硬脑膜动静脉瘘患者颅内出血的危险因素分析

目的除了合并皮层静脉引流这一危险因素之外，目前尚无其他因素被公认是硬脑膜动静脉瘘（DAVF）患者颅内出血的独立危险因素。本研究的目的在于通过单因素和多因素分析，阐明DAVF患者颅内出血的危险因素。方法回顾分析2007年1月～2012年12月第二军医大学长海医院临床神经医学中心收治的190例DAVF患者。其中颅内出血60例，非出血表现130例。收集临床和影像学资料，提取人口学特征、临床表现类型、血管构筑学特征等参数，对比不同表现DAVF在上述参数上的差异，并进行Logistic回归分析。结果Logistic回归分析发现颅内出血发病的危险因素为瘘口位于大静脉窦区（OR4．296，95％CI：1．126-16．393，P=0．033），Borden分级Ⅱ级（OR3．852，95％CI：1．123～13．207。P=0．032）和Ⅲ级（OR14．070．95％CI：2．741～72．237，P=0．002）。结论瘘口位于大静脉窦区，引流方式为BordenⅡ级和Ⅲ级是DAVF患者发生颅内出血的独立危险因素。

Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulas

Objective To date, no other factors have been recognized as independent risk factors for intracranial hemorrhage except for cortical venous drainage in patients with dural arteriovenous fistulas （DAVFs）. The purpose of this study was to analyze the risk factors for hemorrhagic presentation. Method One hundred ninety cases with DAVFs from Clinical Center of Neuroscience of Changhai Hospital of Second Military Medical University were retrospectively reviewed, who were treated during the interval from January of 2007 to December of 2012, including 60 patients in hemorrhagic group and 130 in non-hemorrhagic group. The difference between the two groups were analyzed and logistic regression analysis was performed concerning the clinical features and angioarchitecture. Result The logistic regression analysis showed that DAVFs involving the large venous sinus （OR 4.296, 95% Ch 1.126 - 16.393, P=0.033）, of Borden Ⅱ（OR 3.852, 95%Ch 1.123 - 13.207, P=0.032） and Borden Ⅲ （OR 14.070, 95%CI： 2.741 - 72.237, P=0.002） drainage pattern were independent risk factors for intracranial hemorrhage. Conclusion DAVFs involving large venous sinuses, of Borden Ⅱand of Borden m drainage pattern were independent risk factors for hemorrhage presentation.