基于人群标准空间分析的MRI探索血脂对急性缺血性脑卒中病灶分布模式的影响

Exploration of the effect of blood lipids on the lesion distribution pattern in acute ischemic stroke based on MRI study with population standard spatial analysis

目的采用基于人群标准空间分析的MRI技术,探索血脂对急性缺血性脑卒中梗死灶分布空间模式的影响。方法回顾性收集2015年1月至2020年12月东部战区总医院以及2013年1月至2021年12月南京市第一医院1202例缺血性脑卒中患者急性期MRI数据,其中男871例,女331例,年龄26~94(64±11)岁。根据血脂情况分为血脂异常组(n=683)和血脂正常组(n=519)。将弥散加权成像(DWI)图像人工智能自动分割后的梗死灶,配准到标准空间绘制病灶位置频次热图。采用χ^(2)检验比较两组病灶位置的差异,广义线性模型回归分析观察各血脂指标与病灶位置的相关性,并采用组间比较和相关性分析观察各血脂指标与病灶体积的关系。结果相比血脂正常组,血脂异常组病灶范围更广泛,多分布在由右侧大脑后动脉供血的枕颞区及由左侧大脑中动脉供血的额区。其中高甘油三脂(TG)和高低密度脂蛋白胆固醇(LDL-C)组差异脑区集中在后循环;高总胆固醇(TC)和低高密度脂蛋白胆固醇(HDL-C)组差异脑区集中在前循环(均P<0.05)。前循环梗死体积中,高TC组高于TC正常组[(27.58±5.34)比(17.73±1.18)ml,P=0.029]。后循环梗死体积中,高LDL-C组和TG组高于LDL-C和TG正常组[(7.55±2.51)比(3.55±0.31)ml、(5.76±1.19)比(3.36±0.30)ml](均P<0.05)。相关性分析结果显示TC、LDL-C与前循环梗死体积之间呈非线性(U型)趋势(均P<0.05)。结论不同血脂对缺血性脑卒中梗死灶分布模式及体积有影响,不同高血脂与特定的梗死灶脑区分布位置有关,并且与更大的梗死范围有关。

Objective To explore the effect of blood lipids on the lesion distribution pattern in patients with acute ischemic stroke by using MRI technology based on population standard spatial analysis.Methods The MRI data of 1202 patients with acute ischemic stroke in General Hospital of Eastern Theater Command from January 2015 to December 2020 and Nanjing First Hospital from January 2013 to December 2021 were retrospectively collected,including 871 males and 331 females,aged 26 to 94(64±11)years.According to the condition of blood lipids,they were divided into the dyslipidemia group(n=683)and the normal blood lipids group(n=519).After the automatic segmentation of diffusion-weighted imaging(DWI)images by artificial intelligence,the infarct sites were registered to the standard space which was used to draw the frequency heat map.The chi-square test was used to compare the difference in lesion location between the two groups.Generalized linear model regression analysis was used to observe the correlation between each blood lipid index and lesion site,and inter-group comparison and correlation analysis were used to observe the relationship between each blood lipid index and lesion volume.Results Compared with the normal blood lipid group,the lesions in the dyslipidemia group were more extensive,mostly distributed in the occipital temporal region of the right posterior cerebral artery and the frontal region of the left middle cerebral artery.The brain regions of higher triglyceride(TG)and higher low-density lipoprotein cholesterol(LDL-C)groups were concentrated in the posterior circulation.The brain regions in the higher total cholesterol(TC)and lower high-density lipoprotein cholesterol(HDL-C)groups were concentrated in the anterior circulation(all P<0.05).In the anterior circulation infarct volume,the higher TC group was significantly higher than the normal TC group[(27.58±5.34)vs(17.73±1.18)ml,P=0.029].In the posterior circulation infarct volume,the higher LDL-C group and the TG group were significantly higher than the normal LDL-C and TG groups[(7.55±2.51)vs(3.55±0.31)ml;(5.76±1.19)vs(3.36±0.30)ml](both P<0.05).Correlation analysis showed that TC and LDL-C were non-linearly(U-shaped)correlated with anterior circulation infarct volume(both P<0.05).Conclusions Different blood lipids have effects on the distribution pattern and volume of ischemic stroke infarcts.Different hyperlipidemia is related to the specific distribution site and the larger extent of infarction.