An Xiuhu, Huan Linchun, Liu Pengran, Zhao Yan, Zhang Nai, Li Yaohua, Lin Yunpeng, Wang Jiwen, Hao Jiheng, Yang Xinyu, Wang Bangyue
Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China.
Department of Neurosurgery, Linyi People's Hospital, Linyi, Shandong, China.
Front Neurol. 2025 Apr 30;16:1566246. doi: 10.3389/fneur.2025.1566246. eCollection 2025.
The natural course of unruptured intracranial aneurysms (UIAs) has been well described in developed countries, but there is a lack of large studies on UIAs in China. This article aims to fill this gap by detailing the current status and natural course of UIAs in China and identifying the major risk factors for their rupture, providing a basis for clinical decision-making.
We included all patients with UIAs consecutively admitted to 12 tertiary care centers in 4 provinces in northern China between January 2017 and December 2020. The mean follow-up was 3.1 years (range 0-7.3 years). The current status of UIA patients in China was described in detail. Risk ratios for rupture were analyzed using the Cox proportional hazards model, and Kaplan-Meier curves were analyzed for long-term rupture rates.
In this study, among the 1,475 patients, 33.4% declined surgical treatment. Of the 1,189 patients who completed follow-up, 10.3% initially received conservative treatment but later underwent surgery. A total of 1,337 patients with UIAs who met the criteria were included in the statistical analysis. The annual rupture rate was 1.75%. Cox proportional hazards model identified the following risk factors for rupture: age over 70 years (HR 2.136, 95% CI 1.302-3.504, = 0.003), aneurysm size of 10-20 mm (HR 3.543, 95% CI 1.501-8.363, = 0.004) and ≥20 mm (HR 4.455, 95% CI 1.034-19.187, = 0.045). ICA (HR 0.427, 95% CI 0.203-0.897, = 0.025) was a protective factor.
In China, treatment options for UIA patients are unique, with a low willingness to undergo surgery leading to a higher rupture rate. A significant percentage of Chinese patients refuse treatment, and those who initially choose conservative management are unlikely to opt for surgical intervention later. Advanced age, specific locations, and size are associated with UIA rupture. This study has important implications for clinical decision-making, public awareness of UIAs, and the development of health policies.
发达国家已对未破裂颅内动脉瘤（UIAs）的自然病程有了充分描述，但中国缺乏关于UIAs的大型研究。本文旨在通过详细阐述中国UIAs的现状和自然病程，并确定其破裂的主要危险因素，为临床决策提供依据，以填补这一空白。
我们纳入了2017年1月至2020年12月期间在中国北方4个省份的12家三级医疗中心连续收治的所有UIAs患者。平均随访时间为3.1年（范围0 - 7.3年）。详细描述了中国UIA患者的现状。使用Cox比例风险模型分析破裂的风险比，并分析Kaplan-Meier曲线以得出长期破裂率。
在本研究中，1475例患者中，33.4%拒绝手术治疗。在1189例完成随访的患者中，10.3%最初接受保守治疗，但后来接受了手术。共有1337例符合标准的UIA患者纳入统计分析。年破裂率为1.75%。Cox比例风险模型确定了以下破裂的危险因素：年龄超过70岁（HR 2.136，95% CI 1.302 - 3.504，P = 0.003）、动脉瘤大小为10 - 20 mm（HR 3.543，95% CI 1.501 - 8.363，P = 0.004）和≥20 mm（HR 4.455，95% CI 1.034 - 19.187，P = 0.045）。颈内动脉（HR 0.427，95% CI 0.203 - 0.897，P = 0.025）是一个保护因素。
在中国，UIA患者的治疗选择具有独特性，手术意愿低导致破裂率较高。相当一部分中国患者拒绝治疗，而那些最初选择保守治疗的患者后期不太可能选择手术干预。高龄、特定部位和大小与UIA破裂相关。本研究对临床决策、公众对UIAs的认识以及卫生政策的制定具有重要意义。
