颅内动脉瘤血管内治疗后复发的临床多因素分析

Multivariate Analysis of Risk Factors for Recurrence of Intracranial Aneurysm After Intravascular Therapy

目的旨在建立动脉瘤复发的风险评估系统,为颅内动脉瘤血管内治疗及治疗后的管理提供参考指标。方法选取221例颅内动脉瘤血管内治疗后病例,根据入院时病情分为破裂动脉瘤组及未破裂动脉瘤组,对患者进行随访动脉瘤是否复发。入院时收集患者的外周血细胞数据,计算外周血系统免疫-炎症指数(SII)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)、淋巴细胞/单核细胞比值(LMR)5项指标;利用容积再现技术软件自动测量动脉瘤体积。以单因素分析比较复发与未复发动脉瘤间的全身炎症反应指数差异,以多因素Logistic回归分析构建动脉瘤复发风险预测模型。以R软件及多因素分析构建复发风险评分量表,并对量表可靠性进行评估。结果未破裂动脉瘤组中,体积>0.3235 mL、填塞率<20.06、LMR>3.505的未破裂动脉瘤易于复发;在破裂动脉瘤组中,体积>0.1158 mL、填塞率<18.72、LMR>0.5027的动脉瘤易于复发。结论以体积、填塞率及LMR所建立的动脉瘤血管内治疗后复发评估系统能有效预测动脉瘤血管内治疗后的复发可能。

Aim To establish a risk assessment system for the recurrence of aneurysms after intracranial aneurysm endovascular therapy,which is associated not only with the treatment but also with intracranial aneurysm size,site,and autoimmune parameters,providing a reference for intracranial aneurysm endovascular treatment and post-treatment management.Methods Two hundred twentyone patients with aneurysm after endovascular treatment in our hospital were selected according to inclusion and exclusion criteria for intracranial aneurysms,and were divided into two groups according to the status of admission:ruptured aneurysm and unruptured aneurysm.Then patients were followed up and divided into two subgroups according to whether the aneurysm recurred.Peripheral blood cell data was collected and established based on platelet,neutrophil,lymphocyte,monocyte SII(systemic immune-inflammation index),NLR(neutrophil to lymphocyte ratio),PLR(platelet to lymphocyte ratio),LMR(lymphocyte monocyte ratio)and L(lymphocyte).At the same time,the image data was collected and the volume of aneurysm was measured automatically by using volume reconstruction technology software.The tamponade rate of aneurysm was calculated according to the state of treatment.The differences of systemic inflammatory response index(SII)between recurrent and non-recurrent aneurysms were compared by univariate analysis.Multivariate analysis was performed to analysis the risk factor for the recurrence of aneurysms.Therecurrence risk rating scale was constructed in R and the reliability of the scale was analyzed.Results Unruptured aneurysms with a size>0.3235 m L,a tamponade rate<20.06,and LMR>3.505 had a higher recurrence rate.And ruptured aneurysms with a size>0.1158 m L a tamponade rate<18.72,and LMR>0.507 had a higher recurrence rate.An aneurysm recurrence risk assessment scale was developed,which included volume tamponade rate and L,and was evaluated with a C index of 0.92.Conclusion Elevated LMR in patients with unruptured aneurysms increased the risk of intracranial aneurysm,which could be a novel predictor for aneurysm recurrence after endovascular therapy.Volume,tamponade rate and LMR were important predictors for aneurysm recurrence,and the risk assessment scale established based on volume,tamponade rate and LMR has a good clinical predictive power for aneurysm recurrence.