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JAMA N：极小动脉瘤(≤3mm)的管理策略

2018-02-08 杨中华 脑血管病及重症文献导读

极小动脉瘤管理策略进展
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在普通人群中，未破裂颅内动脉瘤（UIA）相对常见，并且被诊断的人数越来越多；其中大部分为极小动脉瘤（<=3 mm）。对于这种偶发极小UIA，当前的临床实践和指南的管理策略都存在很大的异质性。因此，探讨不同管理策略的作用非常重要。


在普通人群中，未破裂颅内动脉瘤（UIA）相对常见，并且被诊断的人数越来越多；其中大部分为极小动脉瘤（<=3 mm）。对于这种偶发极小UIA，当前的临床实践和指南的管理策略都存在很大的异质性。因此，探讨不同管理策略的作用非常重要。

2018年1月来自耶鲁医学院的Ajay Malhotra等在JAMA Neurology上公布了他们的研究结果，目的在于评价不同管理方法的优劣。

该研究根据医学文献采用了决策分析模型进行有效性比较分析。从PubMed选取最可靠的数据和最适宜的相关文献，分析了10000迭代模拟（iterations simulating）成人患者，这些患者偶然检测到<=3mm的动脉瘤，并且无SAH病史。评价了极小UIA五种不同管理策略的优劣：1.每年MRA扫描，2.每两年MRA扫描，3.每5年MRA扫描，4.动脉瘤栓塞并随访，5.不治疗或不预防性随访。

这些患者的平均年龄为50岁，他们发现不治疗或不预防性随访的健康获益最高（mean [SD] 质量调整生命年, 19.40[0.31]）。在随访影像学的管理策略中，每5年一次MRA检查是最佳策略，也是第二有效的策略（mean [SD] 质量调整生命年, 18.05 [0.62]）。当非生长UIA每年破裂风险低于1.7时，不随访是最佳策略。当风险高于1.7%时，应该直接进行弹簧圈栓塞。

最终作者认为鉴于当前文献，对于<=3mm的UIA，不进行预防性治疗或不进行影像学随访能够达到较好的健康预后，是最有效的策略。积极的影像学随访监测动脉瘤生长或预防性治疗更适用于破裂高风险的患者。

原始出处：

Ajay Malhotra，et al.Management of Tiny Unruptured Intracranial Aneurysms: A Comparative Effectiveness Analysis.JAMA Neurol. 2018 Jan 1;75(1):27-34. doi: 10.1001/jamaneurol.2017.3232.

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    2019-01-17 gous

    #管理策略#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1966950, encodeId=9fc319669505d, content=<a href='/topic/show?id=b5bde60540a' target=_blank style='color:#2F92EE;'>#管理策略#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76054, encryptionId=b5bde60540a, topicName=管理策略)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Thu Jan 17 17:35:00 CST 2019, time=2019-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300463, encodeId=028030046354, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b6d2184980, createdName=1207fadam17(暂无昵称), createdTime=Wed Mar 28 07:53:56 CST 2018, time=2018-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296861, encodeId=651c296861ae, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Fri Mar 16 19:35:13 CST 2018, time=2018-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287590, encodeId=ae9228e5902c, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Tue Feb 13 09:13:15 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=286825, encodeId=2daa28682599, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Sat Feb 10 16:22:48 CST 2018, time=2018-02-10, status=1, ipAttribution=)]
    2018-03-28 1207fadam17(暂无昵称)

    学习了.很好

    0

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    2018-03-16 wxl882001

    学习一下

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1966950, encodeId=9fc319669505d, content=<a href='/topic/show?id=b5bde60540a' target=_blank style='color:#2F92EE;'>#管理策略#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76054, encryptionId=b5bde60540a, topicName=管理策略)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Thu Jan 17 17:35:00 CST 2019, time=2019-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300463, encodeId=028030046354, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b6d2184980, createdName=1207fadam17(暂无昵称), createdTime=Wed Mar 28 07:53:56 CST 2018, time=2018-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296861, encodeId=651c296861ae, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Fri Mar 16 19:35:13 CST 2018, time=2018-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287590, encodeId=ae9228e5902c, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Tue Feb 13 09:13:15 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=286825, encodeId=2daa28682599, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Sat Feb 10 16:22:48 CST 2018, time=2018-02-10, status=1, ipAttribution=)]
    2018-02-13 大爰

    学习了谢谢分享!!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1966950, encodeId=9fc319669505d, content=<a href='/topic/show?id=b5bde60540a' target=_blank style='color:#2F92EE;'>#管理策略#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76054, encryptionId=b5bde60540a, topicName=管理策略)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Thu Jan 17 17:35:00 CST 2019, time=2019-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300463, encodeId=028030046354, content=学习了.很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b6d2184980, createdName=1207fadam17(暂无昵称), createdTime=Wed Mar 28 07:53:56 CST 2018, time=2018-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=296861, encodeId=651c296861ae, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Fri Mar 16 19:35:13 CST 2018, time=2018-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287590, encodeId=ae9228e5902c, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Tue Feb 13 09:13:15 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=286825, encodeId=2daa28682599, content=学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOgo3iaicb1Imgk1yIfnvr6oXzibcAFB6puAyNJXbzWhNuLqaFYBVRWjh7rghkvFLPxMAfD5ib3nXwVD/0, createdBy=bed21972958, createdName=wxl882001, createdTime=Sat Feb 10 16:22:48 CST 2018, time=2018-02-10, status=1, ipAttribution=)]
    2018-02-10 wxl882001

    学习一下

    0