确定A1段发育不全与脑出血的关系,并进一步分析其与出血侧和出血部位的关联。结果A1段发育不全发生率为15.7%(78/498)。其中脑出血组50例,对照组28例,差异有显著统计学意义(P=0.007)。伴有A1段发育不全脑出血患者中出血好发于基底节和丘脑区(38例),部分发生于额顶叶(11例),极少发生于颞叶(1例);出血发生在A1段优势侧26例,发育不全侧24例,差异无统计学意义(P>0.05)。单因素和多因素logistic回归分析显示,A1段发育不全不论在单独分析(P=0.007,OR=1.984),还是与纳入的其他相关危险因素混杂分析(P=0.004,OR=2.215),均与脑出血有明显的统计学相关性。结论大脑前动脉A1段发育不全作为一重要危险因素,与脑出血关系密切。但脑出血并不具有按优势A1段呈特征性分布,即与出血侧和出血部位无相关性。其潜在机制需通过血流动力学指标检测进一步验证。

Objective To investigate thecorrelation between the hypoplasia of A1 segment of anterior cerebral arteryand the cerebral hemorrhage so as to provide reference for its clinical prevention and treatment.Methods By using a group-designed case-control study method,248 patients with the diagnosis of cerebral hemorrhage(cerebral hemorrhage group)were retrospectively collected,and other 248 patients with no cerebral hemorrhage(control group),who were admitted to the Department of Traditional Chinese Medicine and who were matched with the patients of the cerebral hemorrhage group according to gender,were also collected.The hypoplasia of A1 segment of anterior cerebral arterywas defined as follows:on angiography the A1 segment on one side was obviously thickened(dominant side)while the A1 segment on the opposite side was not visualized or its diameter was half less than that on the dominant side.By using SPSS software version 25.0,univariate analysis and multivariate logistic regression analysis were conducted to determine the correlation between A1 segment hypoplasia and cerebral hemorrhage,and the relationship of A1 segment hypoplasia withthe bleeding side andlocation was further analyzed.Results The incidence of A1 segment hypoplasia was 15.7%(78/498).Of the 78 patients,50 patients were in the cerebral hemorrhage group and 28 in the control group,the difference between the two groups was statistically significant(P=0.007).In patients with cerebral hemorrhage accompanied by A1 segment hypoplasia,the hemorrhage had a strong predilection on the basal ganglia and thalamus(n=38),it also occurred in the frontal-parietal lobe(n=11),but rarely in the temporal lobe(n=1).The hemorrhage occurred at the dominant side of A1 segment in 26 patients and at the hypoplasia side of A1 segment in 24 patients,the difference in the incidence of hemorrhage between the dominant side and hypoplasia side was not statistically significant(P>0.05).Univariate analysis and multivariate logistic regression analysis indicated that A1 segment hypoplasia,whether using separate analysis(P=0.007,OR=1.984)or using mixed analysiswith other incorporatedrelevant risk factors(P=0.004,OR=2.215),bore a statistically significant relationship to the occurrence of cerebral hemorrhage.Conclusion Being an important risk factor,the hypoplasia of A1 segment of anterior cerebral arteryis closely correlated with cerebral hemorrhage.However,cerebral hemorrhage does not showthe distribution feature in accordance with the locationof dominant A1 segment,it means that the hypoplasia of A1 segment is not linked with theside of cerebral hemorrhage or the location of bleeding.The underlying mechanism needs to be further verified by hemodynamic testing.