伴随动眼神经麻痹后交通动脉瘤血液动力学机制研究

发布时间：2019-04-01 20:01

【摘要】：目的:颅内动脉瘤的发生、发展、稳定或者破裂与血流动力学密切相关。但以往的血流动力学研究都是基于破裂和未破裂动脉瘤,而忽略破裂事件可能对动脉瘤形态的影响而导致血流动力学参数的改变。本研究主要应用计算机数值模拟技术探讨伴随动眼神经麻痹后交通动脉瘤的血流动力学特征。方法:连续选择2015年1月至12月在皖南医学院弋矶山医院神经外科血管组接受脑血管造影并诊断为伴随动眼神经麻痹的后交通动脉瘤14枚,以及破裂后交通动脉瘤30枚。重建三维脑血管造影图像获得合格特异性动脉瘤模型,并应用计算流体力学(computational fluid dynamics CFD)的数值模拟的方法分析伴随动眼神经麻痹后交通动脉瘤的血流动力学特征。结果:18例破裂后交通动脉的血流流动模式Ⅲ,12例是Ⅳ,而伴动眼神经麻痹的后交通动脉瘤有8例属于Ⅲ,6例属于Ⅳ。两者都属于不稳定的流动模式。平均壁面切应力(wall shear stress WSS)伴随动眼神经麻痹组明显低于破裂后交通动脉瘤组(7.96±3.03 vs 13.78±1.17,P=0.01)。破裂组低壁面切应力面积百分数(LSA%)明显低于动眼神经麻痹组[3.23(2.32,3.24)%vs 9.17(8.35,12.05)%,P0.01]。然而,两组间的剪切振荡系数(oscillatory shear index OSI)(0.04±0.338vs 0.018±0.004,P=0.48),归一化的WSS(normalized wall shear stress NWSS)(0.53±0.26 vs 0.86±0.34,p=0.15)都没有明显差异。年龄(p=0.12)、性别(p=0.75)、高血压(p=0.46)、糖尿病(P=0.82)、吸烟(p=0.87)等临床特征在两组之间也无明显差异。结论:伴随动眼神经麻痹的后交通动脉瘤有很高的破裂风险,研究此种类型的动脉瘤对临床血流动力学的研究具有极其重要的意义。高LSA%以及低WSS可能是最终导致伴随动眼神经麻痹的后交通动脉瘤的破裂的原因。年龄、性别、高血压、糖尿病、吸烟等临床特征并不影响动眼神经麻痹后交通动脉瘤的破裂风险。基于影像学的计算机流体力学在评估颅内动脉瘤破裂风险方面具有重要意义。现在的研究表明无论是高或者低的WSS都能导致动脉瘤的生长和破裂。这些不同结果的产生有可能源自于不同参数的定义,研究样本量过小,或者是颅内动脉瘤生长和破裂内在的复杂性。但Meng等提出了统一的假设:高或者低的WSS分别通过壁细胞介导和炎症细胞介导的破坏性重建通路促进动脉瘤的生长和破裂。我们也回顾性分析了各个文献中不同WSS参数的定义和近期计算机流体力学的研究。未来,我们期待更大的数据、更好的数据分析方法、以及更全面血液动力学生物机制的理解。这些都能有助于提供更准确颅内动脉瘤风险评估预测模型。
[Abstract]:Objective: the occurrence, development, stability or rupture of intracranial aneurysms is closely related to hemodynamics. However, previous hemodynamic studies were based on ruptured and unruptured aneurysms and ignored the effects of ruptured events on the morphology of aneurysms, which resulted in changes in hemodynamic parameters. In this study, the hemodynamic characteristics of communicating aneurysms associated with oculomotor nerve paralysis were studied by computer numerical simulation. Methods: 14 posterior communicating artery aneurysms with oculomotor paralysis and 30 ruptured posterior communicating aneurysms were selected from January to December 2015 in the neurosurgical vessel group of Yijishan Hospital of Southern Anhui Medical College and diagnosed as posterior communicating aneurysms with oculomotor paralysis. Three-dimensional cerebral angiography images were reconstructed to obtain a qualified and specific aneurysm model. The hemodynamic characteristics of communicating aneurysms associated with oculomotor nerve paralysis were analyzed by numerical simulation of computational fluid dynamics (computational fluid dynamics CFD). Results: of the 18 cases of ruptured posterior communicating artery, 12 cases were 鈪，

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