摘要
目的 探讨颅内动脉重塑(Brain artery remodeling,BAR)评分对脑小血管病(Cerebral small vessel disease,CSVD)总负荷严重程度的预测价值.方法 选取2020年7月2022年7月医院收治的CS-VD患者218例,采用核磁共振成像(Magnetic resonance imaging,MRI)、计算机断层扫描(Computed tomo-graphy,CT)和血管成像(CT angiography,CTA)检测患者颅内各动脉直径,计算得出BAR评分;应用MRI评估腔隙性脑梗死、脑微出血、脑白质高信号(White matter hyperintensities,WMHs)、脑萎缩及血管周围间隙扩大(Enlarge perivascular spaces,EPVS)4种影像学标记物,并计算CSVD总负荷评分,根据CSVD总负荷评分将患者分为无-轻度组(0～1分)和中重度组(2～4分);单因素分析CSVD总负荷加重的影响因素,Logistic回归分析CSVD总负荷加重的独立影响因素,受试者工作特征(Receiver operating characteristic,ROC)曲线分析BAR评分对CSVD总负荷严重程度的预测价值.结果 CSVD总负荷中重度组年龄、既往脑梗死史占比、BAR评分＞1个标准差(1 s)占比、降脂药物治疗占比及抗血小板聚集药物治疗占比均高于CSVD总负荷无-轻度组(P＜0.05);Logistic回归分析显示,年龄较大、有既往脑梗死史、BAR评分＞1s、接受降脂药物治疗及抗血小板聚集药物治疗均是CSVD患者总负荷为中重度的独立危险因素(P＜0.05);Spearman相关性分析显示,BAR评分与CSVD总负荷评分呈正相关(r=0.305,P＜0.05);ROC曲线分析显示,BAR评分预测CS-VD总负荷中重度的曲线下面积(Area under curve,AUC)为0.623,敏感性为34.15％,特异性为90.44％.结论 BAR评分对CSVD总负荷中重度具有一定预测价值,颅内动脉扩张性重塑患者可能具有较高CSVD负荷.
Abstract
Objective To investigate the predictive value of the intracranial artery remodeling(BAR)score for the severity of total cerebral small vessel disease(CSVD)load.Methods A total of 218 patients with cerebral small vessel disease(CSVD)were selected for the study.Patients were diagnosed between July 2020 and July 2022.The diameters of the intracranial arteries were measured using MRI and CT angiography(CTA),and the BAR score was calculated.MRI was employed to assess four imaging markers:lacuna,cere-bral microbleeds,white matter hyperintensity(WMHs),brain atrophy,and perivascular space enlargement(EPVS).Subsequently,the total load score of the CSVD was determined.Patients were categorized into two groups based on the total load score:the no-mild group(0～1 points)and the moderate-severe group(2～4 points).Single factor analysis,logistic regression analysis,and receiver operating characteristic(ROC)curve analysis were also conducted to analyze the factors influencing the severity of the total load of CSVD and to as-sess the predictive value of the BAR score for determining the severity of the total load of CSVD.Results The present study revealed that the CSVD group with moderate and severe total loads had a greater proportion of older individuals,those with a history of previous cerebral infarction,those with a BAR＞1 SD,and those taking lipid-lowering drugs and antiplatelet aggregation drugs than did the CSVD group without mild total load(P1 SD);moreover,the use of lipid-lowering drugs and antiplatelet aggregation drugs were found to be inde-pendent risk factors for moderate to severe total load in CSVD patients(P＜0.05).Additionally,Spearman correlation analysis revealed a positive correlation between the BAR score and the CSVD total load score(r=0.305,P＜0.05).The ROC curve analysis demonstrated that the BAR score had an area under the curve(AUC)of 0.623 for predicting moderate and severe total loads of CSVD,with a sensitivity of 34.15％and a specificity of 90.44％.Conclusion The BAR score has some predictive value for moderate-to-severe total CS-VD load,and patients with dilated remodeling of the intracranial arteries may have a high CSVD load.
NETL
NSTL
万方数据