颅内动脉瘤破裂并发脑内血肿的危险因素
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摘要
目的探讨颅内动脉瘤破裂并发脑内血肿(ICH)的危险因素。方法回顾性分析2014年9月至2018年9月收治的颅内破裂动脉瘤425例的临床资料,采用多因素Logistic回归分析检验并发ICH的危险因素,采用受试者工作特征(ROC)曲线分析影响因素截断值。结果 425例中,合并ICH 107例。多因素Logistic回归分析显示,合并高血压、合并糖尿病、动脉瘤位于大脑前动脉及大脑中动脉、动脉瘤直径较大是合并ICH的独立危险因素(P<0.05)。ROC曲线分析显示以动脉瘤直径=1.1 cm预测颅内动脉瘤破裂合并ICH的曲线下面积为0.736,灵敏度为78.3%,特异度为64.1%。结论合并高血压、合并糖尿病、动脉瘤位于大脑前及大脑中动脉,以及动脉瘤直径在1.1 cm以上的颅内动脉瘤病人,一旦动脉瘤破裂,合并ICH风险较高,临床注意防治。
Objective To explore the risk factors of intracranial aneurysm rupture complicated with intracerebral hematoma(ICH). Methods The clinical data of 425 patients with ruptured intracranial aneurysm who were hospitalized from September, 2007 to September, 2018 were analyzed retrospectively. The risk factors of intracranial aneurysm rupture complicated with ICH were analyzed by multivariate Lgistic regression. The best cut-off values of risk factors were analyzed by receiver operator characteristic(ROC) curve.Results Of 425 patients with ruptured intracranial aneurysm, 107 patients were complicated with ICH. The multivariate Logistic regression analysis showed that the independent risk factors of intracranial aneurysm rupture complicated with ICH inclued hypertension, diabetes, aneurysms locating at middle and anterior cerebral arteries, and the diameter of aneurysm(P<0.05). The ROC curve analysis showed the best cut-off value of the diameter of aneurysm to predict the intracranial aneurysm rupture complicated with ICH was 1.1 cm, of which the area under curve was 0.736, the sensitivity was 78.3% and the specificity was 64.1%. Conclusions The close attention should be paid to the intracranial aneurysm patients who are associated with hypertension, diabetes, aneurysms locating at the anterior and middle cerebral arteries, and intracranial aneurysm diameter more than 1.1 cm, because they have high risk of developing ICH after the intracranial aneurysm rupture.
Objective To explore the risk factors of intracranial aneurysm rupture complicated with intracerebral hematoma(ICH). Methods The clinical data of 425 patients with ruptured intracranial aneurysm who were hospitalized from September, 2007 to September, 2018 were analyzed retrospectively. The risk factors of intracranial aneurysm rupture complicated with ICH were analyzed by multivariate Lgistic regression. The best cut-off values of risk factors were analyzed by receiver operator characteristic(ROC) curve.Results Of 425 patients with ruptured intracranial aneurysm, 107 patients were complicated with ICH. The multivariate Logistic regression analysis showed that the independent risk factors of intracranial aneurysm rupture complicated with ICH inclued hypertension, diabetes, aneurysms locating at middle and anterior cerebral arteries, and the diameter of aneurysm(P<0.05). The ROC curve analysis showed the best cut-off value of the diameter of aneurysm to predict the intracranial aneurysm rupture complicated with ICH was 1.1 cm, of which the area under curve was 0.736, the sensitivity was 78.3% and the specificity was 64.1%. Conclusions The close attention should be paid to the intracranial aneurysm patients who are associated with hypertension, diabetes, aneurysms locating at the anterior and middle cerebral arteries, and intracranial aneurysm diameter more than 1.1 cm, because they have high risk of developing ICH after the intracranial aneurysm rupture.
引文
[1] Chen J, Zhu J, He J, et al. Ultra-early microsurgical treatment within 24 h of SAH improves prognosis of poor-grade aneurysm combined with intracerebral hematoma[J]. Oncol Lett, 2016, 11(5):3173-3178.
[2] Wan A, Jaja BN, Schweizer TA, et al. Clinical characteristics and outcome of aneurysmal subarachnoid hemorrhage with intracerebral hematoma[J]. J Neurosurg, 2016, 125(6):1344-1351.
[3] Darkwah Oppong M, Skowronek V, Pierscianek D, et al. Aneurysmal intracerebral hematoma:Risk factors and surgical treatment decisions[J]. Clin Neurol Neurosurg, 2018,173:1-7.
[4]李斐,陈谦学,陈治标,等.不同手术策略治疗动脉瘤性颅内血肿并脑疝的疗效分析[J].医学研究杂志,2017,46(10):4-6,10.
[5] Talamonti G, Nichelatti M, Al Mashni AA, et al. Lifethreatening cerebral hematoma owing to aneurysm rupture[J]. World Neurosurg, 2016, 85:215-227.
[6] Nemoto M, Masuda H, Sakaeyama Y, et al. Clinical characteristics of subarachnoid hemorrhage with an intracerebral hematoma and prognostic factors[J]. J Stroke Cerebrovasc Dis, 2018, 27(5):1160-1166.
[7] Bohnstedt BN, Nguyen HS, Kulwin CG, et al. Outcomes for clip ligation and hematoma evacuation associated with 102patients with ruptured middle cerebral artery aneurysms[J].World Neurosurg, 2013, 80(3-4):335-341.
[8]常青,窦以河,李照建,等.大脑中动脉瘤影像学特点分析[J].青岛大学医学院学报,2013,49(4):357-358.
[9] Investigators UJ, Morita A, Kirino T, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort[J]. N Engl J Med, 2012, 366(26):2474-2482.
[10] Walsh KB, Woo D, Sekar P, et al. Untreated hypertension:a powerful risk factor for lobar and non-lobar intracerebral hemorrhage in Whites, Blacks, and Hispanics[J]. Circulation, 2016,134(19):1444-1452.
[11] Boulanger M, Poon MT, Wild SH, et al. Association between diabetes mellitus and the occurrence and outcome of intracerebral hemorrhage[J]. Neurology, 2016, 87(9):870-878.
[2] Wan A, Jaja BN, Schweizer TA, et al. Clinical characteristics and outcome of aneurysmal subarachnoid hemorrhage with intracerebral hematoma[J]. J Neurosurg, 2016, 125(6):1344-1351.
[3] Darkwah Oppong M, Skowronek V, Pierscianek D, et al. Aneurysmal intracerebral hematoma:Risk factors and surgical treatment decisions[J]. Clin Neurol Neurosurg, 2018,173:1-7.
[4]李斐,陈谦学,陈治标,等.不同手术策略治疗动脉瘤性颅内血肿并脑疝的疗效分析[J].医学研究杂志,2017,46(10):4-6,10.
[5] Talamonti G, Nichelatti M, Al Mashni AA, et al. Lifethreatening cerebral hematoma owing to aneurysm rupture[J]. World Neurosurg, 2016, 85:215-227.
[6] Nemoto M, Masuda H, Sakaeyama Y, et al. Clinical characteristics of subarachnoid hemorrhage with an intracerebral hematoma and prognostic factors[J]. J Stroke Cerebrovasc Dis, 2018, 27(5):1160-1166.
[7] Bohnstedt BN, Nguyen HS, Kulwin CG, et al. Outcomes for clip ligation and hematoma evacuation associated with 102patients with ruptured middle cerebral artery aneurysms[J].World Neurosurg, 2013, 80(3-4):335-341.
[8]常青,窦以河,李照建,等.大脑中动脉瘤影像学特点分析[J].青岛大学医学院学报,2013,49(4):357-358.
[9] Investigators UJ, Morita A, Kirino T, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort[J]. N Engl J Med, 2012, 366(26):2474-2482.
[10] Walsh KB, Woo D, Sekar P, et al. Untreated hypertension:a powerful risk factor for lobar and non-lobar intracerebral hemorrhage in Whites, Blacks, and Hispanics[J]. Circulation, 2016,134(19):1444-1452.
[11] Boulanger M, Poon MT, Wild SH, et al. Association between diabetes mellitus and the occurrence and outcome of intracerebral hemorrhage[J]. Neurology, 2016, 87(9):870-878.