摘要
目的 探讨脑小血管病(CSVD)总负荷及影像标志物与单侧大脑中动脉(MCA)狭窄程度的关系.方法 该研究为横断面研究.回顾性分析2015年10月至2019年1月就诊于解放军总医院第一医学中心并接受多模态MRI检查的慢性单侧MCA狭窄患者的临床及影像资料.共纳入261例患者,男187例、女74例.根据MCA狭窄程度将患者分为重度狭窄-闭塞组(狭窄程度≥70％)102例和轻中度狭窄组(狭窄程度＜70％)159例.根据脑小血管病国际影像标准1评估2组患者CSVD影像标志物评分(包括脑白质高信号、血管周围间隙、脑微出血、血管源性腔隙),并计算CSVD总负荷评分.2组间各指标比较采用Mann-Whitney U检验,然后在调整血管危险因素(年龄、性别、饮酒、吸烟、高血压、高脂血症、房颤和冠心病)后,最终将CSVD总负荷评分及影像标志物评分纳入多因素二元logistic回归,评估CSVD影像标志物与MCA重度狭窄-闭塞的关系.结果 轻中度狭窄组和重度狭窄-闭塞组患者CSVD总负荷评分、半卵圆中心血管周围间隙评分、血管源性腔隙评分差异均有统计学意义(P均＜0.05),其余影像标志物评分差异均无统计学意义(P均＞0.05).多因素二元logistic回归分析显示,CSVD总负荷评分(OR=1.300,95％CI1.047～1.613,P=0.017)、半卵圆中心血管周围间隙评分(OR=2.099,95％CI 1.540～2.860,P＜0.001)和血管源性腔隙(OR=2.609,95％CI 1.294～5.261,P=0.007)与MCA重度狭窄-闭塞独立相关.结论 CSVD总负荷评分、半卵圆中心血管周围间隙评分和血管源性腔隙评分高与MCA患者重度狭窄-闭塞有关.
Abstract
Objective To investigate the relationship between the cerebral small vascular disease(CSVD)total burden and the imaging markers and the degree of unilateral middle cerebral artery[MCA)stenosis.Methods The study was a cross-sectional study.Clinical and imaging data of patients with chronic unilateral MCA stenosis who underwent multimodal MRI from October 2015 to January 2019 in the First Medical Center of PLA General Hospital were retrospectively analyzed.A total of 261 patients were included,187 males and 74 females.According to the degree of MCA stenosis,the patients were divided into 102 cases in severe stenosis-occlusion group(stenosis degree ≥70％)and 159 cases in mild-moderate stenosis group(stenosis degree＜70％).CSVD imaging marker scores(including white matter hyperintensity,perivascular space,cerebral microbleed,and lacune of presumed vascular origin)were assessed according to the standards for reporting vascular changes on neuroimaging 1 in the 2 groups,and the CSVD total burden score was calculated.Mann-Whitney U test was used to compare the indicators between the two groups,and the CSVD total burden score and imaging marker scores were ultimately included in a multifactorial binary logistic regression to assess the association of CSVD imaging markers with severe stenosis-occlusion of the MCA after adjusting for vascular risk factors(age,gender,drinking,smoking,hypertension,hyperlipidemia,atrial fibrillation and coronary heart disease).Results There were significant differences in the CSVD total burden,centrum semiovale perivascular space and lacune of presumed vascular origin score between the mild-to-moderate stenosis group and the severe stenosis-occlusion group(all P＜0.05),and none of the differences in the remaining imaging marker scores were statistically significant(all P＞0.05).Multivariate binary logistics regression analysis showed CSVD total burden score(OR=1.300,95％CI 1.047-1.613,P=0.017),centrum semiovale perivascular space score(OR=2.099,95％CI 1.540-2.860,P＜0.001)and lacune of presumed vascular origin score(OR=2.609,95％CI 1.294-5.261,P=0.007)were independent associated with severe stenosis-occlusion of MCA.Conclusion The higher CSVD total burden score,centrum semiovale perivascular space score and lacune of presumed vascular origin score are associated with severe stenosis-occlusion of MCA.
维普
万方数据