| ObjectiveBy Retrospective analysis of the clinical features of the patients with cerebral arteriovenous malformation,the influencing factors of hemorrhage within 1 years after embolization treatment,and the TCM syndrome of unruptured cerebral arteriovenous malformation from 2004 to 2017 years in Guangdong Provincial Hospital of Chinese Medicine,It is to provide clinical evidence for avoiding rupture and hemorrhage of BAVM and explore the etiology and pathogenesis of BAVM,so that the understanding of TCM and Western medicine could be further improved.Methods1.Collect and analyze the clinical case data in encephalopathy center of the Guangdong Provincial Hospital of Chinese Medicine in 2004-2017,and follow up the patients(follow up methods:telephone,hospitalization,outpatient)to know whether there are hemorrhagic events occurring within 1years after the treatment of embolization therapy.2.The patients are divided into groups:?According to whether there is spontaneous rupture and hemorrhagic within 1 years after embolization,it is analyzed the influencing factors of spontaneous rupture and hemorrhagic within1 years after embolism.?According to the main TCM symptoms of unruptured cerebral arteriovenous malformations,they are divided into headache group and epilepsy group.summarize the distribution characteristics of TCM syndromes in patients with unruptured arteriovenous malformations,and analyze the pathogenesis of unruptured BAVM.3.SPSS 22 software is used to complete data analysis.P<0.05 is considered statistically significant.Results1.Age and sex There was no significant difference between hemorrhage and the other group in average age of onset(t=1.040,P=0.302)and gender(c~2=0.212,P=0.645).2.Complication of aneurysm Aneurysms are more likely to appear in the cerebellum than in other parts of the brain.(c~2=19.160,P=0.002)3.The results of logistic regression analysis before embolization show that AVM position and maximum diameter are the control factors(P=0.104;P=0.054).They can not be considered as an independent factor.Combined with clinical,It can be speculated that the incidence of haemorrhage of Small AVM and the AVM in the deep part of the brain and cerebellum.4.The residual rate of logistic regression analysis after embolization is an independent risk factor for hemorrhage(P=0.004,OR=1.034).Further ROC curve analysis shows that the area of ROC curve is 0.820,and the best critical value is 15%.The residual rate of BAVM malformed regiment is significant(P=0.000006).Small volume is a protective factor for bleeding(P=0.133,OR=0.397).However,in the univariate analysis of bleeding within 1 years after embolization,there is no significant difference in the location of AVM (P=0.281).5.Complete embolization and maximum diameter,it is statistically analyzed on the basis of complete embolization and maximum diameter according to embolization therapy.It is found that there is statistical significance(c~2=14.203,P=0.001).After the residual comparison,small AVM is more likely to achieve complete occlusion.6.Analysis of TCM Syndrome In the study of TCM Syndromes of unruptured cerebral arteriovenous malformation,"liver and kidney deficiency,phlegm and stasis obstructing collaterals"are the most common,accounting for 32.7%of all syndrome types.There is a statistically significant difference in the distribution of TCM syndrome in headache and epilepsy(c~2=7.081,P=0.008;c~2=4.51,P=0.034).Conclusion1.The cerebral arteriovenous malformation is found in middle-aged patients.The incidence of men is more than that of women.2.This study also confirms that the risk of deep brain AVM hemorrhage is higher than that of other parts.However,deep brain AVM is not a risk factor for hemorrhage within 1 years after embolization.The incidence of bleeding in cerebellar arteriovenous malformations is second only to the deep part of brain tissue.Meanwhile,The possibility of cerebellar joint aneurysm is higher than that of other parts.3.The residual rate after embolization is an independent risk factor for haemorrhage within 1 years.It is recommended that the volume of the abnormal group be removed at least 85%,which can reduce the risk of haemorrhage.4.Small AVM has a high incidence of hemorrhage.Incidence of hemorrhage in small AVM after embolization is low,and small AVM is more likely to achieve complete embolization.5.Unruptured arteriovenous malformations can be attributed to headache and epilepsy according to their clinical manifestations.The etiology and pathogenesis of unruptured cerebral arteriovenous malformations are mainly caused by deficiency of liver and kidney,phlegm and blood stasis obstructing the collaterals.In different clinical manifestations,distribution of TCM Syndrome and pathogenesis of Unruptured arteriovenous malformations are also different.Epilepsy is often seen with wind phlegm and stagnation of blood stasis syndrome,while Multiple symptoms of qi deficiency,phlegm and stasis of collaterals is more common in headache... |
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