青年动脉闭塞型脑梗死合并脑小血管病及其相关临床危险因素研究

Analysis of cerebral small vessel disease and clinical factors in young patients with symptomatic cerebral infarction

目的探讨青年性脑梗死患者是否存在脑小血管病变(cerebral small vessel disease,CSVD),并分析其临床影响因素。材料与方法回顾性收集临床确诊的新近发生青年性脑梗死患者54例(男43例,女11例;年龄39.5岁)及新近发生老年性脑梗死患者57例(男37例,女20例;年龄69岁),征募21名年龄、性别与青年梗死组相匹配的健康人(男17名,女4名;年龄41岁)作为对照组。收集青年与老年脑梗死患者入院时的临床资料,并观察脑内各种CSVD的MRI表现并进行评分,包括双侧基底节区及半卵圆中心区血管周围间隙扩大(enlarged perivacular space,EPVS)、脑室周围及深部白质高信号(white matter hyperintense,WMH)、腔隙性梗死(lacunar infarction,LI)以及微出血(cerebral microbleeds,CMBs),计算脑小血管病总体负担评分(total burden scores of CSVD,TBS)并进行分级。比较3组间CSVD差异,并通过多因素Logistic回归分析其影响因素。结果与健康对照组相比,青年性脑梗死患者CSVD发生率明显增高,但比老年性梗死低(P<0.05)。多因素Logistic有序回归分析显示高血压与青年性脑梗死基底节和半卵圆中心EPVS以及总体负担评分具有独立相关性;LI与年龄密切相关;吸烟是CMBs的影响因素(P<0.05)。结论青年症状性脑梗死患者常同时合并脑小血管疾病改变。高血压、吸烟及年龄可能是青年性梗死患者脑小血管疾病的影响因素。

Objective:Cerebral small vessel disease(CSVD)is considered to be a common manifestation of senile cerebrovascular disease,and has a clear correlation with clinical symptoms and characteristics.At the present,limited studies are available for investigating the CSVD in young patients with cerebral infarction have CSVD and the impacting clinical factor,which is the aim of this explorative study.Materials and Methods:A total of 111 cases of primary acute cerebral infarction were enrolled in this study,including 54 cases of young cerebral infarction(43 men and 11 women;39.5 yrs)with the age less than 45 years old and 57 cases of senile cerebral infarction(37 men and 20 women;69 yrs).Ethical approval was obtained in the local institute and consent forms were obtained.Clinical data of all patients at admission were collected,including blood pressure,fasting blood glucose,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,homocysteine,and smoking and drinking.All subjects underwent routine MR sequences(including T1WI,T2WI and T2 FLAIR)and DWI on 1.5 T MRI scanner.Two experienced radiologists evaluated the CSVD independently as the following:enlarged perivascular spaces(EPVS)were counted and scored in basal ganglia(BG)and centrum semiovale(CS);lacunar infarction(LI)were counted,white matter hyperintensity lesions(WMH)were graded and recorded.To reduce the bias in assessment of the severity of the patient's CSVD,the patient's EPVS,WMH,LI,and CMBs scores were collectively accounted to derive the total burden scores of CSVD(TBS)(0-4 scores).The Kruskal-Wallis H test were used to compare the ranked data between groups.Correlation between CSVD and clinical factors were assessed by Multivariate Logistic regression analysis.Results:Difference among the scores of the three groups was observed(P<0.01).Based on a pair-to-pair comparison,there was significant difference in TBS among the three groups(P<0.05 after adjustment).The score of the infarction group was significantly higher than that of the control group,but significantly lower than the aged group.Hypertension was observed as the influencing factor of EPVS and the influencing factors of TBS(P<0.05).Smoking was the influencing factor of CMBs(P<0.05).LI was closely related to age(P<0.05).Conclusions:Young patients with acute symptomatic cerebral infarction often combined with CSVD,and hypertension,smoking and age are the influencing factors.