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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2023, Vol. 13 ›› Issue (02) : 78 -83. doi: 10.3877/cma.j.issn.2095-2015.2023.02.004

论著

基于血流动力学、血脂及外周血炎症标志物的眼段动脉瘤破裂风险相关研究
李田利1, 张照龙2, 孙成建2, 刘国平2, 谢宜兴2, 赵晓龙2, 邵黎明2, 郑璇2, 王长鑫3, 徐锐2,†()   
  1. 1. 266071　山东省，青岛大学在读研究生；266000　山东省，青岛大学附属医院介入医学科
    2. 266000　山东省，青岛大学附属医院介入医学科
  • 收稿日期:2023-02-01 出版日期:2023-04-01
  • 通信作者: 徐锐
  • 基金资助:
    山东省自然科学基金面上项目(ZR202102190696)

Study on the risk of ophthalmic artery segment aneurysm rupture based on hemodynamics, blood lipid and peripheral inflammatory indexes

Tianli Li1, Zhaolong Zhang2, Chengjian Sun2, Guoping Liu2, Yixing Xie2, Xiaolong Zhao2, Liming Shao2, Xuan Zheng2, Changxin Wang3, Rui Xu2,†()   

  1. 1. Graduate Department of Qingdao University, Qingdao 266071, China; Department of Interventional Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
    2. Department of Interventional Radiology, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
    3. Graduate Department of Qingdao University, Qingdao 266071, China
  • Received:2023-02-01 Published:2023-04-01
  • Corresponding author: Rui Xu
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引用本文：

李田利, 张照龙, 孙成建, 刘国平, 谢宜兴, 赵晓龙, 邵黎明, 郑璇, 王长鑫, 徐锐. 基于血流动力学、血脂及外周血炎症标志物的眼段动脉瘤破裂风险相关研究[J/OL]. 中华消化病与影像杂志(电子版), 2023, 13(02): 78-83.

Tianli Li, Zhaolong Zhang, Chengjian Sun, Guoping Liu, Yixing Xie, Xiaolong Zhao, Liming Shao, Xuan Zheng, Changxin Wang, Rui Xu. Study on the risk of ophthalmic artery segment aneurysm rupture based on hemodynamics, blood lipid and peripheral inflammatory indexes[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(02): 78-83.

目的

分析形态规则及不规则眼动脉段动脉瘤血流动力学参数，并研究动脉瘤规则与否与血脂及外周血炎性指标的相关性。

方法

回顾性收集青岛大学附属医院介入医学科2019年1月至2022年10月收治，未破裂眼动脉段动脉瘤76例患者，根据其形态将其分为规则动脉瘤和不规则动脉瘤。所有患者行三维全脑血管造影进行血流动力分析及形态学参数分析，通过非参数Mann-Whitney U检验比较并分析两组形态学参数特征与血流动力学关系，将不规则组动脉瘤分为分叶、子瘤、其他类型三种亚组，采取Kruskal-Wallis检验进行组间血流动力学分析。并比较规则与不规则两组患者在血脂及外周血炎性指标方面差异。

结果

不规则动脉瘤组较规则动脉瘤组具有较低水平的平均壁面剪应力(WSS)、标准化动脉瘤平均WSS及较高的动脉瘤震荡剪切指数(P<0.05)，两组在动脉瘤大小、纵横比、尺寸比等形态指学指标存在统计学差异(P<0.05)。亚组分析表明分叶型动脉瘤比其他类型不规则动脉瘤具有较高的载瘤动脉WSS(H＝8.13，P＝0.01)。在不规则动脉瘤血脂及外周血炎性指标研究中发现低水平的中性粒细胞/淋巴细胞比(P<0.001)、全身免疫炎症指数(P＝0.004)，较高水平的总胆固醇和载脂蛋白B、低密度脂蛋白与动脉瘤不规则相关(P<0.05)。

结论

眼动脉段动脉瘤形态是否规则与血流动力学、血脂、外周血炎性指标相关，其可能在动脉瘤的形态变化中起到一定作用。

关键词: 颅内动脉瘤, 血流动力学, 形态学, 血脂, 外周血炎性指标
Objective

To analyze the hemodynamic parameters of ophthalmic artery segment aneurysm with regular and irregular shape, and study the correlation between the regularity of aneurysms and blood lipid and inflammatory indexes of peripheral blood.

Methods

A total of 76 patients with unruptured ophthalmic artery segment aneurysm admitted to the Department of Interventional Radiology, the Affiliated Hospital of Qingdao University from January 2019 to October 2022 were retrospectively collected, who were divided into regular aneurysm group and irregular aneurysm group according to their morphology.All patients underwent three-dimensional whole-brain angiography for hemodynamic analysis morphological parameter analysis.Non-parameter Mann-Whitney U test was used to compare and analyze the relationship between the characteristics of morphological parameters and hemodynamics of the two groups.Then, aneurysms in the irregular group were divided into three subgroups, namely lobus type, subtumor type and other type.Kruskal-Wallis test was used to analyze the hemodynamics between groups.Meanwhile, blood lipid and peripheral blood inflammatory indexes were compared between the regular and irregular groups.

Results

The irregular group had lower mean wall shear stress(WSS), normalized mean WSS and higher oscillatory shear index(P<0.05). There were statistically significant differences between the two groups in the size, aspect ratio and size ratio(P<0.05). Subgroup analysis showed that lobus type had higher parent artery WSS than other type of irregular aneurysm(H=8.13, P=0.01). Low levels of neutrophil-to-lymphocyte ratio(P<0.001)and systemic immune inflammation index(P=0.004), high levels of total cholesterol, apolipoprotein B and low density lipoprotein were found to be associated with irregular aneurysm(P<0.05)in the study of blood lipid and peripheral blood inflammatory indexes of irregular aneurysm.

Conclusion

Whether the shape of ophthalmic artery segment aneurysm is regular or not is related to hemodynamics, blood lipid and inflammatory indexes of peripheral blood, which may play a role in the morphological changes of aneurysm.

Key words: Intracranial aneurysm, Hemodynamics, Morphology, Blood lipid, Peripheral blood inflammatory indexes
图1 不同类型眼段动脉瘤血流动力学示图注：A、a为子囊型动脉瘤I；B、b为分叶型动脉瘤；C、c为瘤壁突出即其他类型动脉瘤；D、d为规则组动脉瘤。上图均为壁切应力；下图均为震荡剪切指数
表1 两组患者基本信息
组别 例数 性别[例(%)] 年龄(岁，±s) 高血压[例(%)] 糖尿病[例(%)] 吸烟[例(%)] 饮酒[例(%)] 体质量指数(kg/m2，±s)
男 女
不规则组 37 4(11) 33(89) 58.51±8.34 15(41) 5(14) 3(8) 2(5) 25.54±3.35
规则组 39 9(23) 30(77) 55.41±10.18 16(41) 3(8) 4(10) 4(10) 25.04±3.89
表2 两组患者动脉瘤形态学及血流动力学比较[M(Q1，Q3)]
组别 例数 平均WSS 最大WSS 载瘤动脉WSS 标准化动脉瘤平均WSS 平均OSI 动脉瘤大小
不规则组 37 3.76(2.68，4.86) 15.46(11.41，25.08) 4.53(3.46，7.10) 0.79(0.49，1.00) 0.020(0.010，0.033) 5.07(4.19，6.71)
规则组 39 4.81(3.38，5.82) 13.07(10.20，19.00) 4.93(3.70，7.13) 0.98(0.77，1.11) 0.013(0.008，0.018) 3.32(2.77，3.97)
Z值   －2.57 －1.39 －0.67 －2.48 －2.66 －4.95
P值   0.01 0.17 0.5 0.01 <0.01 <0.01
组别 例数 AR SR 动脉瘤形态不规则指数 动脉瘤倾角 载瘤动脉角度 动脉瘤中部直径
不规则组 37 0.91(0.70，1.20) 1.39(1.10，1.93) 0.0533(0.031，0.100) 89.44(89.22，89.65) 73.78(60.92，84.15) 5.79(5.08，7.25)
规则组 39 0.69(0.60，0.91) 0.85(0.66，1.02) 0.024(0.010，0.039) 89.67(89.54，89.81) 67.24(58.87，80.66) 4.30(3.65，4.93)
Z值   －2.22 －4.83 －4.4 －3.75 －0.88 －4.54
P值   0.03 <0.01 <0.01 <0.01 0.38 <0.01
组别 例数 瘤颈 载瘤动脉直径 动脉瘤垂直高度 动脉瘤表面积 动脉瘤体积
不规则组 37 4.65(4.19，6.02) 3.83(3.46，4.05) 4.37(3.45，5.72) 100.09(72.94，171.71) 76.24(44.90，181.27)
规则组 39 4.00(3.42，4.65) 3.97(3.78，4.23) 3.05(2.46，3.69) 51.22(34.78，72.17) 27.67(16.31，49.69)
Z值   －3.7 －1.65 －3.89 －4.86 －4.58
P值   <0.01 0.1 <0.01 <0.01 <0.01
表3 不规则动脉瘤患者亚组间载瘤动脉壁切应力分析
组别 例数 中位数(P25，P75) 秩和检验
H值 P值
子囊组 11 4.08(3.63，6.20)    
分叶组 18 6.90(3.75，8.38) 8.13 0.01
其他组 8 3.24(2.00，4.64)    
表4 两组患者血脂、外周血炎性指标比较[M(Q1，Q3)]
组别 例数 甘油三酯 总胆固醇 APOB/APOA 脂蛋白a Apo-B Apo-A1
不规则组 37 1.320(0.825，1.725) 5.270(4.135，5.770) 0.580(0.455，0.770) 166.400(79.950，349.650) 0.950(0.735，1.165) 1.650(1.330，1.845)
规则组 39 0.980(0.840，1.660) 4.340(3.420，5.370) 0.550(0.390，0.760) 162.400(64.000，286.500) 0.750(0.680，1.020) 1.480(1.280，1.660)
Z值   －1.107 －2.271 －0.977 －0.359 －2.022 －1.403
P值   0.268 0.003 0.328 0.72 0.043 0.161
组别 例数 HDL LDL NLR PLR SII
不规则组 37 1.460(1.115，1.665) 3.080(2.280，3.695) 1.335(1.102，1.762) 113.559(92.161，140.321) 348.723(256.057，411.548)
规则组 39 1.250(1.030，1.620) 2.420(1.930，3.310) 2.004(1.679，2.510) 123.664(103.041，150.556) 445.417(332.099，638.075)
Z值   －1.19 －2.105 －4.567 －1.221 －2.842
P值   0.234 0.035 <0.001 0.222 0.004
1
Li MH，Chen SW，Li YD，et al.Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years：a cross-sectional study[J]．Ann Intern Med，2013，159(8)：514-521.
2
Gross BA，Lai PM，Du R．Impact of aneurysm location on hemorrhage risk[J]．Clin Neurol Neurosurg，2014，123：78-82.
3
Rinaldo L，Nesvick CL，Rabinstein AA，et al.Differences in Size Between Unruptured and Ruptured Saccular Intracranial Aneurysms by Location[J]．World Neurosurg，2020，133：e828-e834.
4
Axier A，Rexiati N，Wang Z，et al.Effect of hemodynamic changes on the risk of intracranial aneurysm rupture：a systematic review and meta-analysis[J]．Am J Transl Res，2022，14(7)：4638-4647.
5
Jirjees S，Htun ZM，Aldawudi I，et al.Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture：A Review[J]．Cureus，2020，12(7)：e9178.
6
Sawyer DM，Pace LA，Pascale CL，et al.Lymphocytes influence intracranial aneurysm formation and rupture：role of extracellular matrix remodeling and phenotypic modulation of vascular smooth muscle cells[J]．J Neuroinflammation，2016，13(1)：185.
7
Wan H，Huang L，Ge L，et al.Are hemodynamics of irregular small carotid-ophthalmic aneurysms different from those of regular ones and large aneurysms based on numerical simulation？[J]．Neuroradiology，2020，62(4)：511-518.
8
Meng H，Tutino VM，Xiang J，et al.High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation，growth，and rupture：toward a unifying hypothesis[J]．AJNR Am J Neuroradiol，2014，35(7)：1254-1262.
9
Zhang X，Ares WJ，Taussky P，et al.Role of matrix metalloproteinases in the pathogenesis of intracranial aneurysms[J]．Neurosurg Focus，2019，47(1)：E4.
10
Cebral JR，Sheridan M，Putman CM.Hemodynamics and bleb formation in intracranial aneurysms[J]．AJNR Am J Neuroradiol，2010，31(2)：304-310.
11
Lampropoulos DS，Boutopoulos ID，Bourantas GC，et al.Hemodynamics of anterior circulation intracranial aneurysms with daughter blebs：investigating the multidirectionality of blood flow fields[J]．Comput Methods Biomech Biomed Engin，2023，26(1)：113-125.
12
Feng X，Zhang B，Guo E，et al.Bifurcation Location and Growth of Aneurysm Size Are Significantly Associated with an Irregular Shape of Unruptured Intracranial Aneurysms[J]．World Neurosurg，2017，107：255-262.
13
Qi P，Feng X，Lu J，et al.Morphological Irregularity of Unruptured Intracranial Aneurysms is More Related with Aneurysm Size Rather Than Cerebrovascular Atherosclerosis：A Case-Control Study[J]．Clin Interv Aging，2021，16：665-674.
14
Liu Q，Zhang Y，Yang J，et al.The Relationship of Morphological-Hemodynamic Characteristics，Inflammation，and Remodeling of Aneurysm Wall in Unruptured Intracranial Aneurysms[J]．Transl Stroke Res，2022，13(1)：88-99.
15
Feng X，Qi P，Wang L，et al.Relationship between cerebrovascular atherosclerotic stenosis and rupture risk of unruptured intracranial aneurysm：A single-center retrospective study[J]．Clin Neurol Neurosurg，2019，186：105543.
16
Tokgozoglu L，Casula M，Pirillo A，et al.Similarities and differences between European and American guidelines on the management of blood lipids to reduce cardiovascular risk[J]．Atheroscler Suppl，2020，42：e1-e5.
17
Ishii D，Choi A，Piscopo A，et al.Increased Concentrations of Atherogenic Proteins in Aneurysm Sac Are Associated with Wall Enhancement of Unruptured Intracranial Aneurysm[J]．Transl Stroke Res，2022，13(4)：577-582.
18
Huang Q，Shang-Guan HC，Wu SY，et al.High-Density Lipoprotein Is Associated with Progression of Intracranial Aneurysms[J]．World Neurosurg，2018，120：e234-e240.
19
Can A，Castro VM，Dligach D，et al.Lipid-Lowering Agents and High HDL(High-Density Lipoprotein)Are Inversely Associated With Intracranial Aneurysm Rupture[J]．Stroke，2018，49(5)：1148-1154.
20
Giede-Jeppe A，Reichl J，Sprugel MI，et al.Neutrophil-to-lymphocyte ratio as an independent predictor for unfavorable functional outcome in aneurysmal subarachnoid hemorrhage[J]．J Neurosurg，2019，132(2)：400-407.
21
Hou Y，Li H，Yang H，et al.Prognostic significance of combined score of fibrinogen and neutrophil-lymphocyte ratio for functional outcome in patients with aneurysmal subarachnoid hemorrhage[J]．Front Neurol，2022，13：916968.
22
Guo Y，Liu J，Zeng H，et al.Neutrophil to lymphocyte ratio predicting poor outcome after aneurysmal subarachnoid hemorrhage：A retrospective study and updated meta-analysis[J]．Front Immunol，2022，13：962760.
23
Wu XB，Zhong JL，Wang SW，et al.Neutrophil-to-Lymphocyte Ratio Is Associated With Circumferential Wall Enhancement of Unruptured Intracranial Aneurysm[J]．Front Neurol，2022，13：879882.
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