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摘要: 目的 以计算机断层扫描血管造影(CTA)为基础分析除最大直径以外的其他影响腹主动脉瘤破裂的形态学指标。方法 通过性别，年龄(±3岁)，最大瘤体直径(±2.5 mm)进行破裂腹主动脉瘤(破裂组)与稳定腹主动脉瘤(稳定组)的1：1匹配，收集2组患者的临床基线资料与腹主动脉瘤解剖形态信息，通过单因素统计检验以及多元回归分析比较二者间的差异，分析影响动脉瘤破裂的危险因素。结果 破裂组(39例)与稳定组(39例)的临床基线情况无差异，破裂组的平均瘤颈长度明显短于稳定组[(25.26±17.99) mm vs(36.19±19.40) mm，P=0.013]，双侧髂总动脉近端直径明显小于稳定组[(右侧：(18.21±7.84) mm vs(21.73±8.27) mm，P=0.030；左侧：(16.28±5.23) mm vs(19.00±5.80) mm，P=0.048]。Logistic回归分析结果显示，瘤颈长度 < 12 mm(OR＝7.28，95%CI：1.47~36.04，P=0.015)、双侧髂总动脉近端直径之和与腹主动脉瘤最大直径之比 < 0.56(OR＝3.67，95%CI：1.13~11.92，P=0.030)是腹主动脉破裂的危险因素。结论 与直径相似的稳定腹主动脉瘤相比，破裂腹主动脉瘤的瘤颈长度更短，髂总动脉近端直径更小。短瘤颈与小髂总动脉近端直径是腹主动脉瘤破裂的独立危险因素。Abstract: Objective To analyze computed tomography angiography(CTA) based on morphological parameters affecting abdominal aortic aneurysm rupture except for maximum diameter.Methods Ruptured abdominal aortic aneurysms and stable abdominal aortic aneurysms were matched 1 : 1 by gender, age(±3 years), and maximum aneurysm diameter(±2.5 mm). Clinical and morphological information of aneurysms were collected and compared through univariate statistical tests and multiple regression analysis, and the factors affecting aneurysm rupture were analyzed.Results There was no difference in clinical baseline between the ruptured and stable groups(39 cases each), and the mean neck length of ruptured abdominal aortic aneurysms was significantly shorter than that of stable abdominal aortic aneurysms[(25.26±17.99) mm vs(36.19±19.40) mm, P=0.013]. The proximal diameter of bilateral common iliac arteries in the ruptured abdominal aortic aneurysm group was significantly smaller than that in the stable abdominal aortic aneurysm group[(right: (18.21±7.84) mm vs(21.73±8.27) mm, P=0.030; left: (16.28±5.23) mm vs(19.00±5.80) mm, P=0.048]. The results of conditional logistic regression analysis showed that aneurysm neck length < 12 mm(OR＝7.28, 95%CI: 1.47~36.04, P=0.015), the proportion of bilateral common iliac artery proximal diameter with maximum aneurysm diameter < 0.56(OR＝3.67, 95%CI: 1.13~11.92, P=0.030) were risk factors for abdominal aortic aneurysm rupture.Conclusion Compared with stable abdominal aortic aneurysms of similar diameter, ruptured abdominal aortic aneurysms have a shorter neck and a smaller proximal diameter of the common iliac artery. A short aneurysm neck and small proximal diameter of the common iliac artery are independent risk factors for abdominal aortic aneurysm rupture.
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Key words:
- abdominal aortic aneurysm /
- rupture /
- morphology /
- risk factors
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表 1 2组患者基线资料
Table 1. Baseline demographics
例(%), M(P25, P75), X±S 指标 稳定组(39例) 破裂组(39例) P 年龄/岁 67.95±6.23 68.10±6.67 - 男性 36(92.3) 36(92.3) - 身高/cm 171.13±6.30 171.00±6.44 0.942 体重/kg 72.00(68.50，78.00) 70.00(69.00，75.50) 0.657 BMI 24.61(23.15，23.68) 23.97(22.87，24.77) 0.179 吸烟 28(71.8) 26(70.3) 0.884 高血压 28(71.8) 30(81.1)1) 0.341 糖尿病 8(20.5) 2(5.4)1) 0.108 高脂血症 20(51.3) 17(45.9)1) 0.642 脑卒中 11(28.2) 7(18.9)1) 0.341 冠心病 12(30.8) 17(43.6)1) 0.241 射血分数/% 61(60，65) 60(57，62)2) 0.082 注：1)缺失数据量为2；2)缺失数据量为4。 
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表 2 2组形态学指标及单因素检验结果
Table 2. Morphology parameters and results of statistical tests
例(%), M(P25, P75), X±S 指标 稳定组(39例) 破裂组(39例) P 肾下腹主动脉 中心线长度/mm 152.90±21.93 149.88±23.54 0.719 直线长度/mm 129.67±15.34 128.78±18.67 0.229 扭曲程度 1.18±0.13 1.17±0.12 0.545 瘤颈 长度/mm 36.19±19.40 25.26±17.99 0.013 近端直径/mm 26.54±4.08 26.10±3.88 0.775 远端直径/mm 28.84±4.09 28.42±4.37 0.593 腹主动脉瘤 最大直径/mm 76.00±13.69 76.34±14.17 0.914 总体积/mL 372.98(218.48，449.45) 357.56(199.78，488.68) 0.730 血流腔体积/mL 157.44(111.06，240.89) 161.63(100.06，301.59) 0.513 腔内血栓体积/mL 144.31(97.57，247.70) 103.81(63.72，214.49) 0.140 腔内血栓比例/% 52.8(26.4，63.7) 44.7(21.2，59.0) 0.149 钙化体积/μL 376.7(167.4，837.6) 400.3(83.7，975.2) 0.944 髂动脉 右髂总动脉 中心线长度/mm 48.48±16.56 51.15±21.00 0.834 直线长度/mm 44.46±14.05 46.89±17.36 0.657 近端直径/mm 21.73±8.27 18.21±7.84 0.030 远端直径/mm 16.61±5.36 15.73±4.80 0.639 最小直径/mm 15.28±5.63 12.97±3.08 0.094 血流腔体积/mL 11.17(5.49，16.77) 9.69(4.59，14.16) 0.254 钙化体积/μL 117.65(53.05，234.55) 156.3(62.40，263.50) 0.791 右髂外动脉近端直径/mm 11.21±2.74 10.61±2.23 0.320 左髂总动脉 中心线长度/mm 47.95±17.69 52.21±21.41 0.838 直线长度/mm 43.38±15.47 47.41±17.61 0.529 近端直径/mm 19.00±5.80 16.28±5.23 0.048 远端直径/mm 16.68±5.58 14.81±4.48 0.197 最小直径/mm 14.30±4.74 12.22±2.95 0.074 血流腔体积/mL 7.74(5.20，16.31) 9.53(4.34，13.82) 0.738 钙化体积/μL 123.20(29.20，340.30) 110.60(57.05，238.90) 0.979 左髂外动脉近端直径/mm 11.28±2.63 10.33±2.48 0.174
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