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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2022, Vol. 10 ›› Issue (04) : 404 -407. doi: 10.3877/cma.j.issn.2095-5782.2022.04.011

神经介入

颅内动脉瘤破裂合并脑室出血的危险因素分析
李敬峰1, 赵林波1, 倪恒1, 贾振宇1, 曹月洲1, 施海彬1, 刘圣1,†()   
  1. 1. 210029　江苏南京，南京医科大学第一附属医院介入放射科
  • 收稿日期:2022-05-07 出版日期:2022-11-25
  • 通信作者: 刘圣

Risk factors affecting development of intraventricular hemorrhage in patients with aneurysmal subarachnoid hemorrhage

Jingfeng Li1, Linbo Zhao1, Heng Ni1, Zhenyu Jia1, Yuezhou Cao1, haibian Shi1, Sheng Liu1,†()   

  1. 1. Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Nanjing 210029, China
  • Received:2022-05-07 Published:2022-11-25
  • Corresponding author: Sheng Liu
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李敬峰, 赵林波, 倪恒, 贾振宇, 曹月洲, 施海彬, 刘圣. 颅内动脉瘤破裂合并脑室出血的危险因素分析[J]. 中华介入放射学电子杂志, 2022, 10(04): 404-407.

Jingfeng Li, Linbo Zhao, Heng Ni, Zhenyu Jia, Yuezhou Cao, haibian Shi, Sheng Liu. Risk factors affecting development of intraventricular hemorrhage in patients with aneurysmal subarachnoid hemorrhage[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 404-407.

目的

探讨颅内动脉瘤破裂合并脑室出血的危险因素。

方法

回顾性收集2017年1月至2020年8月于我中心收治的动脉瘤性蛛网膜下腔出血患者的临床和影像学资料，采用单因素和多因素Logistic回归方法分析颅内动脉瘤破裂合并脑室出血的危险因素。

结果

共纳入596例患者，其中合并脑室出血198例（33.2%）。单因素分析提示年龄、糖尿病史、动脉瘤最大径以及动脉瘤位于后循环与动脉瘤破裂合并脑室出血相关（P < 0.05）。多因素Logistic回归分析表明高龄（OR = 1.017，95%CI：1.001~1.033，P = 0.037）、有糖尿病史（OR = 2.545，95%CI：1.244~5.208，P = 0.011）、动脉瘤较大（OR = 1.101，95%CI：1.031~1.177，P = 0.004）和动脉瘤位于后循环（OR = 1.863，95%CI：1.104~3.144，P = 0.02）是动脉瘤破裂合并脑室出血发生的独立危险因素。

结论

患者高龄、伴有糖尿病史、动脉瘤较大及动脉瘤位于后循环与颅内动脉瘤破裂并发脑室出血相关。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, 脑室出血, 危险因素
Objective

To identify independent risk factors for intraventricular hemorrhage development caused by ruptured aneurysm.

Methods

From January 2017 to August 2020, the clinical and imaging data of patients with aneurysmal subarachnoid hemorrhage were analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors for intraventricular hemorrhage from ruptured aneurysm.

Results

A total of 596 patients who met the criteria were enrolled in this study, and intraventricular hemorrhage was present in 198 patients (33.2%).Univariate analysis showed that age, history of diabetes mellitus, aneurysm size, and aneurysm located at posterior circulation were related to intraventricular hemorrhage. Multivariate logistic regression analysis showed that increasing age (OR = 1.017, 95%CI: 1.001-1.033, P = 0.037), history of diabetes mellitus (OR = 2.545, 95%CI: 1.244-5.208, P = 0.011), increasing aneurysm size (OR = 1.101, 95%CI: 1.031-1.177, P = 0.004) and location in the posterior circulation (OR = 1.863, 95%CI: 1.104-3.144, P = 0.02) were independent risk factors for intraventricular hemorrhage development due to ruptured aneurysm.

Conclusions

Higher age, history of diabetes mellitus, increasing aneurysm size and location in the posterior circulation are associated with the occurrence of aneurysmal intraventricular hemorrhage.

Key words: Aneurysm, Subarachnoid Hemorrhage, Intraventricular hemorrhage, Risk factors.
表1 脑室出血形成的危险因素的单因素分析结果
因素 脑室出血(n = 198) 非脑室出血(n = 398) P值
性别[男(%)] 131 (0.66) 70 (0.18) 0.870
年龄(±s，岁) 60.33 ± 12.38 57.60 ± 11.03 0.009
高血压[例(%)] 128 (0.65) 225 (0.57) 0.058
高血脂[例(%)] 3 (0.02) 7 (0.02) 1.000
糖尿病[例(%)] 20 (0.10) 15 (0.04) 0.002
心脏病[例(%)] 15 (0.08) 26 (0.07) 0.636
吸烟史[例(%)] 22 (0.11) 38 (0.10) 0.550
血小板(×109/L) 194.00(145.75，258.00) 189.00(148.00，243.25) 0.482
凝血酶原时间(s) 12.3 (11.6，13.2) 12.2 (11.6，13.0) 0.389
活化部分凝血活酶时间(s) 29.3 (26.6，32.0) 28.55 (26.10，31.80) 0.121
纤维蛋白原(g/L) 2.66 (2.18，3.34) 2.73 (2.31，3.34) 0.302
凝血酶时间(s) 17.4 (16.00,19.32) 17.6 (16.4,19.00) 0.669
动脉瘤最大径(mm) 4.8 (3.6，6.9) 4.4 (3.3，6.1) 0.026
动脉瘤位置      
  颈内动脉-后交通[例(%)] 68 (0.34) 158 (0.40) 0.182
  大脑前动脉-前交通[例(%)] 69 (0.35) 125 (0.31) 0.434
  大脑中动脉[例(%)] 30 (0.15) 78 (0.20) 0.172
  后循环[例(%)] 31 (0.17) 37 (0.09) 0.011
表2 脑室出血形成的危险因素的Logistic多因素分析结果
因素 P值 OR 95%CI
年龄 0.037 1.017 1.001~1.033
高血压 0.261 1.235 0.855~1.786
糖尿病 0.011 2.545 1.244~5.208
动脉瘤最大径 0.004 1.101 1.031~1.177
后循环 0.020 1.863 1.104~3.144
图1 后循环破裂动脉瘤合并脑室出血典型病例1A：入院头颅CT平扫示蛛网膜下腔出血合并第四脑室出血；1B：术前CTA显示左侧小脑后下动脉远端动脉瘤(箭头指向示)，靠近第四脑室；1C：术中左侧椎动脉造影证实为左侧小脑后下动脉远端假性动脉瘤（三角形指向示）。
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