基于临床病例库和血流动力学的颅内动脉瘤破裂风险评估研究

Intracranial aneurysm is a serious threat to human life. With the development of medical level, more and more unruptured aneurysms were found, and deciding on those aneurysms that require prophylactic treatment can be a quandary. The intracranial aneurysm rupture risk is derived from results of large cases of epidemiological studies, with different conclusion and unclear rupture mechanisms, and it is difficult to predict a certain individual case's rupture risk. Our preliminary studies indicate that the hemodynamic factors play an important role in the aneurismal initiation, development and rupture. With insufficient sample size, inadequate research methods and not considering the patient epidemiological data together, the international hemodynamic studies for aneurysm rupture can not form a widely accepted theory. On the basis of the preliminary work and the established clinical image database, our group intends to do three-dimensional numerical simulation analysis of hemodynamics for large-sample of intracranial aneurysm cases. Combined with the patient epidemiological data and hemodynamic factors, utilizing Multiple Logistic Regression method, the assessment and prediction system of aneurismal rupture risk will be established. Then individualized case risk assessment will be achieved and the quantitative indicators will be determined. This study will joint clinical and experimental studies and set up a bridge between them, helping to find a direct reference index in clinical preoperative assessment, and get a deeper understanding of the mechanism of aneurysm rupture.

颅内动脉瘤严重威胁人类健康。随着医学水平的提高，越来越多未破裂动脉瘤被发现，治疗与否面临抉择。但目前对破裂风险的探讨主要借助于大宗病例的流行病学研究，结论各异，也很难预测某一个体病例破裂风险。项目组初步研究表明，血流动力学对动脉瘤发生、发展和破裂发挥重要作用。但目前国际上对动脉瘤破裂的血流动力学研究样本不足、研究方法存在局限，亦没有结合病人的临床资料进行深入分析，不能形成被广泛接受的理论。本项目组在前期工作的基础上，拟利用已经建立的临床影像数据库，针对大宗的颅内动脉瘤病例，进行血流动力学三维数值模拟分析。结合患者的流行病学资料和血流动力学因素，利用Logistic回归统计方法，建立动脉瘤破裂风险的评估预测系统，进行病例个体化评估并确定有效的量化的指标。本研究联合了临床研究和实验研究，并架起了二者之间的桥梁，有助于找到有效的直接应用于临床术前评估的参考指标，并对动脉瘤破裂机理有更加深刻的认识

颅内动脉瘤严重威胁人类健康。随着医学水平的提高，越来越多未破裂动脉瘤被发现，治疗与否面临抉择。但目前对破裂风险的探讨主要借助于大宗病例的流行病学研究，结论各异，也很难预测某一个体病例破裂风险。本课题在前期工作的基础上，利用已经建立的临床影像数据库，针对大宗的颅内动脉瘤病例，在合理分组的情况下，进行血流动力学三维数值模拟分析。结合临床、形状和血流动力学因素分析，利用Logistic 回归统计方法，从而确定了有破裂预测意义的临床-形状-血流动力学参数和阈值。研究发现破裂-未破裂配对的多发动脉瘤病例是很好的排除了病例个体化因素、研究动脉瘤自身破裂因素的疾病模型；排除病人个体差异的影响，大瘤、高径颈比和低壁面切应力是多发动脉瘤破裂相关的独立风险因子；对濒临破裂动脉瘤的研究发现，低壁面切应力、高的径颈比以及不规则的形状是未破裂动脉瘤破裂的提示因子；年龄低、不规则形状和低壁面切应力是后交通动脉瘤破裂相关的独立风险因子；而栓塞治疗后动脉瘤的再破裂出血与局部低壁面切应力密切相关。本研究联合了临床研究和实验研究，找到了有效的直接应用于临床术前评估的参考指标，并对动脉瘤破裂机理有更加深刻的认识。