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Radiology:老年患者非破裂颅内动脉瘤的临床管理

2019-08-09 shaosai MedSci原创

背景:非破裂性动脉瘤(UIA)相对常见,诊断率越来越高,以老年患者为主(>65岁)。影像学随访常常用来评估UIA大小及形态变化,动脉瘤的增大是破裂的高危表现。然而,影像学随访的频率和间期尚不确定。本研究旨在评价65岁老年患者常规治疗(动脉瘤弹簧圈植入术)与4种不同临床策略的性价比对照。

背景:非破裂性动脉瘤(UIA)相对常见,诊断率越来越高,以老年患者为主(>65岁)。影像学随访常常用来评估UIA大小及形态变化,动脉瘤的增大是破裂的高危表现。然而,影像学随访的频率和间期尚不确定。本研究旨在评价65岁老年患者常规治疗(动脉瘤弹簧圈植入术)与4种不同临床策略的性价比对照。

本研究根据社会角度利用Markov决策分析模型进行分析。根据已发表文章确定年龄依赖性指标。分析包括年龄超过65岁、偶然发现UIA且未有蛛网膜下腔出血病史老年人。评价5种对UIA的临床决策:(a)年度MRA随访、(b)半年MRA随访、(c)每5年MRA随访、(d)仅在UIA发现后随访2年。对质量调整生命年(QALYs)结果进行评价。进行概率分析、单向及双向敏感性分析。

结果为,在诊断后前2两年进行随访是性价比最高的(花费$24 572,获益为13.73 QALYs),花最少的钱获最大的受益。该结论在概率分析、和单向分析中也是很明显的。动脉瘤增长的年增长率和破裂风险不一,有期限的影像学随访是最佳临床管理决策。如果未增长动脉瘤破裂风险超过7.1%,那应该尽快进行弹簧圈植入术。

本研究表明,对于非破裂颅内动脉瘤老年患者,常规预防性治疗或周期影像学随访不是一个性价比高的临床管理方法。对于具有破裂高危风险的患者来说应该采取更激进的办法,比如动脉瘤>7mm及后循环的动脉瘤。

原始出处:

Malhotra A, Wu X, Forman HP,et al.Management of Unruptured Intracranial Aneurysms in Older Adults: A Cost-effectiveness Analysis.Radiology.DOI:10.1148/radiol.2019182353

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    2019-09-23 jyzxjiangqin

    老年患者的治疗。

    0

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    2019-08-09 最帅小男护

    好好好

    0

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    2019-08-09 yjs木玉

    好好好好好好

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1819599, encodeId=f885181959958, content=<a href='/topic/show?id=7dea9958321' target=_blank style='color:#2F92EE;'>#非破裂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99583, encryptionId=7dea9958321, topicName=非破裂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ce4238, createdName=dangious, createdTime=Sat Oct 26 12:25:00 CST 2019, time=2019-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=373100, encodeId=f8c33e3100e3, content=老年患者的治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Mon Sep 23 17:25:54 CST 2019, time=2019-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487081, encodeId=5ee8148e08159, content=<a href='/topic/show?id=2b902295e5b' target=_blank style='color:#2F92EE;'>#临床管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22957, encryptionId=2b902295e5b, topicName=临床管理)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d89d8256855, createdName=shuangle, createdTime=Sat Aug 10 15:25:00 CST 2019, time=2019-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=370981, encodeId=6f793e0981d2, content=好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/07/01/577acf4668c2eb760152040cdd4c4196.jpg, createdBy=dc3f5107879, createdName=最帅小男护, createdTime=Fri Aug 09 07:46:50 CST 2019, time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=370975, encodeId=66ca3e09750d, content=好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Fri Aug 09 05:44:10 CST 2019, time=2019-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=370972, encodeId=f82b3e097274, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Fri Aug 09 01:08:31 CST 2019, time=2019-08-09, status=1, ipAttribution=)]
    2019-08-09 飛歌

    学习了很有用不错

    0

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