基于倾向性评分方法研究颈内动脉扭曲与颈内动脉瘤形成的关系

Tortuosity of the internal carotid artery and the formation of internal carotid aneurysms:an exploratory study based on propensity score method

目的探讨颈内动脉扭曲程度与颈内动脉瘤形成的相关性。方法回顾性分析2009年7月至2017年3月在东部战区总医院因可疑脑血管病而就诊的患者。所有患者均接受头颅CT血管成像和数字减影血管造影检查,将单发颈内动脉段动脉瘤患者归为动脉瘤组,未见明显异常血管疾病的患者归为对照组。收集患者的一般资料,包括年龄、性别、高血压史、糖尿病史等信息,测量动脉瘤大小以及颈内动脉扭曲参数,包括颈内动脉扭曲程度分类、前膝角(A角)、后膝角(P角)、前后膝角度之和(AP角)和前后膝的高度差(D值)。使用SPSS软件进行倾向性评分匹配(PSM)。采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验、Fisher确切概率法比较2组各参数差异,使用Spearman相关系数评估动脉瘤大小与颈内动脉扭曲参数的相关性,以logistic回归分析动脉瘤形成的独立危险因素,并构建预测颈内动脉瘤形成的logistic回归模型。模型效能采用受试者操作特征曲线及曲线下面积进行分析。结果PSM后,颈内动脉瘤组和对照组各纳入108例患者,动脉瘤组患者颈内动脉扭曲的比例小于对照组[19.4%(21/108)和32.4%(35/108),χ^(2)=4.72,P=0.030],动脉瘤组A角、P角、AP角明显大于对照组(U=7105.50,P=0.006;U=7139.00,P=0.004;t=-3.14,P=0.002)。多因素logistic回归分析中,AP角(OR=1.010,95%CI 1.003~1.016,P=0.002)是动脉瘤形成的独立危险因素,基于AP角的logistic模型预测颈内动脉瘤形成的曲线下面积为0.624(95%CI 0.549~0.699)。颈内动脉瘤大小与AP角呈弱的正相关(r=0.210,P=0.002)。结论颈内动脉扭曲与颈内动脉瘤形成相关,且AP角是颈内动脉瘤形成的独立风险因素,与动脉瘤大小呈现弱正相关性,为从载瘤动脉的形态特征理解动脉瘤形成提供了新的思路。

Objective To investigate the correlation between the tortuosity of the internal carotid artery and the formation of internal carotid aneurysms.Methods The clinical data of patients with suspected cerebrovascular disease admitted to the Jinling Hospital from July 2009 to March 2017 were retrospectively collected.All patients underwent head CT angiography and digital subtraction angiography.Patients with single internal carotid artery aneurysm were classified as the aneurysm group,and patients without obvious abnormal vascular disease were classified as the control group.The demographic information of the patients,including age,gender,history of hypertension and diabetes,were collected.The size of the aneurysm and the tortuosity parameters of the internal carotid artery were measured,including the classification of the tortuosity of internal carotid artery,anterior genu angle(A angle),posterior genu angle(P angle),sum of the angles of A angle and P angle(AP angle)and height difference of anterior genu and posterior genu(D value).SPSS software was used for propensity score matching(PSM).Independent sample t test,Mann-Whitney U test orχ^(2) test,Fisher exact test were used to compare the differences of each parameter between the two groups.Spearman analysis was used to analyze the correlation between the tortuosity and aneurysm size.A multivariate logistic regression was used to analyze the independent risk factors of aneurysm formation and to predict the formation of internal carotid aneurysm.The receiver operating characteristic curve and the area under the curve were used for model performance.Results After PSM,108 patients were included in each group.The proportion of tortuous internal carotid artery in the aneurysm group was lower than that in the control group[19.4%(21/108)vs.32.4%(35/108),χ^(2)=4.72,P=0.030].A,P and AP angles in the aneurysm group were significantly larger than those in the control group(U=7105.50,P=0.006;U=7139.00,P=0.004;t=-3.14,P=0.002).Multivariate logistic regression analysis showed that AP angle(OR=1.010,95%CI 1.003-1.016,P=0.002)was an independent risk factor for aneurysm formation.The area under the curves of logistic regression model based on AP angle was 0.624(95%CI 0.549-0.699).There was a weak correlation between the size of internal carotid artery aneurysm and AP angle(r=0.210,P=0.002).Conclusions The tortuosity of the internal carotid artery is associated with the formation of internal carotid artery aneurysms,and the AP angle is an independent risk factor for the formation of internal carotid artery aneurysms,and a weak positive correlation with the size of the aneurysm is observed.It provides a new idea for understanding the formation of internal carotid artery aneurysms from the morphological characteristics of the parent artery.