硬脑膜动静脉瘘出血及非出血性神经功能障碍的危险因素分析

Risk factors for dural arteriovenous fistula bleeding and non-hemorrhagic neurological dysfunction

目的:探讨硬脑膜动静脉瘘(DAVF)出血及非出血性神经功能障碍(NHND)的危险因素。方法:选择经DSA确诊的161例DAVF患者,收集临床资料,分析其年龄、性别、临床表现、影像学特点、治疗方式及预后等情况,并进行随访。研究的终点事件为出血和NHND。采用Cox回归分析颅内出血和NHND的危险因素。结果:161例患者中发生颅内出血26例,发生NHND 30例。瘘口位置位于大静脉窦区54例,海绵窦区46例,其他窦区61例。根据有无皮层静脉引流(CVD)和皮层引流静脉扩张(VE)分为3组:无CVD组38例,有CVD无VE组100例,CVD+VE组23例。Cox回归分析结果显示VE是DAVF发生出血(HR=3.759,95%CI=1.515~9.328,P=0.004)和NHND(HR=4.351,95%CI=1.922~9.852,P<0.001)的危险因素。结论:VE是DAVF患者发生出血和NHND的危险因素。

Aim:To explore the risk factors of dural arteriovenous fistula(DAVF)bleeding and non-hemorrhagic neurological dysfunction(NHND).Methods:A total of 161 DAVF patients who underwent DSA examination were selected.The clinical data were collected,and their age,gender,clinical manifestations,imaging features,treatment methods and prognosis were analyzed and followed up.The endpoint events observed were bleeding and NHND.Cox regression analysis was used to evaluate the risk factors for intracranial bleeding and NHND.Results:Among the 161 patients,bleeding occurred in 26 cases,and NHND occurred in 30 cases.The fistulas were located in the cavernous sinus of 54 cases,in the cavernous sinus area of 46 cases,and in other sinus areas of 61 cases.According to the presence or absence of cortical venous drainage(CVD)and cortical drainage of venous ectasia(VE),the patients were divided into 3 groups:no CVD group(n=38),CVD but no VE group(n=100),CVD+VE group(n=23).Cox regression analysis showed that VE was a risk factor for cerebral bleeding in patients with DAVF(HR=3.759,95%CI=1.515-9.328,P=0.004)and NHND(HR=4.351,95%CI=1.922-9.852,P<0.001).Conclusion:VE is a risk factor for bleeding and NHND in DAVF patients.