颅内动脉瘤生长的危险因素：系统评价与Meta分析
Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis.
作者信息
Brinjikji W, Zhu Y-Q, Lanzino G, Cloft H J, Murad M H, Wang Z, Kallmes D F
机构信息
From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.).
出版信息
AJNR Am J Neuroradiol. 2016 Apr;37(4):615-20. doi: 10.3174/ajnr.A4575. Epub 2015 Nov 26.
BACKGROUND AND PURPOSE
Understanding risk factors for intracranial aneurysm growth is important for patient management. We performed a meta-analysis examining risk factors for intracranial aneurysm growth in longitudinal studies and examined the association between aneurysm growth and rupture.
MATERIALS AND METHODS
We searched the literature for longitudinal studies of patients with unruptured aneurysms. We examined the associations of demographics, multiple aneurysms, prior subarachnoid hemorrhage, family history of aneurysm or subarachnoid hemorrhage, smoking, and hypertension; and aneurysm shape, size, and location with aneurysm growth. We studied the association between aneurysm growth and rupture. A meta-analysis was performed by using a random-effects model by using summary statistics from included studies.
RESULTS
Twenty-one studies including 3954 patients with 4990 aneurysms with 13,294 aneurysm-years of follow-up were included. The overall proportion of growing aneurysms was 3.0% per aneurysm-year (95% CI, 2.0%-4.0%). Patient risk factors for growth included age older than 50 years (3.8% per year versus 0.9% per year, P < .01), female sex (3.2% per year versus 1.3% per year, P < .01), and smoking history (5.5% per year versus 3.5% per year, P < .01). Characteristics associated with higher growth rates included cavernous carotid artery location (14.4% per year), nonsaccular shape (14.7% per year versus 5.2% per year for saccular, P < .01), and aneurysm size (P < .01). Aneurysm growth was associated with a rupture rate of 3.1% per year compared with 0.1% per year for stable aneurysms (P < .01).
CONCLUSIONS
Observational evidence provided multiple clinical and anatomic risk factors for aneurysm growth, including age older than 50 years, female sex, smoking history, and nonsaccular shape. These findings should be considered when counseling patients regarding the natural history of unruptured intracranial aneurysms.
背景与目的
了解颅内动脉瘤生长的危险因素对患者管理至关重要。我们进行了一项荟萃分析，以研究纵向研究中颅内动脉瘤生长的危险因素，并探讨动脉瘤生长与破裂之间的关联。
材料与方法
我们检索了有关未破裂动脉瘤患者纵向研究的文献。我们研究了人口统计学、多发动脉瘤、既往蛛网膜下腔出血、动脉瘤或蛛网膜下腔出血家族史、吸烟和高血压；以及动脉瘤形状、大小和位置与动脉瘤生长之间的关联。我们研究了动脉瘤生长与破裂之间的关联。使用随机效应模型，根据纳入研究的汇总统计数据进行荟萃分析。
结果
纳入了21项研究，共3954例患者，4990个动脉瘤，随访时间达13294个动脉瘤年。动脉瘤每年生长的总体比例为3.0%（95%可信区间，2.0%-4.0%）。与生长相关的患者危险因素包括年龄大于50岁（每年3.8% 对比每年0.9%，P <.01）、女性（每年3.2% 对比每年1.3%，P <.01）和吸烟史（每年5.5% 对比每年3.5%，P <.01）。与较高生长率相关的特征包括海绵窦段颈内动脉位置（每年14.4%）、非囊状形状（每年14.7%，囊状为每年5.2%，P <.01）和动脉瘤大小（P <.01）。动脉瘤生长与每年3.1%的破裂率相关，而稳定动脉瘤的破裂率为每年0.1%（P <.01）。
结论
观察性证据提供了多个动脉瘤生长的临床和解剖学危险因素，包括年龄大于50岁、女性、吸烟史和非囊状形状。在向患者咨询未破裂颅内动脉瘤的自然病史时，应考虑这些发现。
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