动脉瘤性蛛网膜下腔出血动脉瘤特征及其与临床相关性研究

目的 探讨蛛网膜下腔出血患者动脉瘤瘤径大小与其位置及临床分级之间的关系。方法 回顾性分析动脉瘤性蛛网膜下腔出血患者的临床相关资料， 包括年龄、 性别、 动脉瘤瘤径大小、 位置、 Hunt-Hess （H-H） 分级等。通过对 CT、 数字减影血管造影 （DSA）、 磁共振血管造影 （MRA） 等图像判读， 将动脉瘤按照瘤径大小 （A 组 d＜5.00 mm、B 组 5.00 mm≤d＜10.00 mm、 C 组 d≥10.00 mm）、 发生位置及 H-H 分级进行分类， 观察动脉瘤瘤径大小与位置、 分级 之间的关系。结果 实际可纳入 750 例 （多发动脉瘤患者中瘤径包含 A、 B、 C 3 组 1 例， 包含 A、 B 2 组 2 例， 包含 A、C 2 组 2 例， 包含 B、 C 2 组 3 例）， 平均年龄（56.14±11.88）岁， 其中男 292 例， 女 458 例。共检出动脉瘤 903 个， 多发性动脉瘤 91 例 （12.13%）。A、 B、 C3 组动脉瘤在大脑前动脉、 大脑中动脉、 大脑后动脉、 颈内动脉、 前交通动脉、 椎-基底系统动脉的发生数及比例分别为 20（3.9%）、 12（3.8%）、 5（7.5%）； 70（13.6%）、 39（12.2%）、 10（14.9%）； 2（0.4%）、 4（1.3%）、 2 （3.0%）； 112 （21.7%）、 70 （21.9%）、 36 （53.7%）； 165 （32.0%）、 94 （29.4%）、 6 （9.0%）； 130 （25.2%）、 90 （28.1%）、 6（9.0%）； 17（3.3%）、 11（3.4%）、 2（3.0%）。A、 B、 C3 组动脉瘤在 H-H 分级Ⅰ、 Ⅱ、 Ⅲ、 Ⅳ、 Ⅴ的发生数及比例分别为 48（9.3%）、 45（14.1%）、 12（17.9%）； 228（44.2%）、 150（46.9%）、 14（20.9%）； 68（13.2%）、 54（16.9%）、 30（44.8%）； 142（27.5%）、 43 （13.4%）、 9 （13.4%）； 30 （5.8%）、 28 （8.8%）、 2 （3.0%）。动脉瘤瘤径大小与 H-H 分级呈负相关 （rs=-0.075，P=0.024）。结论前交通动脉、 后交通动脉处为较小动脉瘤高发部位， 颈内动脉处为较大动脉瘤高发部位； 瘤径大小与 H-H 分级呈负相关。

Research on the relationship between characteristics of aneurysm after aneurysmal subarachnoid hemorrhage and its clinical classification#br#

Objective To explore the relationship between the size and location of the aneurysm after subarachnoid hemorrhage (aSAH) and its clinical classification. Methods A retrospective study was performed in patients with aSAH from January 1, 2008 to December 31, 2014. The relevant clinical data were collected including age, gender, aneurysm size, location, and Hunt-Hess (H-H) classification. The aneurysms were classified by size (A group d＜5.00 mm, B group 5.00 mm≤d＜10.00 mm, C group d≥10.00 mm), location and H-H classification according to the results of CT, digital subtraction angiography (DSA), and magnetic resonance angiography (MRA). The relationship between size, position of aneurysm and H-H classification was observed and analyzed. Results There were 750 cases included in this study, with average age (56.14±11.88), male 292 and female 458. The total number of aneurysms was 903, and the number of multiple aneurysms was 91 (12.13%). There was one case with multiple aneurysms that can be included in A, B and C groups. There were two cases with multiple aneurysms that can be included in A and B groups, two cases can be included in A and C groups, and three cases can be included in B and C groups. The number of aneurysms and the ratios of groups A, B and C were 20(3.9%), 12 (3.8%), 5 (7.5%), 70 (13.6%), 39 (12.2%), 10(14.9%), 2 (0.4%), 4 (1.3%), 2 (3.0%), 165 (32.0%), 94 (29.4%), 6(9.0%), 130 (25.2%), 90 (28.1%), 6 (9.0%), 17 (3.3%), 11 (3.4%) and 2 (3.0%) for the location in the anterior cerebral artery, the middle cerebral artery, the posterior cerebral artery, the internal carotid artery, the anterior communicating artery, the posterior communicating artery, and the vertebral basilar artery, respectively. The number of aneurysms and the ratios of H-H classificationⅠ， Ⅱ， Ⅲ， Ⅳand Ⅴin groups A, B and C were 48 (9.3%), 45 (14.1%), 12 (17.9%), 228 (44.2%), 150 (46.9%), 14 (20.9%), 68 (13.2%), 54 (16.9%), 30 (44.8%), 142 (27.5%), 43 (13.4%), 9 (13.4%), 30 (5.8%), 28 (8.8%) and 2 (3.0%). There was a negative correlation between the size of aneurysm and the H-H grade (rs=-0.075, P=0.024). Conclusion The anterior communicating artery and posterior communicating artery are high-risk areas for smaller aneurysms. The internal carotid artery is high-risk areas for larger aneurysms. The size of aneurysm is negatively correlated with H-H classification.