老年前循环小动脉瘤破裂危险因素分析

Analysis of risk factors for rupture of anterior circulation small aneurysms in elderly patients

目的探讨老年颅内前循环小动脉瘤(≤5 mm)的临床特征、动脉瘤形态学特征及其参数对小动脉瘤破裂的影响。方法收集2016年1月—2018年11月在昆医附一院就诊的202例前循环小动脉瘤患者的临床及动脉瘤影像学特征资料,所有患者均在院内外行全脑血管造影(DSA)检查明确诊断,分为破裂组(135例)和未破裂组(67例)。采用单因素、多元Logistic回归及ROC曲线分析患者的临床及动脉瘤形态特征。结果前循环小动脉瘤破裂组与未破裂组间比较,收缩压、舒张压、血糖、动脉瘤位置、带有子囊、形状不规则、AR、SR之间差异有统计学意义(P<0.05)。多元Logistic回归分析提示,收缩压、血糖值、带有子囊、不规则形、AR、SR为破裂的独立危险因素。ROC曲线显示,血糖最佳预测值为5.55 mmol/L(曲线下面积:0.674,95%CI:0.586~0.761)、收缩压最佳预测值为130 mmHg(曲线下面积:0.707,95%CI:0.634~0.780)、AR最佳预测值为1.13(曲线下面积:0.621,95%CI:0.540~0.703)、SR最佳预测值为1.25(曲线下面积:0.614,95%CI:0.533~0.694)。结论子囊、形态不规则、收缩压、血糖、长颈比AR、大小比SR是前循环小动脉瘤破裂的独立危险因素;收缩压>130 mmHg、血糖>5.55 mmol/L、AR>1.13、SR>1.25的前循环小动脉瘤的破裂危险显著增加,应积极处理。

Objective To investigate the clinical and morphological characteristics of intracranial anterior circulation small aneurysms(≤5 mm)in the elderly and the influence of their parameters on the rupture of small aneurysms.Methods The data of the clinical and imaging characteristics of 202 patients with anterior circulation small aneurysms treated in First Affiliated Hospital of Kunming Medical University from January 2016 to November 2018 were collected.All patients were diagnosed by whole-brain angiography(DSA)in and outside the hospital and were divided into rupture group(135 cases)and un-ruptured group(67 cases).Univariate,multiple logistic regression and ROC curve were used to analyze the clinical and morphological characteristics of aneurysms.Results There were statistically significant differences in systolic blood pressure,diastolic blood pressure,blood glucose,aneurysm location,appended ascus,irregular shape,AR and SR between the two groups(P<0.05).Multiple Logistic regression analysis showed that systolic blood pressure,blood glucose,appended ascus,irregular shape,AR and SR were independent risk factors for rupture.The ROC curve showed that the optimal predictive value of blood glucose was 5.55 mmol/L(area under the curve:0.674,95%CI:0.586-0.761),the optimal predictive value of systolic blood pressure was 130 mmHg(area under the curve:0.707,95%CI:0.634-0.780),the optimal predictive value of AR was 1.13(area under the curve:0.621,95%CI:0.540-0.703),and the optimal predictive value of SR was 1.25(area under the curve:0.614,95%CI:0.533-0.694).Conclusion Appended ascus,irregular shape,systolic blood pressure,blood glucose,length to neck ratio AR,size ratio SR are independent risk factors for rupture of anterior circulation small aneurysms.The patients with systolic blood pressure>130 mmHg,blood glucose>5.55 mmol/L,AR>1.13,SR>1.25 have a greatly increased risk of rupture of anterior circulation small aneurysms.Therefore,they should be actively treated.