脑动静脉畸形出血相关危险因素分析

发布时间：2018-02-13 19:45

本文关键词： 颅内动静脉畸形颅内出血危险因素 logistic回归　出处：《浙江大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：脑动静脉畸形(Brain arteriovenous malformations, BAVM)患者面临的最大风险即为畸形团破裂导致出血性脑卒中。目前引起BAVM出血的危险因素仍未完全明确。研究目的：分析总结BAVM出血的相关可能因素。研究方法：本研究回顾性分析了浙江大学医学院附属第二医院神经外科2013年4月-2014年3月收治的84例脑动静脉畸形患者临床资料,根据患者头颅CT情况分为出血组和非出血组,先进行单因素分析年龄、性别、病灶部位以及大小、供血数目、引流静脉、有无合并颅内其他血管异常等,再对于其中有显著性差异的结果行多因素Logistic回归分析。研究结果：在84例BAVM患者中：其中男性58人,女性26人,男女比例为2.23：1；年龄最小者3岁8个月,最大者为68岁,中位年龄31岁,平均年龄为35.25±15.65岁,21岁～30岁为高峰发病段,占总人数27.10%。出血组患者49人,以突发头痛、恶心呕吐为主要首发症状,14.3%(7例)以癫痫为首发症状；非出血组35位患者中,以反复头痛、头晕为主要首发症状,发生癫痫的患者占22.86%(8例)。BAVM位于幕上占84.5%,幕下占15.5%。枕叶以及小脑分别各占总数的15.47%；脑叶交界处的BAVM中,枕顶叶所占比例略大,为10.71%；位于脑深部(包括小脑)占29.76%。BAVM直径小于等于3cm较多见,占总人数的58.3%。根据Spetzler-Martin分级,Ⅰ级占21.43%,Ⅱ级25%,Ⅲ级占28.57%,1V级占16.67%,V级占8.33%,而Ⅵ级未见；合并动脉瘤、瘤样扩张以及硬脑膜动静脉瘘占21.4%(18例),其中合并动脉瘤占17.86%(15例)；动脉瘤样扩张伴局部血管狭窄2例,局部血管狭窄伴烟雾样血管改变1例；多支供血动脉占23.81%,其中多支伴穿支动脉供血占9.52%(8例)；有单纯深静脉引流占25.00%,单纯浅表静脉引流占71.42%,同时有深浅静脉引流占3.57%(3例)。出血相关危险因素分析显示：在年龄、性别、病灶部位以及大小、供血数目、引流静脉、有无合并颅内其他血管异常各单因素中,BAVM最大直径小于等于3cm(χ2=3.931p0.047)、BAVM在脑深部(χ2=10.467p0.001)、深静脉引流(χ2=2.900p0.089)为出血危险因素；对上述出血危险因素进行多因素Logistic分析得出,对BAVM出血有影响的是BAVM最大直径以及深静脉引流。结论：BAVM多见于青年,男性发病比例高于女性,BAVM多位于大脑半球浅表,供血动脉多为一支或两支,皮层浅表静脉引流多见,合并动脉瘤以及动静脉瘘约占1/5,Spetzler-Martin分级V级以上者少见。BAVM最大直径小于等于3cm、位于脑深部以及有深静脉引流为出血危险因素。
[Abstract]:Background: the greatest risk for brain arteriovenous malformations (BAVMs) is hemorrhagic stroke caused by the rupture of malformation. The risk factors of BAVM hemorrhage are not fully defined. Objective: to analyze and summarize the related factors of BAVM hemorrhage. Methods: the clinical data of 84 patients with cerebral arteriovenous malformation admitted from April 2013 to March 2014 in the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. The patients were divided into hemorrhage group and non-bleeding group according to the CT findings of the patient. Age, sex, location and size of the lesion, blood supply, drainage vein, and other intracranial vascular abnormalities were analyzed by univariate analysis. Then the multivariate Logistic regression analysis was performed for the results with significant differences. Results: among 84 patients with BAVM, 58 were male and 26 female, the ratio of male to female was 2.23: 1, the youngest was 3 years old and 8 months old, the largest was 68 years old, the median age was 31 years old, the mean age was 35.25 卤15.65 years old and 21 years old to 30 years old. In the bleeding group, 49 patients, with sudden headache, nausea and vomiting as the main initial symptoms of 14. 3%) epilepsy as the first symptom, 35 patients in the non-bleeding group, repeated headache, dizziness as the main initial symptoms, The occipital and cerebellar lobes accounted for 15.47% of the total, and the occipital lobe and cerebellum accounted for 15.47% of the total, and the occipital parietal lobe accounted for a slightly larger proportion of the BAVM at the junction of the cerebral lobes. The depth of the brain (including the cerebellum) is 29.76.BAVM is less than 3cm in diameter, accounting for 58.3 percent of the total number of people. According to the Spetzler-Martin classification, the first grade is 21.43, the second is 25, the third is 28.57V, the other is 16.67V, 8.33, but not in grade VI. There were 18 cases of aneurysm dilatation and dural arteriovenous fistula, of which 17.86 cases were associated with aneurysm, 2 cases were aneurysm dilatation with local vascular stenosis, 1 case was local vascular stenosis with smog vessel change. There were 8 cases with multiple perforating artery supply, 25.00% with deep venous drainage, 71.42% with superficial venous drainage, 3 cases with deep venous drainage and 3.57% with superficial venous drainage. Hemorrhage related risk factors analysis showed that: age, sex, location and size of lesion, blood supply, drainage vein, The maximum diameter of BAVM was less than 3 cm in each single factor (蠂 2: 3.931 p0.047) in the deep part of brain (蠂 2 + 10.467 p0.001) and deep venous drainage (蠂 2 + 2.900 p 0.089) as a risk factor for hemorrhage. The maximum diameter of BAVM and deep venous drainage were the main factors affecting the bleeding of BAVM. Conclusion the incidence rate of male BAVM is higher than that of female BAVM in the cerebral hemispheres, the blood supply artery is mostly one or two, and the superficial cortical venous drainage is more common. Aneurysms and arteriovenous fistulas accounted for less than 1 / 5 Spetzler-Martin grade V grade in rare cases. The maximum diameter of BAVM was less than or equal to 3 cm. Deep brain drainage and deep venous drainage were risk factors for bleeding.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.4

【参考文献】