目的: 通过CTA成像技术研究Willis环完整性与颅内动脉瘤发生的相关性,并探讨影响颅内动脉瘤形成的危险因素。方法: 对在本院行脑动脉CTA检查的患者进行回顾性分析,按照是否存在动脉瘤分为病例组171例及对照组513例,按照Willis环的完整性将其分为I-IV四型,统计比较病例组与对照组Willis环各分型构成比,并根据患者的临床资料探究影响颅内动脉瘤形成的危险因素。结果: 病例组与对照组间Willis环完整性分型构成比间差异有统计学意义(P＜0.05)。病例组Willis环前、后循环均不完整的比例高于对照组(P＜0.05)。饮酒史、高血压史、Willis环变异与颅内动脉瘤的形成具有相关性(P＜0.05)。结论: Willis环前、后循环不完整是影响动脉瘤发生的重要因素,饮酒史、高血压史、Willis环变异是颅内动脉瘤形成的危险因素。
Objective: To explore the correlation between the integrity of Circle of Willis (CoW) and intracranial aneurysm through computed tomographic angiography (CTA), and to study the risk factors for the formation of intracranial aneurysms. Methods: Retrospective analysis was performed on patients who underwent cerebral artery CTA examination in our hospital. The patients were divided into case group (n=171) and control group (n=513) according to the presence of aneurysm. The CoW was divided into four types according to its integrity. The constituent ratio of various types of CoW was compared between two groups. And the risk factors for the formation of intracranial aneurysms were explored based on the clinical data of the patients. Results: There was significant difference in the constituent ratio of various types of CoW between the case and control group (P＜0.05). The proportion of incomplete anterior and posterior circulation of CoW in the case group was significantly higher than that in controls (P＜0.05). Alcohol-abuse, hypertension, variation of CoW and were correlated with the formation of intracranial aneurysms (P＜0.05). Conclusion: The incomplete anterior and posterior circulation of CoW is an important factor for the occurrence of aneurysms. Alcohol-abuse, hypertension, variation of CoW are all risk factors for the formation of intracranial aneurysms.
[1] 韩萍, 于春水.医学影像诊断学[M].4版.北京:人民卫生出版社, 2016:91-93.
[2] Jahed M, Ghalichi F, Farhoudi M.Fluid-structure interaction of patient-specific Circle of Willis with aneurysm:Investigation of hemodynamic parameters[J].Biomed Mater Eng, 2018, 29(3):357-368.
[3] Brinjikji W, Zhu YQ, Lanzino G, et al.Risk factors for growth of intracranial aneurysms: a systematic review and meta-analysis[J].AJNR Am J Neuroradiol, 2016, 37(4):615-620.
[4] Kang HG, Kim BJ, Lee J, et al.Risk factors associated with the presence of unruptured intracranial aneurysms[J].Stroke, 2015, 46(11):3093-3098.
[5] 杨平.Willis环完整性与颅内动脉瘤的危险关系研究[D].宁夏:宁夏医科大学, 2019.
[6] 熊义林, 彭长秀, 兰永树, 等.MSCT分析Willis环完整性与环上动脉瘤的关系[J].中国介入影像与治疗学, 2018, 15(3):167-170.
[7] 杨帆.Willis环变异与颅内动脉瘤关系的临床探讨[J].中国医师杂志, 2016, 18(3):418-421.
[8] 林惠岚, 李玉民.颅内动脉瘤的影像检查与形成相关因素的研究现状[J].中国中西医结合影像学杂志, 2014, 12(6):650-652.
[9] 高涢, 王雄伟.颅内动脉瘤遗传学研究进展[J].国际脑血管病杂志, 2016, 24(8):760-764.
[10] Jin D, Song C, Leng X, et al.A systematic review and meta-analysis of risk factors for unruptured intracranial aneurysm growth[J].Int J Surg(London, England), 2019, 69:68-76.
[11] 徐文, 郑晓林.256层螺旋CT血管成像诊断脑动脉瘤的价值并与DSA的比较[J].中国CT和MRI杂志, 2014, 12(4):92-95.
[12] 胡小辉, 张世明.颅内动脉瘤形成机制的研究进展[J].中国临床神经科学, 2016, 24(4):453-456.
[13] Zhen L, Yan C, GuoZ, et al.Anatomical variations in circle of willis and intracranial aneurysm formation[J].MCB, 2017, 14(1):19-33.
[14] Rinaldo L, Lanzino G. Anatomic predictors of unruptured anterior communicating artery aneurysm growth[J].World Neurosurg, 2017, 108:662-668.
[15] He Z, Wan Y.Is fetal-type posterior cerebral artery a risk factor for intracranial aneurysm as analyzed by multislice CT angiography[J].Exp Ther Med, 2018, 15(1):838-846.
[16] Rinaldo L, McCutcheon BA, Murphy ME, et al.Relationship of A1 segment hypoplasia to anterior communicating artery aneurysm morphology and risk factors for aneurysm formation[J].J Neurosurg, 2017, 127(1):89-95.
[17] Zhang J, Can A, Lai PMR, et al.Vascular geometry associated with anterior communicating artery aneurysm formation[J].World Neurosurg, 2021, 146:1318-1325.
[18] 白志峰, 高天, 汪晶, 等.高血压与颅内动脉瘤关系及血压管理[J].临床荟萃, 2016, 31(4):456-457, 461.
[19] 张建忠, 吴曦, 黄清海, 等.血流动力学诱导炎性反应对颅内动脉瘤形成机制的研究进展[J].中国脑血管病杂志, 2014, 11(7):381-384.
