动脉瘤形态、血流动力学和微小RNA对颅内动脉瘤术中破裂的影响及预测价值

Effect of aneurysm morphology,hemodynamic parameters and microRNA on the intraoperative rupture of intracranial aneurysms and its predictive value

目的 分析动脉瘤形态、血流动力学和微小RNA(miRNA)对颅内动脉瘤(IA)术中破裂的影响及预测价值。方法 根据术中IA是否破裂,将195例IA患者分为破裂组33例和未破裂组162例。比较两组患者的动脉瘤形态、血流动力学参数和miR-126、miR-143、miR-145、miR-29a的水平。采用Logistic多因素回归分析IA破裂的危险因素,比较动脉瘤形态危险因素、血流动力学参数危险因素和miRNAs危险因素对IA破裂的预测价值。结果 与未破裂组比较,破裂组瘤体长径、瘤体最长径、瘤体最长径与瘤颈宽度的比值(AR)、瘤体最大长径/载瘤动脉直径(SR)和形状不规则患者比率显著升高,瘤体宽径显著降低(均P<0.05)。破裂组平均壁面剪切力(WSSA)和低剪切力面积比值(LSQR)水平显著高于未破裂组(均P<0.05)。与未破裂组比较,破裂组miR-126、miR-29a水平显著升高,miR-143、miR-145水平显著降低(均P<0.05)。多因素Logistic回归分析显示,AR、SR、形状不规则、WSSA、LSQR、miR-126和miR-29a为IA破裂的危险因素,miR-143和miR-145为IA破裂的保护因素(P<0.05~0.01)。AR、SR、形状不规则联合检测和WSSA、LSQR联合检测预测IA破裂的曲线下面积显著大于miR-126、miR-29a联合检测(Z=5.201,Z=4.865;均P<0.001)。结论 AR、SR、形状不规则、WSSA、LSQR、miR-126和miR-29a为影响IA破裂的危险因素。AR、SR、形状不规则联合检测,WSSA、LSQR联合检测对IA破裂的预测价值均高于miR-126和miR-29a联合检测,具有较高的临床应用价值。

Objective To analyze the effect of aneurysm morphology,hemodynamic parameters and microRNA(miRNA) on the intraoperative rupture of intracranial aneurysm(IA) and its predictive value.Methods According to whether the IA was ruptured during the operation,195 patients with IA were divided into the ruptured group with 33 cases and the unruptured group with 162 cases.The aneurysm morphology,hemodynamic parameters and the levels of miR-126,miR-143,miR-145 and miR-29 a were compared between the two groups.Logistic multivariate regression analysis was used to analyze the risk factors affecting IA rupture,and the predictive value of aneurysm morphology risk factors,hemodynamic parameters risk factors and miRNAs risk factors for IA rupture were compared.Results Compared with those in the unruptured group,the tumor length,the ratio of the longest diameter of the tumor,the ratio of the longest diameter of the tumor to the width of the tumor neck(AR),the maximum long diameter of the tumor/the diameter of the tumor-bearing artery(SR),and the ratio of patients with irregular shapes in the ruptured group were significantly increased,the width and diameter of the tumor were significantly reduced(all P<0.05).The average wall shear force(WSSA) and low shear area ratio(LSQR) levels of the ruptured group were significantly higher than those in the unruptured group(all P<0.05).Compared with those in the unruptured group,the levels of miR-126 and miR-29 a in the ruptured group were significantly increased,and the levels of miR-143 and miR-145 were significantly decreased(all P<0.05).Multivariate Logistic regression analysis showed that AR,SR,irregular shape,WSSA,LSQR,miR-126 and miR-29 a were risk factors for IA rupture,and miR-143 and miR-145 were protective factors for IA rupture(P<0.05-0.01).The area under the curve of AR,SR,irregular shape combined detection and WSSA,LSQR combined detection in predicting IA rupture was significantly larger than that of miR-126 and miR-29 a combined detection(Z=5.201,Z=4.865;P<0.001).Conclusions AR,SR,irregular shape,WSSA,LSQR,miR-126 and miR-29 a are risk factors affecting IA rupture.The combined detection of AR,SR,irregular shape,combined detection of WSSA and LSQR have a higher predictive value for IA rupture than the combined detection of miR-126 and miR-29a,which have higher clinical application values.