【摘要】 目的　探讨脑动静脉畸形 (AVM)出血的血管构筑学危险因素。方法　全脑血管DSA检查诊断为脑AVM 2 0 1例 ,对其中 6 0例行血管内栓塞治疗。根据脑AVM血管造影特点 ,将出血可疑危险因素分 14项 4 5个水平运用SAS软件进行统计分析。结果　供血动脉与引流静脉平均直径的平方和之比 (∑D2A/∑D2 v)属偏态分布 ,秩和检验显示两组差异有显著性 (P <0 .0 0 0 1) ,随其值增大 ,出血组所占比例越大。综合卡方检验和Logistic单因素、全因素以及逐步回归分析结果显示 ,∑D2 A/∑D2v 和引流静脉受损为脑AVM出血的危险因素 ,且前者危险度大于后者。结论　由DSA图像分析 ,∑D2 A/∑D2v 升高以及引流静脉受损造成脑AVM内血流压力增高 ,致使管壁的薄弱点破裂是其出血的根源。∑D2 A/∑D2v宜作为评价脑AVM出血的主要指标 ,建议以大于 0 .5为判断出血危险度的临界点。更多还原

【Abstract】 Objective To investigate the hemorrhagic risk factors of cerebral arteriovenous malformations (AVM) on angioarchitecture. Methods 201 cases with AVM diagnosed by digtial subtraction angiography (DSA), including 60 cases by superselective DSA, were devided into two groups. The bleeding group consisted of 138 (68.66%) cases, with ages ranging from 7 to 60 years (average 26 years). The nonbleeding group had 63 (31.34%) cases, whose ages ranged from 11 to 68 years (average 37 years). 14 risk factors with 45 levels were studied by SAS Statistical package. Results The proportion of the total value of square of mean diameters was in partial distribution between the supplying arteries and drainage veins (∑D 2 A/∑D 2 v) in the two groups. Rank sum tests showed significant difference ( P <0.0001) between the two groups. The bigger the ∑D 2 A/∑D 2 v, the more possible would be the bleeding group. Chi square tests and single, multivariate and stepwise variate Logistic regression analyses demonstrated the ∑D 2 A/∑D 2 v and the damage of drainage veins were the risk factors of AVM hemorrhage, and the former was the more dangerous one. Conclusions There are two major hemorrhagic risk factors of AVM on angioarchitecture. The first is the higher proportion of the total value of square of mean diameters between the supplying arteries and drainage vains (∑D 2 A/∑D 2 v), the other is the damage of drainage vains. So ∑D 2 A/∑D 2 v should be an optimal index to evaluate AVM bleeding, and 0.5 is suggested to be a critical threshold.更多还原