【摘要】 目的 探讨中老年颅内动脉粥样硬化性狭窄(ICAS)患者发生颅内动脉瘤(IA)的临床特点及其危险因素。方法 回顾性收集2020—2021年新乡医学院第一附属医院神经外科收治的中老年ICAS患者161例为研究对象。收集患者的临床资料及影像学资料。采用多因素Logistic回归分析探讨中老年ICAS患者发生IA的影响因素。结果 161例中老年ICAS患者中发生IA 91例(56.5%)，其中9例为多发IA，共观察到101个IA；IA位置：颈内动脉颅内段(55个，54.4%)、大脑中动脉(20个，19.8%)、大脑前动脉(15个，14.9%)、椎基底动脉(9个，8.9%)、大脑后动脉(2个，2.0%)；颅内动脉粥样硬化斑块与IA的位置关系：斑块位于IA近心端55例(60.4%)，斑块位于IA瘤壁上3例(3.2%)，斑块位于IA远心端14例(15.3%)，斑块在IA近、远心端均有分布19例(20.9%)。根据是否发生IA将患者分为IA组(n=91)和非IA组(n=70)。两组女性占比、有吸烟史者占比、有高血压史者占比、有高同型半胱氨酸血症史者占比、颅内动脉狭窄程度比较，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，女性〔OR=1.922，95%CI(1.022～3.612)〕、有吸烟史〔OR=2.261，95%CI(1.055～4.844)〕、有高血压史〔OR=1.980，95%CI(1.023～3.832)〕、有高同型半胱氨酸血症史〔OR=2.098，95%CI(1.048～4.198)〕、中度狭窄及重度狭窄〔OR=2.851，95%CI(1.493～5.444)〕为中老年ICAS患者发生IA的独立危险因素(P<0.05)。结论 中老年ICAS患者IA发生率较高，以颈内动脉颅内段IA及斑块位于IA近心端为主。女性、有吸烟史、有高血压史、有高同型半胱氨酸血症史、中度狭窄及重度狭窄为中老年ICAS患者发生IA的独立危险因素。更多还原

【Abstract】 Objective To investigate the clinical characteristics and risk factors of intracranial aneurysms (IA) in middle-aged and elderly patients with intracranial atherosclerotic stenosis (ICAS).Methods A total of 161 middle-aged and elderly patients with ICAS admitted to the Department of Neurosurgery of the First Affiliated Hospital of Xinxiang Medical University from 2020 to 2021 were selected as the study subjects.Clinical and imaging data of the patients were collected.Multivariate Logistic regression analysis was used to explore the influencing factors of IA in middle-aged and elderly patients with ICAS.Results Among 161 middle-aged and elderly patients with ICAS,91 cases (56.5%) developed IA,of which 9 cases had multiple IAs,and a total of 101 IAs were observed,with the distribution of IA locations being the intracrantion segment of the internal carotid artery (55 cases,54.4%),middle cerebral artery (20 cases,19.8%),anterior cerebral arteryartery (15 cases,14.9%),vertebral basilar artery (9 cases,8.9%) and posterior cerebral artery (2 cases,2.0%).The location relationship between intracranial atherosclerotic plaques and IA:plaques were located in the proximal end of IA in 55 cases (60.4%),plaques were located in the wall of the IA tumor in 3 cases (3.2%),plaques were located in the distal end of IA in 14 cases (15.3%),and plaques were located in the proximal and distal parts of IA in both distributions in 19 cases (20.9%).The patients were divided into the IA group (n=91) and the non-IA group (n=70) based on the occurrence of IA.There were significant differences in females,proportion of patients with smoking history,proportion of patients with hypertension history,proportion of patients with hyperhomocysteinemia history,and degree of intracranial artery stenosis between the two groups (P < 0.05).Multivariate Logistic regression analysis showed that females[OR=1.922,95%CI (1.022-3.612)],smoking history[OR=2.261,95%CI (1.055-4.844)],hypertension history[OR=1.980,95%CI (1.023-3.832)],hyperhomocysteinemia history[OR=2.098,95%CI (1.048-4.198)],and moderate to severe stenosis[OR=2.851,95%CI (1.493-5.444)]were independent risk factors for IA in middle-aged and elderly patients with ICAS (P < 0.05).Conclusion The incidence of IA is higher in middle-aged and elderly patients with ICAS,with a predominance of the intracranial segment of the internal carotid artery and plaque located proximal to the IA.Female,smoking history,hypertension history,hyperhomocysteinemia history and moderate to severe tenosis are independent risk factors for IA in middle-aged and elderly patients with ICAS.更多还原