| Background: Aneurysmal subarachnoid hemorrhage due to ruptured intracranial aneurysms is an extremely dangerous,complex,and common cerebrovascular disease with a large number of patients,a wide range of populations,abrupt onset,high treatment costs,and a potentially poor prognosis.Current research focuses on the treatment of ruptured aneurysms,and major advances have been made in endovascular cerebrovascular intervention and cerebrovascular microsurgery.However,the unpredictability of intracranial aneurysm rupture remains a major challenge for clinicians around the world,and prevention of aneurysm rupture is particularly important based on the Chinese medicine concept of "prevention before disease."Objective: This study retrospectively analysed the risk factors and incidence patterns of aneurysm rupture in the joint part of Sichuan,Yunnan,Guizhou,and Chongqing,based on the theory of three categories of etiologic factors and considering the unique geographical,human,and climatic characteristics of Luzhou and its surrounding areas,to provide new ideas for patients with unruptured intracranial aneurysms in the region in terms of rupture prevention and treatment decisions.Methods: Data from 798 patients and a total of 828 aneurysms that met criteria for nadir were collected from Jan 01,2015 to Dec 31,2021 at the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University for retrospective statistical analysis.Clinical data such as age,sex,history of smoking,history of alcohol consumption,history of hypertension,history of diabetes mellitus,history of blood abnormalities,and imaging data such as location,size,and morphology of aneurysms detected on examination were collected.Patients were divided into a group of patients with ruptured aneurysm and a group of patients with nonruptured aneurysm according to whether the intracranial aneurysm was ruptured or not;the aneurysm was divided into a group with ruptured aneurysm and a group with nonruptured aneurysm.Single factor analysis was performed using SPSS 26 to look for risk factors,and another multifactorial binary logistic regression analysis was performed to find independent risk factors;the chi-square goodness-of-fit test was used to assess whether aneurysm rupture was related to change in season,month,time of year,hour,and temperature.Results: The statistical results showed that within the region,hypertension(χ~2=9.908,P=0.002),smoking(χ~2=4.888,P=0.027),alcohol consumption(χ~2=9.932,P=0.002),aneurysm location(χ~2=63.989,P<0.001),and aneurysm morphology(χ~2=54.709,P<0.001)were different between the two groups of patients There were differences between the two groups.Further multifactorial logistic binary regression analysis showed that hypertension(OR=1.701,95%CI1.241-2.330,P=0.001),biased body mass(OR=1.625,95%CI 1.196-2.208,P=0.002),smoking(OR=1.251,95%CI 1.187-1.764,P=0.022),alcohol consumption(OR=1.539,95%CI 1.116～2.123,P=0.009),differences in the distribution of aneurysms(OR=3.527,95%CI 2.517～6.059,P=0.001),and irregular aneurysm morphology(OR=2.932,95%CI 2.192～3.899,P< 0.001)were independent risk factors for intracranial aneurysm rupture.It was also found that the risk of IA rupture was 2.079 times higher in phlegmatic patients than in calm patients(OR=2.079,95%CI 1.352-3.197,P=0.001)and 1.989 times higher in damp-heat patients than in calm patients(OR=1.989,95%CI 1.303-3.038,P=0.001);the risk of aneurysm rupture was 1.848 times higher in patients with poorly controlled blood pressure than in patients without a history of hypertension(OR=1.848,95%CI 1.306-2.614,P=0.01);the risk of aneurysm rupture was 1.785 times higher in patients who smoked >20 cigarettes/day than in patients without a history of smoking(OR=1.785,95%CI 1.244-2.560,P=0.01);and the risk of aneurysm rupture was 1.785 times higher in patients who smoked >20 cigarettes/day than in patients without a history of smoking(OR=1.785,95%CI 1.244-2.560,P=0.001).The risk of aneurysm rupture in patients with excessive alcohol consumption was 2.076 times higher than that in patients without a history of alcohol consumption(OR=2.076,95%CI 1.459-2.955,P=0.003);the risk of rupture of anterior communicating artery aneurysm was 5.62 times higher than that of rupture of internal carotid artery aneurysm(OR=5.620,95%CI 3.537-8.931,P<0.01).The risk of rupture of anterior communicating aneurysm was 5.62 times higher than the risk of rupture of internal carotid aneurysm(OR=5.620,95%CI 3.537～8.931,P<0.001)and the risk of rupture of posterior communicating aneurysm was 2.582 times higher than the risk of rupture of internal carotid aneurysm(OR=2.582,95%CI 1.561～4.271,P<0.001).The incidence of IA rupture in this region was highest in summer and winter(χ~2=46.768,P<0.001);in winter,waxing and July of the lunar calendar(χ~2=20.798,P=0.036<0.05);in winter,snow and summer(χ~2=62.153,P<0.001);and in mean daily temperature ≤10 ℃ and ≥26℃(χ~2=10.404,P=0.032<0.05),and the number of people with the disease was more when the temperature was cooling than when the temperature was warming and constant(χ~2=4.768,P=0.029<0.05);the number of people with the disease was most frequent at Shen hour(Foot Solar Bladder meridian),Zi hour(Foot Conjugate Yin Liver meridian),and Ugly hour(Foot Shaoyang Bile meridian)(χ~2=16.719,P=0.016<0.05).Conclusion: Phlegm-damp body type,damp-heat body type,hypertension,smoking,alcohol consumption,aneurysm location(anterior and posterior traffic),and aneurysm morphology were independent risk factors affecting aneurysm rupture in the region.IA rupture in this region is likely to occur in winter and summer,in the winter,lunar and July months of the lunar calendar,and in the winter,light snow and summer festivals;it is likely to occur when the average daily temperature is ≤10℃ and ≥26℃ and when cooling occurs;it is likely to occur at Shen,Zi and Ugly hours;it is closely related to liver and gallbladder;and it is closely associated with cold,dampness and heat. |
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