血管周围间隙扩大与脑梗死患者中国缺血性脑卒中亚型分型及复发的相关性研究

Correlation of enlarged perivascular space with Chinese ischemic stroke subclassification and its recurrence in cerebral infarction patients

目的探讨不同部位的血管周围间隙扩大(EPVS)与脑梗死患者中国缺血性脑卒中亚型(CISS)分型及复发的相关性。方法选择在我院神经内科住院的老年脑梗死EPVS患者278例,根据EPVS位于基底节区(BG)和半卵圆中心区(CSO)分别分组,BG-EPVS的轻度组113例,中重度组165例;CSO-EPVS的轻度组156例,中重度组122例。按CISS分为大动脉粥样硬化型、穿支动脉疾病及心源性卒中。还分为首发脑梗死173例和复发脑梗死105例。分析EPVS与CISS及复发脑梗死的关系,用多因素logistic回归分析。结果 BG-EPVS中,中重度组入院美国国立卫生研究院卒中量表评分(P=0.002)、脑白质高信号分级(P=0.003)、年龄(P=0.001)、高血压(75.2%vs 54.9%,P=0.000)、前循环梗死(69.7%vs 50.4%,P=0.001)和复发脑梗死比例(45.5%vs 26.5%,P=0.001)明显高于轻度组。CSO-EPVS中,中重度组仅年龄明显高于轻度组,差异有统计学意义(P=0.032)。BG-EPVS的中重度组高血压(75.2%vs 62.3%,P=0.019)、复发脑梗死(45.5%vs 32.8%,P=0.030)和穿支动脉疾病比例(47.9%vs 32.8%,P=0.028)明显高于CSO-EPVS的中重度组,差异有统计学意义。复发脑梗死患者中重度的BG-EPVS(70.5%vs 52.6%,P<0.01)、糖尿病(55.2%vs 42.8%,P<0.05)、穿支动脉疾病(51.4%vs 31.8%,P<0.01)均高于首发脑梗死患者。多因素logistic分析发现,中重度的BG-EPVS及穿支动脉疾病仍是复发脑梗死的相关危险因素。结论中重度的BG-EPVS与CISS分型中的穿支动脉疾病密切相关,是复发脑梗死的独立危险因素。

Objective To study the correlation between enlarged perivascular space(EPVS) and Chinese ischemic stroke subclassification(CISS) and its recurrence in cerebral infarction patients.Methods Two hundred and seventy-eight elderly cerebral infarction patients admitted to our hospital were divided into mild basal gangalia(BG)-EPVS group(n=113) and moderate-severe BG-EPVS group(n=165) according to the location of EPVS in BG or into mild central semiorale(CSO)-EPVS group(n=156) and moderate-severe CSO-EPVS group(n=122) according to the location of EPVS in CSO.Ischemic stroke was divided into large artery atherosclerotic stroke,perforating artery disease and cardiogenic stroke in the CISS.The patients were further divided into first-ever cerebral infarction group(n=173) and recurrent cerebral infarction group(n=105).The correlation of EPVS with CISS and recurrent cerebral infarction was analyzed by multivariate logistic regression analysis.Results In BG-EPVS,the NIHSS score(P=0.002),white matter hypersignal grade(P=0.003),age(P=0.001),hypertension(75.2% vs 54.9%,P=0.000),anterior circulation infarction(69.7% vs 50.4%,P=0.001) and recurrent cerebral infarction(45.5% vs 26.5%,P=0.001) were significantly higher in moderate-severe group than in mild group.In CSO-EPVS,only the age was significantly higher in moderate-severe group than in mild group(P=0.033).The proportion of hypertention(75.2% vs 62.3%,P=0.019),recurrent cerebral infarction(45.5% vs 32.8%,P=0.030) and perforating artery disease(47.9% vs 32.8%,P=0.028) was significantly higher in moderate-severe BG-EPVS group than in moderate-severe CSO-EPVS group.The incidence of moderate-severe BG-EPVS,DM and perforating artery disease was significantly higher in recurrent cerebral infarction group than in first-ever cerebral infarction group(70.5% vs 52.6%,P<0.01;55.2% vs 42.8%,P<0.05;51.4% vs 31.8%,P<0.01).Multivariate logistic regression analysis showed that moderate-severe BG-EPVS and perforating artery disease were the risk factors for recurrent cerebral infarction.Conclusion Moderate-severe BG-EPVS is closely related with perforating artery disease in CISS and is an independent risk factor for recurrent cerebral infarction.