青年颅内囊状动脉瘤临床特征及破裂危险因素分析

Analysis of intracranial cystic aneurysms in the young:clinical characteristics and risk factors of rupture

目的探讨青年(18~44岁)颅内动脉瘤患者颅内动脉瘤的临床特征及影响其破裂的危险因素。方法回顾性连续纳入2018年1月至2020年12月收治于重庆医科大学附属第一医院神经外科颅内动脉瘤患者1172例,其中青年颅内动脉瘤患者112例(9.6%),颅内动脉瘤的诊断基于头部CT血管成像(CTA)和(或)全脑DSA检查结果,且均为囊状动脉瘤。根据颅内动脉瘤破裂与否,将112例患者分为破裂组(69例)与未破裂组(43例)。记录患者的基线及影像学资料,基线资料包括性别、年龄、吸烟史(<20支/d或≥20支/d)、饮酒史(<10年或≥10年)、高血压病及其控制情况、糖尿病、高脂血症、缺血性卒中、多发动脉瘤等;影像学资料包括动脉瘤分布、大小、形态等。比较破裂组与未破裂组患者基线及临床资料、总体动脉瘤(个)的影像学特征,比较责任动脉瘤与非责任动脉瘤的影像学特征。分析吸烟史和性别与动脉瘤分布的关系。将青年颅内动脉瘤患者分为不同年龄段,即18~24、25~34、35~44岁,总结不同年龄段颅内动脉瘤患者的性别分布及其动脉瘤影像学特征。分析青年颅内动脉瘤患者动脉瘤破裂的危险因素。基线资料组间比较以例数计,影像学资料组间比较以动脉瘤数(个)计。以颅内动脉瘤发生破裂为因变量,将单因素分析中P<0.1的参数作为自变量,对多分类变量设哑变量,进行青年颅内动脉瘤破裂影响因素的多因素Logistic回归分析。结果(1)112例青年颅内动脉瘤患者中,男34例,女78例,男∶女为1∶2.29。(2)破裂组与未破裂组患者年龄、性别、高脂血症、糖尿病、缺血性卒中、饮酒史、多发动脉瘤比例的差异均无统计学意义(均P>0.05);破裂组合并高血压病、有吸烟史的比例均高于未破裂组,组间差异均有统计学意义[34.8%(24/69)比16.3%(7/43),χ^(2)=4.531;34.8%(24/69)比14.0%(6/43),χ^(2)=6.669;均P<0.05]。(3)112例颅内动脉瘤患者中共明确诊断动脉瘤130个,颈内动脉系统动脉瘤的比例最高(80个,占61.5%),其次为大脑前动脉及前交通动脉动脉瘤(23个,占17.7%)。破裂组动脉瘤分布以颈内动脉系统为主,占49.4%(39/79),其次为大脑前动脉及前交通动脉(21个,占26.6%)、大脑中动脉(10个,占12.7%)、后循环(9个,占11.4%);未破裂组动脉瘤分布以颈内动脉系统为主,占80.4%(41/51),其次为大脑中动脉(5个,占9.8%)、后循环(3个,占5.9%)、大脑前动脉及前交通动脉(2个,占3.9%)。两组动脉瘤分布的差异有统计学意义(χ^(2)=15.081,P=0.002)。破裂组和未破裂组不规则动脉瘤分别占43.0%(34/79)和17.6%(9/51),两组动脉瘤形状的差异有统计学意义(χ^(2)=9.026,P=0.003)。两组动脉瘤直径的差异无统计学意义(P>0.05)。(4)以动脉瘤破裂为因变量,将基线资料及动脉瘤影像学特征中P<0.1的参数为自变量,进一步行影响因素的多因素Logistic回归分析,结果显示,高血压病、吸烟史(吸烟≥20支/d)、动脉瘤的分布(大脑前动脉及前交通动脉、后循环)及不规则动脉瘤是青年颅内动脉瘤患者动脉瘤破裂的独立危险因素[高血压病:OR=2.730,95%CI:1.022~7.290,P=0.045;吸烟史(≥20支/d):OR=3.122,95%CI:1.032~9.440,P=0.044;大脑前动脉及前交通动脉:OR=9.527,95%CI:2.517~36.059,P=0.001;后循环:OR=1.947,95%CI:1.181~20.717,P=0.029;不规则动脉瘤:OR=1.343,95%CI:1.798~10.488,P=0.001],其中吸烟≥20支/d者动脉瘤破裂风险是不吸烟者的3.122倍,大脑前动脉及前交通动脉动脉瘤患者的破裂风险是颈内动脉系统动脉瘤患者的9.527倍。结论青年颅内囊状动脉瘤患者以女性为著,动脉瘤多见于颈内动脉系统,高血压病、吸烟≥20支/d、位于大脑前动脉及前交通动脉动脉瘤及不规则形态可能增加青年颅内囊状动脉瘤患者动脉瘤破裂的风险。

Objective To investigate the clinical characteristics and risk factors for rupture of intracranial aneurysms(IA)in young patients aged 18 to 44 years old.Methods From January 2018 to December 2020,1172 patients with IA were consecutively admitted to Department of Neurosurgery,the First Affiliated Hospital of Chongqing Medical University,and 112 young patients(9.6%)were recruited.Diagnosis of intracranial cystic aneurysms was based on results of head CT angiography(CTA)and/or whole-brain DSA,and all were cystic aneurysms.A total of 112 patients were divided into ruptured IA group(69 cases)and non-ruptured IA group(43 cases)based on whether aneurysm was ruptured or not.Baseline and imaging data were recorded.Baseline data included gender,age,smoking(<20 cigarettes/day or≥20 cigarettes/day),drinking(<10 years or≥10 years),hypertension and its controlling situation,diabetes mellitus,hyperlipidemia,ischemic stroke,multiple aneurysms,etc.Imaging data included location of aneurysm,size of aneurysm,shape of aneurysm,etc.Not only the baseline data,imaging data and imaging characteristics of aneurysms between ruptured IA group and non-ruptured IA group were compared,but also the imaging characteristics between responsible and non-responsible aneurysms.Relationship between smoking,gender and aneurysm distribution were analyzed.To summarize the gender distribution and aneurysm imaging characteristics of IA patients in different age groups,the young patients were divided into three age groups:18-24,25-34 and 35-44 years old.The risk factors for aneurysm rupture in young patients with IA were analyzed.Comparison of baseline data was calculated by the number of cases,and comparison of imaging data was calculated by the number of aneurysms.Variables with P<0.1 in univariate comparisons were entered as independent variables in multiple Logistic regression analysis to assess independent risk factors related to IA rupture,with IA rupture as the dependent variable and dummy variables for multiple classification variables.Results(1)Among 112 young patients(34 males and 78 females),the male-female ratio was 1∶2.29.(2)Between ruptured IA group and non-ruptured IA group,there were no statistical significance in age,gender,hyperlipidemia,diabetes mellitus,ischemic stroke,drinking history and ratio of multiple aneurysms(all P>0.05).The rates of hypertension and smoking history in ruptured IA group were higher than those in non-ruptured IA group,there were significant differences between the two groups(34.8%[24/69]vs.16.3%[7/43],χ^(2)=4.531;34.8%[24/69]vs.14.0%[6/43],χ^(2)=6.669;all P<0.05).(3)130 aneurysms were diagnosed in 112 young patients.The highest proportion was internal carotid artery(ICA)system aneurysms(80,61.5%),then was anterior cerebral artery and anterior communicating artery(ACA/ACoA;23,17.7%).In ruptured IA group,ICA system aneurysms were dominant,accounting for approximately 49.4%(39/79),the following were ACA/ACoA(21,26.6%),middle cerebral artery(MCA;10,12.7%)and posterior circulation(PC;9,11.4%).In non-ruptured IA group,ICA system aneurysms also had the highest rate,accounting for 80.4%(41/51),and the following were MCA(5,9.8%),PC(3,5.9%)and ACA/ACoA(2,3.9%).Distribution of aneurysms differed between two groups(χ^(2)=15.081,P=0.002).Irregular aneurysms occurred in 43.0%(34/79)and 17.6%(9/51)of the ruptured and non-ruptured IA group,respectively.The distribution of aneurysms also differed between two groups(χ^(2)=9.026,P=0.003).There was no significant difference of aneurysms diameter between two groups(P>0.05).(4)Variables with P<0.1 in baseline and imaging data were entered as independent variables in multiple Logistic regression analysis,with IA rupture as the dependent variable.The results showed that hypertension,smoking(≥20 cigarettes/day),aneurysm distribution(ACA/ACoA,PC)and irregular shape were independent risk factors for rupture of IA in young patients(hypertension:OR,2.730,95%CI 1.022-7.290,P=0.045;smoking[≥20 cigarettes/day]:OR,3.122,95%CI 1.032-9.440,P=0.044;ACA/ACoA:OR,9.527,95%CI 2.517-36.059,P=0.001;PC:OR,1.947,95%CI 1.181-20.717,P=0.029;irregular shape:OR,1.343,95%CI 1.798-10.488,P=0.001).Compared with never smokers,the risk of aneurysm rupture in patients who smoked≥20 cigarettes/day was 3.122 times higher.Meanwhile,the rupture risk of aneurysm was 9.527 times higher of ACA/ACoA than that of ICA system.Conclusions Young patients with cystic IA were largely females.Aneurysms were most common in the ICA system.Hypertension,smoking(≥20 cigarettes/day),aneurysms distribution(ACA/ACoA)and irregular shape may increase the risk of aneurysm rupture in young patients with cystic IA.