本文關(guān)鍵詞： 顱內(nèi)動(dòng)靜脈畸形 顱內(nèi)出血 危險(xiǎn)因素 logistic回歸　出處：《浙江大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景：腦動(dòng)靜脈畸形(Brain arteriovenous malformations, BAVM)患者面臨的最大風(fēng)險(xiǎn)即為畸形團(tuán)破裂導(dǎo)致出血性腦卒中。目前引起B(yǎng)AVM出血的危險(xiǎn)因素仍未完全明確。 研究目的：分析總結(jié)BAVM出血的相關(guān)可能因素。 研究方法：本研究回顧性分析了浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院神經(jīng)外科2013年4月-2014年3月收治的84例腦動(dòng)靜脈畸形患者臨床資料,根據(jù)患者頭顱CT情況分為出血組和非出血組,先進(jìn)行單因素分析年齡、性別、病灶部位以及大小、供血數(shù)目、引流靜脈、有無合并顱內(nèi)其他血管異常等,再對(duì)于其中有顯著性差異的結(jié)果行多因素Logistic回歸分析。 研究結(jié)果：在84例BAVM患者中：其中男性58人,女性26人,男女比例為2.23：1；年齡最小者3歲8個(gè)月,最大者為68歲,中位年齡31歲,平均年齡為35.25±15.65歲,21歲～30歲為高峰發(fā)病段,占總?cè)藬?shù)27.10%。出血組患者49人,以突發(fā)頭痛、惡心嘔吐為主要首發(fā)癥狀,14.3%(7例)以癲癇為首發(fā)癥狀；非出血組35位患者中,以反復(fù)頭痛、頭暈為主要首發(fā)癥狀,發(fā)生癲癇的患者占22.86%(8例)。BAVM位于幕上占84.5%,幕下占15.5%。枕葉以及小腦分別各占總數(shù)的15.47%；腦葉交界處的BAVM中,枕頂葉所占比例略大,為10.71%；位于腦深部(包括小腦)占29.76%。BAVM直徑小于等于3cm較多見,占總?cè)藬?shù)的58.3%。根據(jù)Spetzler-Martin分級(jí),Ⅰ級(jí)占21.43%,Ⅱ級(jí)25%,Ⅲ級(jí)占28.57%,1V級(jí)占16.67%,V級(jí)占8.33%,而Ⅵ級(jí)未見；合并動(dòng)脈瘤、瘤樣擴(kuò)張以及硬腦膜動(dòng)靜脈瘺占21.4%(18例),其中合并動(dòng)脈瘤占17.86%(15例)；動(dòng)脈瘤樣擴(kuò)張伴局部血管狹窄2例,局部血管狹窄伴煙霧樣血管改變1例；多支供血?jiǎng)用}占23.81%,其中多支伴穿支動(dòng)脈供血占9.52%(8例)；有單純深靜脈引流占25.00%,單純淺表靜脈引流占71.42%,同時(shí)有深淺靜脈引流占3.57%(3例)。 出血相關(guān)危險(xiǎn)因素分析顯示：在年齡、性別、病灶部位以及大小、供血數(shù)目、引流靜脈、有無合并顱內(nèi)其他血管異常各單因素中,BAVM最大直徑小于等于3cm(χ2=3.931p0.047)、BAVM在腦深部(χ2=10.467p0.001)、深靜脈引流(χ2=2.900p0.089)為出血危險(xiǎn)因素；對(duì)上述出血危險(xiǎn)因素進(jìn)行多因素Logistic分析得出,對(duì)BAVM出血有影響的是BAVM最大直徑以及深靜脈引流。 結(jié)論：BAVM多見于青年,男性發(fā)病比例高于女性,BAVM多位于大腦半球淺表,供血?jiǎng)用}多為一支或兩支,皮層淺表靜脈引流多見,合并動(dòng)脈瘤以及動(dòng)靜脈瘺約占1/5,Spetzler-Martin分級(jí)V級(jí)以上者少見。BAVM最大直徑小于等于3cm、位于腦深部以及有深靜脈引流為出血危險(xiǎn)因素。
[Abstract]:Background: the greatest risk for brain arteriovenous malformations (BAVMs) is hemorrhagic stroke caused by the rupture of malformation. The risk factors of BAVM hemorrhage are not fully defined. Objective: to analyze and summarize the related factors of BAVM hemorrhage. Methods: the clinical data of 84 patients with cerebral arteriovenous malformation admitted from April 2013 to March 2014 in the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. The patients were divided into hemorrhage group and non-bleeding group according to the CT findings of the patient. Age, sex, location and size of the lesion, blood supply, drainage vein, and other intracranial vascular abnormalities were analyzed by univariate analysis. Then the multivariate Logistic regression analysis was performed for the results with significant differences. Results: among 84 patients with BAVM, 58 were male and 26 female, the ratio of male to female was 2.23: 1, the youngest was 3 years old and 8 months old, the largest was 68 years old, the median age was 31 years old, the mean age was 35.25 鹵15.65 years old and 21 years old to 30 years old. In the bleeding group, 49 patients, with sudden headache, nausea and vomiting as the main initial symptoms of 14. 3%) epilepsy as the first symptom, 35 patients in the non-bleeding group, repeated headache, dizziness as the main initial symptoms, The occipital and cerebellar lobes accounted for 15.47% of the total, and the occipital lobe and cerebellum accounted for 15.47% of the total, and the occipital parietal lobe accounted for a slightly larger proportion of the BAVM at the junction of the cerebral lobes. The depth of the brain (including the cerebellum) is 29.76.BAVM is less than 3cm in diameter, accounting for 58.3 percent of the total number of people. According to the Spetzler-Martin classification, the first grade is 21.43, the second is 25, the third is 28.57V, the other is 16.67V, 8.33, but not in grade VI. There were 18 cases of aneurysm dilatation and dural arteriovenous fistula, of which 17.86 cases were associated with aneurysm, 2 cases were aneurysm dilatation with local vascular stenosis, 1 case was local vascular stenosis with smog vessel change. There were 8 cases with multiple perforating artery supply, 25.00% with deep venous drainage, 71.42% with superficial venous drainage, 3 cases with deep venous drainage and 3.57% with superficial venous drainage. Hemorrhage related risk factors analysis showed that: age, sex, location and size of lesion, blood supply, drainage vein, The maximum diameter of BAVM was less than 3 cm in each single factor (蠂 2: 3.931 p0.047) in the deep part of brain (蠂 2 + 10.467 p0.001) and deep venous drainage (蠂 2 + 2.900 p 0.089) as a risk factor for hemorrhage. The maximum diameter of BAVM and deep venous drainage were the main factors affecting the bleeding of BAVM. Conclusion the incidence rate of male BAVM is higher than that of female BAVM in the cerebral hemispheres, the blood supply artery is mostly one or two, and the superficial cortical venous drainage is more common. Aneurysms and arteriovenous fistulas accounted for less than 1 / 5 Spetzler-Martin grade V grade in rare cases. The maximum diameter of BAVM was less than or equal to 3 cm. Deep brain drainage and deep venous drainage were risk factors for bleeding.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.4

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