同侧大脑后动脉偏侧优势与颈内动脉重度狭窄患者脑白质高信号的相关性

Correlation between ipsilateral prominent posterior cerebral artery laterality and white matter hyperintensity in patients with severe internal carotid artery stenosis

目的探讨同侧大脑后动脉偏侧优势(posterior cerebral artery laterality, PCAL)与颈内动脉(internal carotid artery, ICA)重度狭窄患者脑白质高信号(white matter hyperintensities, WMHs)的相关性。方法纳入2016年4月至2017年12月在辽宁省人民医院神经内科住院的单侧ICA狭窄≥70%(包括闭塞)且对侧ICA狭窄<50%或无狭窄的患者。根据ICA狭窄同侧是否存在PCAL分为阳性组和阴性组,比较两组WMHs严重程度。根据总体WMHs以及ICA狭窄同侧深部WMHs(deep WMHs, DWMHs)和脑室周围WMHs(periventricular WMHs, PWMHs)严重程度分组,应用多变量logistic回归分析确定WMHs的独立相关因素。结果共纳入131例患者,其中65例(49.62%)ICA狭窄同侧PCAL阳性,该组重度DWMHs的构成比显著低于同侧PCAL阴性组(38.46%对59.09%;χ2=5.578,P=0.018)。多变量logistic回归分析显示,高龄[优势比(odds ratio, OR)2.196,95%可信区间(confidence interval, CI)1.278~3.773;P=0.004]、高血压(OR 3.279,95% CI 1.107~9.709;P=0.032)和收缩压高(OR 1.027,95% CI 1.002~1.053;P=0.031)与重度总体WMHs独立相关;高龄(OR 1.957,95% CI 1.141~3.358;P=0.015)和高血压(OR 4.739,95% CI 1.570~14.286;P=0.006)与ICA狭窄同侧重度DWMHs独立相关,同侧PCAL(OR 0.340,95% CI 0.135~0.856;P=0.022)与ICA狭窄同侧轻度DWMHs独立相关;高龄(OR 1.805,95% CI 1.175~2.775;P=0.007)和收缩压高(OR 1.030,95% CI 1.007~1.053;P=0.010)与ICA狭窄同侧重度PWMHs独立相关。结论同侧PCAL为重度ICA狭窄患者同侧DWMHs的独立保护因素。

Objective To investigate the correlation between ipsilateral prominent posterior cerebral artery laterality (PCAL) and white matter hyperintensities (WMHs) in patients with severe internal carotid artery (ICA) stenosis. Methods From April 2016 to December 2017, patients with unilateral ICA stenosis ≥70%(including occlusion) and contralateral ICA stenosis <50% or no stenosis admitted to the Department of Neurology, Liaoning Provincial People's Hospital were enrolled. According to the presence or absence of PCAL on the ipsilateral side of ICA stenosis, they were divided into positive group and negative group, and the severity of WMHs was compared between the 2 groups. The patients were grouped according to the severity of overall WMHs and deep WMHs (DWMHs) and periventricular WMHs (PWMHs) on the ipsilateral side of ICA stenosis. Multivariate logistic regression analysis was used to determine the independently relevant factors of WMHs. Results A total of 131 patients were enrolled, 65 of them (49.62%) had ipsilateral PCAL positive. The proportion of severe DWMHs in this group was significantly lower than that in the ipsilateral PCAL negative group (38.46% vs. 59.09%;χ2=5.578, P=0.018). Multivariate logistic regression analysis showed that advanced age (odds ratio [OR] 2.196, 95% confidence interval [CI] 1.278-3.773;P=0.004), hypertension (OR 3.279, 95% CI 1.107-9.709;P=0.032), and high systolic blood pressure (OR 1.027, 95% CI 1.002-1.053;P=0.031) were independently associated with severe overall WMHs;advanced age (OR 1.957, 95% CI 1.141-3.358;P=0.015) and hypertension (OR 4.739, 95% CI 1.570-14.286;P=0.006) were independently correlated with ipsilateral severe DWMHs, ipsilateral PCAL (OR 0.340, 95% CI 0.135-0.856;P=0.022) was independently correlated with ipsilateral mild DWMHs;advanced age (OR 1.805, 95% CI 1.175-2.775;P=0.007) and high systolic blood pressure (OR 1.030, 95% CI 1.007-1.053;P=0.010) were independently correlated with ipsilateral severe PWMHs. Conclusion Ipsilateral PCAL is an independent protective factor for ipsilateral DWMHs in patients with severe ICA stenosis.