颅内多发动脉瘤破裂的临床与影像学危险因素分析

Clinical and Imaging Risk Factors for Rupture of Multiple Intracranial Aneurysms

目的:探讨颅内多发动脉瘤破裂的临床与影像学中的潜在危险因素。方法:回顾性分析2013年4月至2021年12月在本院收治的颅内多发动脉瘤患者的临床和影像数据,根据动脉瘤是否破裂分为破裂组与未破裂组,对两组临床和影像学参数进行单因素分析筛选出具有统计学意义的危险因素,并将其作为自变量,进一步进行多因素Logistic回归分析。探讨影响颅内多发动脉瘤破裂的危险因素。结果:单因素回归分析结果表明破裂组(n=52)与未破裂组(n=85)两组患者的年龄、性别、高血压、高脂血症、血管硬化性疾病、动脉瘤最长径、宽度、长宽比及动脉瘤部位均具有统计学差异(均P<0.05);年龄越小,越容易破裂(P<0.05);破裂组的最长径、宽度、长宽比值均显著高于未破裂组(P<0.05);前交通动脉、后交通动脉、大脑中动脉、基底动脉破裂率高于其他部位动脉瘤(P<0.05)。多因素Logistic回归分析结果表明颅内多发动脉瘤破裂的独立危险因素为性别(OR=3.664,95%CI:1.577~8.515,P=0.003)、动脉瘤最长径(OR=1.405,95%CI:1.130~1.747,P=0.002)及动脉瘤位置,而前交通动脉(OR=26.747,95%CI:5.384~132.883,P<0.001)和后交通动脉(OR=15.288,95%CI:3.659~63.885,P<0.001)破裂风险最高;高脂血症是颅内多发动脉瘤破裂的独立保护因素(OR=0.103,95%CI:0.026~0.405,P=0.001)。结论:性别、动脉瘤最长径及动脉瘤位置是颅内多发动脉瘤破裂的独立危险因素,而高脂血症是颅内多发动脉瘤破裂的独立保护因素,这为将来针对颅内多发动脉瘤中未破裂动脉瘤制定个性化的预防策略提供了重要依据。

Objective:To investigate the potential clinical and imaging risk factors for the rupture of multiple intracranial aneurysms.Methods:A retrospective analysis of the clinical and imaging data of patients with multiple intracranial aneurysms treated in our hospital from April 2013 to December 2021 was conducted.Patients were divided into rupture and non-rupture groups based on whether their aneurysms had ruptured.Univariate analysis was performed on the clinical and imaging parameters of both groups to identify statistically significant risk factors,which were then used as independent variables for further multivariate Logistic regression analysis to explore the risk factors influencing the rupture of multiple intracranial aneurysms.Results:Univariate regression analysis indicated significant differences between the rupture group(n=52)and the non-rupture group(n=85)in terms of age,gender,hypertension,hyperlipidemia,atherosclerotic diseases,maximum aneurysm diameter,width,aspect ratio,and aneurysm location(all P<0.05).Younger age was associated with a higher likelihood of rupture(P<0.05).The rupture group had significantly greater maximum diameter,width,and aspect ratio than the non-rupture group(P<0.05).Aneurysms located in the anterior communicating artery,posterior communicating artery,middle cerebral artery,and basilar artery had higher rupture rates compared to aneurysms in other locations(P<0.05).Multivariate Logistic regression analysis identified gender(OR=3.664,95%CI:1.577~8.515,P=0.003),maximum aneurysm diameter(OR=1.405,95%CI:1.130~1.747,P=0.002),and aneurysm location as independent risk factors for the rupture of multiple intracranial aneurysms.Specifically,aneurysms in the anterior communicating artery(OR=26.747,95%CI:5.384~132.883,P<0.001)and posterior communicating artery(OR=15.288,95%CI:3.659~63.885,P<0.001)had the highest risk of rupture.Hyperlipidemia was identified as an independent protective factor against the rupture of multiple intracranial aneurysms(OR=0.103,95%CI:0.026~0.405,P=0.001).Conclusion:Gender,maximum aneurysm diameter,and aneurysm location are independent risk factors for the rupture of multiple intracranial aneurysms,while hyperlipidemia is an independent protective factor.These findings provide crucial evidence for the development of personalized preventive strategies for unruptured aneurysms in patients with multiple intracranial aneurysms.