Research On Correlation Between Mannose-binding Lectin And Hydrodynamics In Rupture Risk Of Unruptured Intracranial Aneurysm

Objective:1.With the improvement of people’s living standards and the development of science and technology,the detection rate of unruptured intracranial aneurysm has gradually increased,and accurate assessment on the rupture risk of unruptured intracranial aneurysm has become an important prerequisite for determining its reasonable treatment strategy.Many studies at home and abroad have confirmed that aneurysm wall inflammation plays a very important role in the occurrence,development and rupture of cerebral aneurysms.The process of inflammatory reaction is mainly mediated by complement activation,then cytokines,growth factors and other mediators secreted by inflammatory cells.Mannose-binding lectin(MBL)plays an important role in the reaction process.This study aims to collect serological data of patients with clinical unruptured aneurysms,introduce aneurysm morphological analysis and PHASES score,explore the risk factors of serum MBL in patients with unruptured intracranial aneurysms,and provide evidence for its application in risk assessment of ruptured intracranial aneurysms.2.Inflammatory reaction of aneurysm wall activated by abnormal intracranial hemorheology will lead to pathological degeneration of aneurysm wall,which is the key mechanism of occurrence,development and rupture of intracranial aneurysm.In the first part of this study,serological detection of serum MBL concentration can be used to evaluate the rupture risk of unruptured intracranial aneurysm.In many studies at home and abroad,the calculation of hydrodynamic parameters of intracranial aneurysms can scientifically and quantitatively analyze hemodynamics,so as to further detect the role of MBL in assessing the risk of unruptured intracranial aneurysms.This study intends to combine serological indicators with computational hemodynamics techniques to study the relationship between MBL and hydrodynamics in the risk of rupture of unruptured intracranial aneurysm and their role in the rupture mechanism of intracranial aneurysms.Methods:1.The cases with unruptured aneurysm found by DSA(Digital Subtraction Angiography)angiography in Wenzhou Central Hospital from June 2018 to December 2020 were selected;inclusion criteria and exclusion criteria were set;the basic data of patients were collected,including age,gender,history of hypertension,history of diabetes and others;the general characteristics of aneurysms were collected,including size,location and shape of aneurysms;venous blood was taken for eligible patients;the MBL concentration of samples was detected by ELISA,and the aneurysm morphology of each patient was analyzed.The multidimensional data maximum likelihood model established according to the clinical information,morphological data and other parameters of the patient was graded.According to the scoring results,the samples were divided into low-risk group,medium-risk group and high-risk group,and the concentration between groups was compared.For patients with 2 or more aneurysms,aneurysms with high scores were selected as control study according to scores.Then,PHASES rupture risk score was used to compare the rupture risk of unruptured aneurysms in each group,and then the correlation between MBL concentration and aneurysm rupture risk in each group was evaluated.2.The cases with unruptured aneurysm found by DSA(Digital Subtraction Angiography)angiography in Wenzhou Central Hospital from June 2018 to December 2020 were selected;inclusion criteria and exclusion criteria were set.For patients with 2 or more aneurysms,aneurysms with high scores were selected as control study according to morphological scores.The basic data of patients were collected,including age,sex,history of hypertension,history of diabetes,etc.The MBL concentration of the samples was detected by ELISA,and the aneurysm morphology of each patient was analyzed.The aneurysm morphology parameters such as aneurysm size(Size),size ratio(SR),aspect ratio(AR),volume neck area ratio(VNR),height.to.width ratio(HW),aneurysm angle θA,incident angle IA and others were collected.According to the data of 3D-DSA spiral contrast images,the calculation model was incorporated into the calculation,and the parameter data were collected,including WSS(WSS),shear shock index(OSI),velocity,percentage of low WSSarea(LSA),pressure,etc.According to the concentration of mannose-binding lectin detected in each patient,the low concentration group was included when the concentration was lower than 0.80mg/L,the medium concentration group was included when the concentration was 0.80-1.10mg/L,and the high concentration group was included when the concentration was higher than 1.10mg/L.The clinical features,hydrodynamic parameters and morphological parameters of the above cases were analyzed by univariate analysis,and then multiple linear regression analysis was further applied to clarify the serum MBL concentration and unruptured intracranial aneurysm.The correlation between morphology and hemodynamics.PHASES score was introduced again to evaluate the risk of unruptured intracranial aneurysm,and then the relationship between serum MBL concentration,intracranial unruptured aneurysm morphology and hydrodynamics on the risk of rupture of unruptured intracranial aneurysm was studied and analyzed.Results:1.According to the set inclusion criteria and exclusion criteria,a total of 120 patients with unruptured cerebral aneurysm were eligible,including 55 males and 65 females;the age range ranged from 32 to 79 years old,with an average age of 51.08±10.35 years old.The aneurysm morphology analysis showed that 58 patients with unruptured aneurysm(48.3%)were in the low risk group,32 patients(26.7%)in the medium risk group and 30 patients(25.0%)in the high risk group.Univariate analysis showed that there were significant differences in aneurysm size(P<0.001)and irregular shape(P=0.013)among the scoring groups.There was no significant difference in gender,age,tobacco and alcohol history,hypertension and diabetes history,previous subarachnoid hemorrhage history,aneurysm location and multiple aneurysms(P>0.05).The MBL concentration among the groups was compared,and the PHASES rupture risk score was used to score and compare the rupture risk of unruptured aneurysms in each group.The results showed that the MBL concentration among the groups with different risk scores of aneurysm morphological analysis was statistically significant.With the increase of the risk of aneurysm rupture,the serum MBL concentration also gradually increased(P<0.001).2.According to the set inclusion criteria and exclusion criteria,a total of 68 patients with unruptured cerebral aneurysms were eligible,including 30 males and 38 females;the age range ranged from 35 to 78 years old,with an average age of 52.22±9.22 years old.The size range of unruptured cerebral aneurysms was 2.5-11.5 mm,with an average of 6.36±2.44mm.The MBL concentration was lower than 0.80 mg/L in 30 cases(44.1%),0.80-1.10 mg/L s in 25 cases(36.8%),and higher than 1.10 mg/L in 13 cases(19.1%).Univariate analysis showed that there was no significant difference in baseline data between different serum MBL concentration groups(P>0.05).In the comparative analysis of aneurysm morphological parameters,the differences of aneurysm size,SR,AR,VNR between different serum MBL concentration groups were statistically significant,and the above parameters were consistent with the change trend of increasing with the increase of serum MBL concentration.There was no significant difference in other morphological parameters such as OSI,AR,θA and IA.Among the hydrodynamic parameters,there were significant differences in WSS,velocity,LSA and relative retention time(RRT)among different serum MBL concentration groups.There was no significant difference in OSI and pressure among different serum MBL concentration groups.Further multiple linear regression analysis showed that aneurysm size ratio(SR)(slope=0.106;95%CI:0.052-0.160;P=0.000),wall shear stress(WSS)(slope=-0.379;95%CI:-0.658--0.099;P=0.009),velocity(slope=-0.617;95%CI:-0.989--0.245;P=0.017),percentage of low wall shear stress area(LSA)(slope=2.145;95%Cl:0.394-3.896;P=0.002),and relative retention time(RRT)(slope=0.597;95%CI:0.129-1.066;P=0.013)were independent risk factors for increased serum MBL concentration in intracranial PHASES rupture risk score was used to compare the rupture risk of unruptured aneurysms in each group.The results suggest that the morphological characteristics of intracranial aneurysms(size,SR,AR,VNR),hemodynamic characteristics(WSS,velocity,LSA,RRT)and serum MBL concentration are statistically significant in different rupture risk score intervals.Conclusion:1.The concentration of serum MBL is not only related to the size of unruptured intracranial aneurysm.There are also concentration differences among different aneurysm morphological risk scores,suggesting that serum MBL concentration detection may become an effective serological index for risk assessment of rupture of unruptured intracranial aneurysm,providing more intuitive and scientific basis for clinical risk prediction of rupture of intracranial aneurysms.2.Serum MBL concentration in patients with unruptured intracranial aneurysm is closely related to aneurysm morphology and hemodynamics.The results show that the hydrodynamic characteristics of unruptured intracranial aneurysm with high risk of rupture are low and changeable wall shear stress,and the morphological characteristics are large and irregular aneurysms with high serum MBL concentration.In this study,the serum MBL concentration,aneurysm morphology and hemodynamic characteristics of patients with unruptured intracranial aneurysm were comprehensively analyzed to provide more accurate scientific basis for evaluating the risk of rupture of unruptured intracranial aneurysm.