烟雾综合征患者脑内血管周围间隙扩大的特征研究

Characteristics of intracranial enlarged perivascular spaces in moyamoya syndrome patients

目的探究烟雾综合征患者脑内不同位置血管周围间隙扩大(enlarged perivascular spaces,EPVS)的特征。方法选择2017年9月1日~2019年9月30日首都医科大学附属北京朝阳医院神经内科诊断为烟雾综合征并完善相关检查的患者53例(烟雾综合征组),另选取年龄和性别匹配的健康体检者53例(对照组)。根据头颅MRI评估基底节区EPVS(basal ganglia EPVS,BG-EPVS)和脑白质区EPVS(white matter EPVS,WM-EPVS)的严重程度。根据WM-EPVS的严重程度又分为重度EPVS组44例和非重度EPVS组62例。Spearman相关分析和二元logistic回归分析脑内不同位置EPVS的严重程度与烟雾综合征的关系。结果烟雾综合征组WM-EPVS和脑白质高信号评分明显高于对照组[4(3,4)分vs 3(1,4)分,P=0.006;3(2,4)分vs 2(1,2)分,P=0.001]。2组BG-EPVS和脑萎缩评分比较,无统计学差异(P>0.05)。Spearman相关分析显示,烟雾综合征与WM-EPVS和脑白质高信号呈正相关(r=0.267,P=0.006;r=0.470,P=0.001),与BG-EPVS不相关(r=0.095,P=0.335)。重度EPVS组烟雾综合征比例明显高于非重度EPVS组(63.6%vs 40.3%,P=0.018)。二元logistic回归分析显示,烟雾综合征增加重度WM-EPVS的发生风险(OR=2.590,95%CI:1.168~5.745,P=0.019)。结论烟雾综合征与WM-EPVS的严重程度相关,是重度WM-EPVS的危险因素,与BG-EPVS的形成无关,WM-EPVS和BG-EPVS的发生机制可能存在不同。

Objective To study the characteristics of intracranial enlarged perivascular spaces(EPVS) in moyamoya syndrome patients.Methods Fifty-three moyamoya syndrome patients admitted to our hospital from 2017-09-01 to 2019-09-30 served as a moyamoya group with 53 age-and gender-matched persons who underwent physical examination in ur hospital served as a control group.The severity of intracranial EPVS located in basal ganglia(BG-EPVS) and that of EPVS located in white matter(WM-EPVS) were assessed according to their brain MRI.The WM-EPVS patients were dvided into severe EPVS group(n=44) and non-severe EPVS group(n=62).The relationship between moyamoya syndrome and EPVS was analyzed by Spearman correlation analysis and binary logistic regression analysis respectively.Results The scores of WM-EPVS and white matter hypersensities(WMH) were significantly higher in moyamoya group than in control group [4(3,4) vs 3(1,4),P=0.006;3(2,4) vs 2(1,2),P=0.001].No significant difference was detected in BG-EPVS and brain atrophy between the two groups(P>0.05).Spearman correlation analysis showed that moyamoya syndrome was positively related with WM-EPVS and WMH(r=0.267,P=0.006;r=0.470,P=0.001) but not related with BG-EPVS(r=0.095,P=0.335).The incidence of moyamoya syndrome was significantly higher in severe WM-EPVS group than in non-severe WM-EPVS group(63.6% vs 40.3%,P=0.018).Binary logistic regression analysis showed that moyamoya syndrome increased the risk of WM-EPVS(OR=2.590,95%CI:1.168-5.745,P=0.019).Conclusion Moyamoya syndrome,a risk factor for severe WM-EPVS,is related with the severity of WM-EPVS but not related with the formation of BG-EPVS.The mechanisms of WM-EPVS and BG-EPVS may be different.