Hofmeister C, Stapf C, Hartmann A, Sciacca R R, Mansmann U, terBrugge K, Lasjaunias P, Mohr J P, Mast H, Meisel J
Berufsgenossenschaftliche Kliniken der Stadt Halle, Bergmannstrost, Halle/Saale, Germany.
Stroke. 2000 Jun;31(6):1307-10. doi: 10.1161/01.str.31.6.1307.
The purpose of this study was to assess demographic, clinical, and morphological characteristics of patients with brain arteriovenous malformations (AVMs).
Prospectively collected data of 1289 consecutive AVM patients from 3 independent databases (1 multicenter [Berlin/Paris/Middle and Far East, n=662] and 2 single centers [New York, n=337, and Toronto, n=290]) were analyzed. The variables assessed were age at diagnosis, sex, AVM size, AVM drainage pattern, AVM location in functionally important brain areas ("eloquence"), and type of presentation (hemorrhage, seizure, chronic headache, or focal neurologic deficit). Comparisons were made by ANOVA, contingency tables, and log-linear models.
Overall, mean age at diagnosis was 31.2 years (95% CI 30.2 to 32.2 years), and 45% of the patients were female (95% CI 42% to 47%). AVM maximum diameter was <3 cm in 38% (95% CI 35% to 41%). Deep venous drainage was present in 55% (95% CI 52% to 59%). An eloquent AVM location was described in 71% (95% CI 69% to 74%). AVM hemorrhage occurred in 53% (95% CI 51% to 56%). Generalized or focal seizures were described in 30% (95% CI 27% to 33%) and 10% (95% CI 8% to 12%), respectively. Chronic headache was recorded in 14% (95% CI 12% to 16%). Persistent neurological deficits were found in 7% (95% CI 6% to 9%), and progressive neurological deficits in 5% (95% CI 4% to 6%). Significant differences between centers were found for age (P<0.001), sex (P=0.04), eloquence (P=0.04), size (P<0.001), hemorrhage (P=0.006), persistent neurological deficit (P<0.001), and reversible neurological deficit (P=0.013). The intercenter difference found for hemorrhage frequency did not remain after adjustment for AVM size.
Baseline characteristics differed considerably between centers. The differences found in patient age and AVM size may be explained by center-specific referral patterns and the influence of access to treatment resources, whereas those found for other characteristics may be attributable to center-specific definitions. Analysis of natural history data from tertiary referral center databases may be improved by consistent definitions applicable to the entire population of AVM patients.
本研究旨在评估脑动静脉畸形（AVM）患者的人口统计学、临床及形态学特征。
对来自3个独立数据库（1个多中心数据库[柏林/巴黎/中东和远东，n = 662]以及2个单中心数据库[纽约，n = 337，多伦多，n = 290]）的1289例连续AVM患者的前瞻性收集数据进行分析。评估的变量包括诊断时的年龄、性别、AVM大小、AVM引流模式、AVM在功能重要脑区（“明确功能区”）的位置以及临床表现类型（出血、癫痫发作、慢性头痛或局灶性神经功能缺损）。采用方差分析、列联表和对数线性模型进行比较。
总体而言，诊断时的平均年龄为31.2岁（95%置信区间30.2至32.2岁），45%的患者为女性（95%置信区间42%至47%）。38%（95%置信区间35%至41%）的AVM最大直径<3 cm。55%（95%置信区间52%至59%）存在深部静脉引流。71%（95%置信区间69%至74%）的AVM位于明确功能区。53%（95%置信区间51%至56%）的AVM发生出血。全身性或局灶性癫痫发作分别见于30%（95%置信区间27%至33%）和10%（95%置信区间8%至12%）的患者。14%（95%置信区间12%至16%）记录有慢性头痛。7%（95%置信区间6%至9%）发现有持续性神经功能缺损，5%（95%置信区间4%至6%）有进行性神经功能缺损。各中心在年龄（P<0.001）、性别（P = 0.04）、明确功能区（P = 0.04）、大小（P<0.001）、出血（P = 0.006）、持续性神经功能缺损（P<0.001）和可逆性神经功能缺损（P = 0.013）方面存在显著差异。在对AVM大小进行调整后，各中心间出血频率的差异不再存在。
各中心的基线特征差异很大。患者年龄和AVM大小的差异可能由各中心特定的转诊模式以及获得治疗资源的影响来解释，而其他特征的差异可能归因于各中心特定的定义。通过适用于所有AVM患者群体的一致定义，可能会改善对三级转诊中心数据库中自然史数据的分析。
