Australian School of Advanced Medicine, Macquarie University, 75 Talavera Road, North Ryde, New South Wales 2109, Australia.
J Clin Neurosci. 2013 Jul;20(7):912-8. doi: 10.1016/j.jocn.2012.12.003. Epub 2013 May 28.
Many people carry cerebral aneurysms but are generally unaware of their presence until they rupture, resulting in high morbidity or mortality. The pathogenesis and aetiology of aneurysms are largely unknown; however, a greater understanding, by analysing the genetic, molecular and haemodynamic risk factors involved in the initiation, enlargement, and rupture of aneurysms, could lead to effective prevention, early diagnosis and more effective treatment. The risk of aneurysm is increased by a family history of aneurysms, and amongst certain populations, namely in Japan and Finland. Several other risk factors are documented, including hypertension, smoking, alcohol consumption, and female sex. Studies indicate a higher occurrence of cerebral aneurysms in females compared to males. Oestrogen protects several components within the artery wall, and inhibits some of the inflammatory molecules that could cause aneurysms. At menopause, the oestrogen level decreases and the incidence of aneurysm increases. Haemodynamic stresses have been shown to be involved in the formation, growth and rupture of aneurysms. This is often associated with hypertension, which also increases the risk of aneurysm rupture. When an unruptured aneurysm is detected the decision to treat can be complicated, since only 1-2% of aneurysms eventually rupture. Haemodynamic simulation software offers an effective tool for the consideration of treatment options for patients who carry unruptured aneurysms. The assessment must consider the risks of interventional treatments versus non-interventional management options, such as controlling blood pressure.
许多人患有脑动脉瘤，但通常在破裂之前都没有意识到它们的存在，这会导致高发病率或死亡率。动脉瘤的发病机制和病因在很大程度上是未知的；然而，通过分析与动脉瘤的形成、扩大和破裂有关的遗传、分子和血液动力学风险因素，可以更好地了解动脉瘤，从而导致有效的预防、早期诊断和更有效的治疗。有动脉瘤家族史的人，以及某些人群（如日本和芬兰）的动脉瘤风险增加。还有其他一些风险因素已被记录在案，包括高血压、吸烟、饮酒和女性。研究表明，女性患脑动脉瘤的几率高于男性。雌激素保护动脉壁的许多成分，并抑制可能导致动脉瘤的一些炎症分子。绝经后，雌激素水平下降，动脉瘤的发病率增加。血液动力学应激已被证明与动脉瘤的形成、生长和破裂有关。这通常与高血压有关，高血压也会增加动脉瘤破裂的风险。当检测到未破裂的动脉瘤时，治疗的决定可能会很复杂，因为只有 1-2%的动脉瘤最终会破裂。血流动力学模拟软件为携带未破裂动脉瘤的患者提供了一种有效的治疗方案选择工具。评估必须考虑介入治疗与非介入管理选择（如控制血压）的风险。
