1 徐州医科大学附属医院神经外科，江苏 徐州 221006
目的：分析不同形态学分型的大脑中动脉分叉处动脉瘤预后的影响因素，从而为在临床上预测动脉瘤患者的预后及制定诊疗方案提供依据。方法：回顾性分析2014年1月至2019年1月就诊于徐州医科大学附属医院的大脑中动脉分叉处动脉瘤患者，并根据CT血管造影(CT angiography，CTA)对动脉瘤进行解剖形态学分型，分析4种类型预后及术后脑梗死发生率有无差异，搜集可能影响患者预后的临床及形态学因素，进行单因素及多因素logistic回归分析，探究影响预后的因素。结果：共搜集符合条件病例93例，I型31(33.3%)例，II型19例(20.4%)，III型30例(32.3%)，IV型13例(14.0%)，4种类型预后无明显差异(χ2=7.603，P=0.055)。年龄(χ2=18.422，P<0.001)、高血压病史(χ2=4.232，P=0.036)、术后脑梗死(χ2=25.522，P<0.001)、术前Hunt-Hess分级(χ2=12.319，P=0.001)对患者预后存在影响。对4种分型的动脉瘤患者术后脑梗死进行分析，发现IV型动脉瘤术后脑梗死发生率高于其他3种类型(χ2=8.422，P=0.038)，差别有统计学意义。多因素logistic回归分析显示：术后脑梗死(OR=0.184，P=0.022)、年龄(OR=1.010，P=0.022)、术前Hunt-Hess分级(OR=2.683，P=0.025)是影响大脑中动脉分叉处动脉瘤预后的独立风险因素。结论：术后并发症、术前Hunt-Hess分级、年龄是影响大脑中动脉分叉处动脉瘤预后的独立危险因素。4种类型的动脉瘤预后无明显差异，但IV型大脑中动脉分叉处动脉瘤术后脑梗死发生率高于其他3种类型。关键词： 大脑中动脉分叉处动脉瘤；形态学特征；临床特征；预后
Analysis of prognostic factors affecting aneurysms in middle cerebral artery bifurcation of different types
CorrespondingAuthor:LI Zhonglin Email: firstname.lastname@example.org
Foundation: This work was supported by the National Natural Science Foundation of China (81772665).
Objective: To analyze the morphological type and clinical factors that affect the prognosis of aneurysms at bifurcation of middle cerebral artery, and to provide certain scientific basis for predicting the prognosis of patients with aneurysms in clinical practice and making diagnosis and treatment plans. Methods: Patients with aneurysm in the bifurcation of the middle cerebral artery, hospitalized in the Affiliated Hospital of Xuzhou Medical University, were analyzed retrospectively, and according to the CT angiography (CTA), digital subtraction angiography (DSA) as a diagnostic basis, such as the examination to dissection aneurysm form for credit, analysis four types prognosis have differences, collect and analysis the clinical factors that may affect the prognosis of patients. Results: Type I 31 (33.3%) cases, type II 19 cases (20.4%), type III 30 cases (32.3%), type IV 13 cases (14.0%). Prognosis was no difference among the 4 types (χ2=7.603, P=0.055). Postoperative complications in patients with the four types of aneurysms were analyzed, and postoperative infarction rates of the type IV aneurysms were higher than that of the other 3 types (P=0.034), the difference was statistically significant. Clinical factors including gender, age, history of hypertension, preoperative Hunt-Hess grade, aneurysm size and postoperative complications were collected, and it was found that age (χ2=18.422, P<0.001), history of hypertension (χ2=4.232, P=0.036), postoperative infarction (χ2=25.522, P<0.001) and preoperative Hunt-Hess grade (χ2=12.319, P=0.001) had an effect on the prognosis of patients. Multivariate analysis showed that postoperative infarction (OR=0.184, P=0.022), age (OR=1.010, P=0.022), and preoperative Hunt-Hess grade (OR=2.683, P=0.025) were independent risk factors for middle cerebral artery bifurcation aneurysms. Conclusion: Postoperative infarction, preoperative Hunt-Hess grade and age are independent risk factors for the prognosis of middle cerebral artery bifurcation aneurysms. Postoperative infarction rates of type IV middle cerebral artery bifurcation aneurysm was higher than that of the other 3 types.Keywords： middle cerebral artery bifurcation aneurysm; morphological characteristics; clinical features; prognosis