颅内多发动脉瘤患者破裂与未破裂动脉瘤形态学特征对比研究

发布时间：2018-03-18 13:48

  本文选题：颅内多发动脉瘤　切入点：蛛网膜下腔出血　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的基于三维脑血管造影,通过对颅内多发囊性动脉瘤合并蛛网膜下腔出血患者中破裂动脉瘤与未破裂动脉瘤三维重建影像的对比分析,减少患者个体差异对动脉瘤破裂的影响及测量误差,探讨动脉瘤形态学特征相关指标与动脉瘤破裂风险的关系,从而探寻预测动脉瘤破裂风险的形态学因素,为更好的制定未破裂动脉瘤的临床决策提供依据。 方法回顾性分析天津市环湖医院自2011年09月至2013年12月收治的94例发生蛛网膜下腔出血的颅内多发囊性动脉瘤患者的病例资料,对其中有完整临床资料及本院三维脑血管造影资料且能明确责任动脉瘤的61例患者中的61个破裂动脉瘤与78个未破裂动脉瘤进行对比分析。在三维脑血管造影影像上,分析多发动脉瘤患者中破裂动脉瘤部位、大小、形状分布特征,测量破裂与未破裂动脉瘤的瘤颈宽度(Wneck)、瘤体高度(H)、瘤体长径(L)、瘤体宽径(W)、载瘤动脉直径(Dv)一维形态学参数,计算瘤体高度与瘤颈宽度的比值(AR)、瘤体高度与瘤体宽径的比值(HWR)、瘤体宽径与瘤颈宽度的比值(BN)、瘤体长径与载瘤动脉直径的比值(SR)二维形态学参数。对以上9项参数进行单因素分析,探讨其与动脉瘤破裂风险的关系,并对各参数进行受试者工作(ROC)曲线分析,以确定其曲线下面积及最佳临界值。将单因素分析中有意义各变量进行多因素logistic回归分析。为便于比较不同形态学指标与动脉瘤破裂相关程度,在进行多因素分析之前,将各连续变量转换为0-10的范围,使转换后的变量每增加1个单位对应其原变量10%的变化。 结果①颅内多发动脉瘤患者中破裂动脉瘤最常见于颈内动脉后交通段,但前交通动脉瘤及大脑前动脉瘤破裂率明显高于颅内其他位置的动脉瘤(P0.05)。②颅内多发动脉瘤患者中破裂动脉瘤最大径为(5.94±3.32)mm,大于未破裂动脉瘤(3.83±2.89)mm,二者具有统计学意义(P0.05),但6例(9.83%)患者中破裂动脉瘤并不是最大的那一个。最大径≤3mm、3mm但≤7mm、7mm者动脉瘤破裂率依次增高,分别为20.0%、58.5%、81.0%,具有统计学差异(P0.05),但61个破裂动脉瘤中,最大径≤3mm者13个(21.3%),最大径3mm但≤7mm者31个(50.8%),仅有17个(27.9%)动脉瘤最大径7mm,且各部位破裂动脉瘤中最大径7mm者所占比例均不超过1/3。③动脉瘤破裂的形态学因素研究中,单因素分析显示破裂与未破裂动脉瘤间Wneck、H、L、AR、BN、SR6项指标差异有统计学意义(P0.05),而W、Dv、HWR3项指标差异无统计学意义(P0.05)；多因素分析显示,只有AR、SR与动脉瘤破裂具有独立相关性,当AR、SR值增加10%,动脉瘤破裂风险性分别为原来的1.34、1.45倍。ROC曲线分析显示AR、SR具有较高的曲线下面积(分别为0.78、0.81),其最佳临界值分别为1.36、1.81。 结论①颅内多发动脉瘤中的破裂和未破裂动脉瘤可以作为研究动脉瘤形态学特征与破裂风险关系的理想模型,在一定程度上解决病例选择偏倚的影响。②微小动脉瘤在颅内破裂动脉瘤中占有一定的比例,蛛网膜下腔出血患者应当在经验丰富的脑血管病诊疗中心接受诊治。③颅内动脉瘤的破裂与动脉瘤位置、大小有关,但仅以此预测动脉瘤破裂风险不能完全反映动脉瘤的形态学及血流动力学特征。④动脉瘤AR、SR值是反映颅内动脉瘤几何特征和瘤内血流动力学的良好形态学指标,可作为评估动脉瘤破裂风险的参数,其数值越大,动脉瘤破裂的风险性越高,但目前预测动脉瘤破裂的AR、SR可靠的临界值尚无定论。在今后动脉瘤形态学特征与破裂风险关系的研究中,需要大样本前瞻性和长期随访的研究,这样才能在临床诊治中更好地运用相关形态学参数,准确预测动脉瘤发生破裂的危险程度,为未破裂颅内动脉瘤患者提供更加完善的术前评估,以做出更恰当的临床决策。
[Abstract]:The purpose of 3D DSA based, through comparison and analysis of the aneurysms and aneurysms rupture in patients with three-dimensional reconstruction of multiple intracranial aneurysms with subarachnoid hemorrhage, reduce the impact of individual differences in patients with rupture of the aneurysm and measurement errors, to explore the relationship between the risk of rupture related indicators of aneurysm morphology and aneurysm the morphological factors in order to explore the prediction of aneurysm rupture risk, provide the basis for clinical decision making better unruptured aneurysms.
Methods a retrospective analysis of Tianjin Huanhu Hospital from 2011 09 to December 2013 were 94 cases of subarachnoid hemorrhage patients with multiple intracranial saccular aneurysm cases with complete clinical data and the 3D angiographic data of 61 aneurysms and 61 cases of clear responsibility aneurysm in patients with 78 unruptured aneurysms were analyzed. In the 3D cerebral angiography image analysis, location of aneurysm rupture were multiple aneurysms in size, shape distribution, measurement of ruptured and unruptured aneurysm neck width (Wneck), the tumor body height (H), tumor size (L), tumor diameter (W), the parent artery diameter (Dv) one dimensional morphological parameters, calculation of the ratio of tumor body height and neck width (AR), the ratio of height and width of tumor tumor diameter (HWR), the ratio of tumor body width and neck width (BN), tumor the body length and diameter The ratio of parent artery diameter (SR) parameters of two-dimensional morphology. Single factor analysis of the above 9 parameters, and to explore the relationship between aneurysm rupture risk, and the subjects of each parameter (ROC) curve analysis, to determine the area under the curve and the optimal critical value. Single factor analysis logistic multi factor regression analysis of each variable. In order to compare different morphological indexes related with aneurysm rupture, before the multi factor analysis, the continuous transformation of each variable to 0-10 range, the conversion of the variable changes each increase of 1 single bits corresponding to the original 10% variables.
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