单发与多发颅内动脉瘤临床特征、治疗方式及短期预后的多中心研究

Clinical features,treatment methods and short-term outcomes of single and multiple intracranial aneurysm s:amulticenter study

目的探讨多发颅内动脉瘤(MIA)与单发颅内动脉瘤(SIA)患者的临床特征、治疗方式及短期预后.方法回顾性分析1082例颅内动脉瘤(IA)患者的临床资料,所有患者均于2017年1月至2018年12月经天津医科大学总医院等13家医院的神经外科确诊并收治,根据动脉瘤的数量将患者分为MIA组[118例(共269个动脉瘤)]和SIA组(964例).观察两组动脉瘤的一般特征,收集并比较两组患者的临床资料,将出院时改良Rankin量表评分0~2分定义为短期预后良好,3~6分定义为短期预后不良.将单因素分析中P<0.5的自变量以及临床上较为关注的自变量均纳入多因素二元logistic回归模型,进一步对MIA组和SIA组的临床资料进行1∶1倾向性评分匹配,比较匹配后的两组患者的治疗方式、住院天数及短期预后.结果MIA组动脉瘤的直径为(5.1±3.5)mm(0.2~25.0 mm),SIA组动脉瘤的直径为(5.7±3.8)mm(0.9~35.0 mm).两组性别、糖尿病史、吸烟史、饮酒史、原发性高血压病的级别、CT Fisher分级、Hunt-Hess分级、格拉斯哥昏迷评分及世界神经外科医师联盟(WFNS)分级的差异均无统计学意义(均P>0.05);与SIA组相比,MIA组患者的年龄更大,差异有统计学意义[分别为(62.4±11.7)岁、(58.8±11.6)岁,P=0.002].将年龄、性别、糖尿病史、饮酒史、吸烟史、原发性高血压的级别、入院CT Fisher分级指标纳入多因素二元logistic回归模型分析,结果显示,MIA组年龄更大,但SIA组原发性高血压(3级)患者比例更高,差异均具有统计学意义(均P<0.05).通过倾向性评分匹配,共精确匹配0对,模糊匹配118对,共计匹配成功118对.匹配后的两组患者住院时长的差异无统计学意义(P>0.05);与SIA组比较,MIA组短期预后较好(P=0.008);两组治疗方式的差异也具有统计学意义(P=0.042),其中MIA组血管内治疗更多.结论与MIA患者比较,SIA患者更易合并原发性高血压3级,但MIA患者的年龄更大,且更倾向于采用血管内治疗,短期效果更好.

Objective To explore the elinical charactristis,tratmet stratrgies and shor-term otomers of multiple intra ranial aneurysns(MIA)and single intracranial ameurysms(SIA),Methods A Tetnepoetive study Wwas conducterd o 1082 putients with MIA or SIA who were diagnoserd and treated at the noumrsungenry depurtments of 13 mrdieal centers ineluding Tanjin Medieal Universily General Hespital from January 2017 to Deenber 2018.Aoording to the number of anrurysts,the pautients were divided intn MIA group[118 eases(269 aneurysms)]and SIA group(964 eises).We obeerved the general chancteristies of aneunysms in the 2 groups.olloeted and compand the elinial dauta of the 2 groups of patientse.The mulifed Rankin scale(mRS)score of 0-2 at discharge wa defimed as a goud short-em uicome,and 3-6 points B a por shurt lerm outeoone.The inde pendent variables with P<0.5 in the uriariale analysis and the einially oncemed inodependent variables were ineluded in the multivariate binary logistie regression nodel,and the elinical data of the MIIA goup and the SIA group werr further matched with 1:1 propensity scores to comnpare the tratment methods,length of stay at hospital and bhr-term outonee of the 2 groups of putiente after matching,Results The diameter of the aneurysm in the MIA group as5.1±3.5 mn(0.2-25.0 mm).and that in the SIA goup was5.7±3.8 mm(0.9-35.0 mm).There wEs m dfrernce betmeen the 2 groups in gender,hislory of duabedes.history of smoking.history o aleohol drinking.grade of essential hypertension,CT Fsber gruole,Hunt-Hes grade,Glasgow om sore(GCS),or Ward Federatin of Neurologieal surgeons(WFNS)sale soures(all P>0.05).Cormpared with the SIA group,the patient's ag in the MIA group was older,and the dfference was saistically signifeant[(62.4±11.7)years old vs.(58.8±11.6)years old,P=0.002],The anger.grauder.histery of diabetes.history of alcobol drinking.history o smnoking.gade of essential hyperension,and CT Fisher yroale at huspital anisisii mere inclunkedl in the mulivarate hinary lgistie reressin mnlel analysis.The rsuls showed thut the putients in the MIA group was older,while the ppopurtion of patients with hypertension(Grade 3)was higher in the SIA grop,and the difences were slisticallyy signifiart(all P<0.05).Thruph properesily sore meatching,no pair Was accurately ratched,there were 118 puirs were successfully matching.and a totll of 118 pains were sucessfully matched.Afer mautching,there was mo significant diferenre in the lengh of hospial stay betweer the 2 group of patients(P>0.05).Compared with the SIA goup,the short-tem outeome in the MIA group ws better(P=0.008).The ifrremoe in treatment methordke between the 2 grups Was alo satstically siguifrant(P=0.042)。and the more endowasular tratmnent was reported in the MIA goup Conclusion Compand with MIA paients,SIA patients are mre likely to have Grale 3 esential hypetenesion,while MIA ptents are older,more inelined io undepp endovaseular treatment and asociated with better short.term outome.