脑小血管病总负荷与颅内动脉搏动指数的关系及危险因素分析

The correlation between the total burden of cerebral small vessel disease and intracranial artery pulsatility index and the risk factors of cerebral small vessel disease

目的初步分析脑小血管病(cSVD)影像学总负荷与颅内动脉搏动指数(PI)的关系及其危险因素。方法选取入院的107例影像学符合cSVD的患者为研究对象,进行经颅多普勒超声检查得出大脑中动脉(MCA)PI;根据核磁共振检查结果,计算影像学标志物(腔隙性梗死、脑白质高信号、脑微出血和血管周围间隙共4项)总体负荷。按照cSVD总负荷评分情况评为1分21例、2分38例、3分32例、4分16例,并将1~2分为低负荷组;3~4分为高负荷组。结果Spearman相关性分析平均MCA PI值与cSVD总负荷呈正相关(rs=0.341,P<0.01);校正混杂因素后,logistic回归分析显示高平均MCA PI值(OR=1.276,95%CI:1.032~1.579,P=0.025)是cSVD负荷增加的独立危险因素;用平均MCA PI预测高负荷cSVD,最佳截断点为0.92,其曲线下面积为0.701(95%CI:0.605~0.796,P=0.001)、敏感度为75%、特异度为66.1%。结论MCA PI与cSVD影像学总负荷呈正相关,颅内动脉搏动性增加是cSVD负荷增加的独立危险因素;MCA PI值对cSVD高负荷具有一定的预测作用,可能成为预测cSVD的指标;降低颅内动脉搏动性有利于减轻小血管损伤。

Objective To analyze the correlation between total imaging burden of cerebral small vessel disease(cSVD)and intracranial artery pulsatility index(PI)and the risk factors of cSVD.Methods A total of 107 patients with cSVD from December 01,2018 to April 31,2020 were selected.Transcranial Doppler ultrasound was used to obtain the PI of the middle cerebral artery(MCA).According to MRI,the total burden of imaging markers,including lacunar infarction,white matter hyperintensity,cerebral microhemorrhage,and perivascular space,were analyzed.According to the cSVD total burden score,21 cases were with 1 point,38 cases were with 2 points,32 cases were with 3 points,and 16 cases were with 4 points.Low-burden and high-burden were defined as cSVD total burden of 1-2 and 3-4,respectively.Results Spearman correlation analysis MCA PI value was significantly positively correlated with cSVD total burden(rs=0.341,P<0.01).After adjusting for correction factors,the average MCA PI value(OR=1.276,95%CI:1.032-1.579,P=0.025)was an independent risk factor for increased cSVD total burden.Average MCA PI was used to predict high burden cSVD,the best cut-off point was 0.92,and the area under the curve is 0701(95%CI:0.605-0.796,P=0.001),with the sensitivity of 75%and specificity of 66.1%.Conclusion MCA PI is positively correlated with total imaging burden of cerebral small vessel disease.Increased intracranial arterial pulsatility is an independent risk factor for increased cSVD burden.The MCA PI value has a certain predictive effect on the high burden of cSVD,and may become an indicator for predicting cSVD.Timely reduction of pulsatility of intracranial arteries is conducive to reducing small vessel damage.