Analysis of risk factors and prognosis of anterior communicating artery aneurysm complicated with intraventricular hemorrhage in the elderly
ZHOU Jiafeng1, CHEN Yongchun1, LIN Boli1, CHEN Lifang1, XIONG Ye2, YANG Yunjun1
1.Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China; 2.Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
ZHOU Jiafeng,CHEN Yongchun,LIN Boli, et al. Analysis of risk factors and prognosis of anterior communicating artery aneurysm complicated with intraventricular hemorrhage in the elderly[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2020, 50(8): 652-656，661.
摘要目的：探讨老年人和中青年人前交通动脉（AComA）动脉瘤破裂后并发脑内血肿（ICH）和（或）脑室内血肿（IVH）的危险因素及预后。方法：回顾性纳入2007年12月至2016年1月温州医科大学附属第一医院神经外科收治的285例AComA动脉瘤破裂后并发ICH和（或）IVH的患者，其中95例行夹闭术，140例行栓塞治疗，50例行保守治疗。根据年龄将285例患者分2组：≤60岁168例，＞60岁117例。术前对所有患者行CTA检查，并测量动脉瘤的形态学参数。采用单因素和多因素logistic回归方法分析老年人和中青年人AComA动脉瘤破裂后合并ICH和（或）IVH的危险因素及预后。结果：单因素分析显示，2组患者性别、高血压
史、吸烟史、血管角度、入射角度、治疗方式及GOS评分差异有统计学意义（P＜0.05）。多因素logistic回归分析显示，高血压史（OR=1.858，95%CI=1.083～3.188，P=0.025），入射角度（OR=1.016，95%CI=1.004～1.028，P=0.010）和治疗方式（栓塞 vs. 保守治疗，OR=0.209，95%CI=0.088～0.497，P＜0.001；夹闭 vs. 保守治疗，OR=0.233，95%CI=0.101～0.541，P=0.001）与老年人AComA动脉瘤破裂后并发ICH和（或）IVH密切相关。老年组不同治疗方式的预后分析显示，接受外科治疗的患者预后相对较好[栓塞 vs. 保守治疗（OR=0.134，95%CI=0.049～0.362，P＜0.001）；夹闭 vs. 保守治疗（OR=0.308，95%CI=0.116～0.820，P=0.018）]。结论：高血压和较大动脉瘤入射角是AComA动脉瘤破裂后并发ICH和（或）IVH的危险因素，而老年人更加明显。老年组手术比率明显低于中青年组，但接受手术治疗后的老年组患者仍有较好的预后。
Abstract：Objective: To investigate the risk factors and prognosis of intracerebral and/or intraventricular hematoma (ICH and/or IVH) after rupture of AComA (anterior communicating artery) aneurysms in elderly and young patients. Methods: From December 2007 to January 2016, a total of 285 consecutive patients suffering from ruptured AComA aneurysms with ICH and/or IVH that admitted to the department of neurosurgery in the First Affiliated Hospital of Wenzhou Medical University, had been enrolled into this retrospective study. Among them, 172 patients underwent clipping, 244 patients underwent Coiling, and 64 patients underwent medical treatment. Patients were divided into two groups based on age:patients of age≤60 years (n=168) and patients of age>60 years (n=117). All patients had been examined by CT angiography (CTA) before surgery and the morphological parameters of the aneurysm had been measured. Single and multiple variate logistic regression methods were used to analyze the risk factors and prognosis of ruptured AComA aneurysms with ICH and/or IVH in elderly and young. Results: The univariate analysis revealed that the two groups had statistically significant differences in the gender, hypertension history, smoking history, vessel angle, flow angle, treatment and GOS score (all P<0.05). The multivariate analysis revealed that hypertension history (OR=1.858, 95%CI=1.083-3.188, P=0.025), flow angle (OR=1.016, 95%CI=1.004-1.028, P=0.010) and treatment (coiling vs. medical treatment OR=0.209, 95%CI=0.088-0.497, P<0.001; clipping vs. medical treatment OR=0.233, 95%CI=0.101-0.541, P=0.001) were closely associated with elderly patients of ruptured AComA aneurysms with ICH and/or IVH. The prognosis analysis of different treatment methods in the elderly group had showed that the prognosis of patients receiving surgical treatment was relatively good (coiling vs. medical treatment OR=0.134, 95%CI=0.049-0.362, P<0.001; clipping vs. medical treatment OR=0.308, 95%CI=0.116-0.820, P=0.018). Conclusion: Hypertension and bigger flow angle are the risk factors of ICH and/or IVH induced by ruptured AComA aneurysms, which is more obvious in the elderly. The operation rate of the elderly group is significantly lower than that of the young group, but the elderly patients after surgical treatment still has a better prognosis.
