大脑中动脉供血单发皮质下小梗死与脑小血管病总负荷的研究

Association between signal small subcortical infarction in middle cerebral artery and total cerebral small vessel disease burden

目的探讨大脑中动脉供血单发皮质下小梗死与脑小血管病(CSVD)总负荷的研究。方法选择大脑中动脉供血单发皮质下小梗死患者150例,根据梗死部位是否累及基底核最低层面分为近端梗死组67例,远端梗死组83例。收集2组一般临床资料,包括年龄、性别、入院时美国国立卫生研究院卒中量表评分、TG、TC、LDL-C、血红蛋白、既往病史(高血压、糖尿病、冠心病)、吸烟、饮酒、颅内外大动脉狭窄比例。头颅MRI评估CSVD总负荷,包括脑白质高信号(WMH)、血管周围间隙、脑微出血、腔隙性脑梗死,并进行组间比较。结果远端梗死组年龄明显高于近端梗死组[(74.4±8.0)岁vs(70.2±8.0)岁,P=0.002],TC、LDL-C、血红蛋白、吸烟、饮酒、颅内外动脉狭窄比例明显低于近端梗死组[(3.6±0.9)mmol/L vs(4.1±0.3)mmol/L,P=0.005;(2.3±0.7)mmol/L vs(2.6±0.9)mmol/L,P=0.032;(128.6±16.9)g/L vs(136.8±12.9)g/L,P=0.001;26.5%vs 55.2%,P=0.001;25.3%vs 46.3%,P=0.007;36.1%vs 53.7%,P=0.031]。远端梗死组中重度血管周围间隙、脑微出血、脑室周围WMH评分、深部白质WMH评分、WMH总分明显高于近端梗死组(P<0.05,P<0.01)。2组CSVD总负荷评分比较,差异有统计学意义(P=0.001)。多因素logistic回归分析显示,CSVD总负担(OR=1.756,95%CI:1.128~2.734,P=0.013)、颅内外动脉狭窄(OR=0.376,95%CI:0.178~0.794,P=0.010)与远端梗死独立相关。结论大脑中动脉供血区远端梗死CSVD总负荷高于近端梗死,发病机制多与CSVD相关。

Objective To study the association between signal small subcortical infarction in middle cerebral artery(MCA)and total cerebral small vessel disease(CSVD)burden.Methods One hundred and fifty patients with signal small subcortical infarction in MCA admitted to our hospital from January 2017 to June 2020 were divided into single proximal subcortical infarction(SPSI)group(n=67)and single distal subcortical infarction(SDSI)group(n=83).Their clinical data were recorded,including age,sex,NIHSS score on admission,serum levels of TG,TC,LDL-C and hemoglobin,past history of hypertension,DM,CHD,smoking,alcohol consumption,and incidence of extracranial and intracranial artery stenosis.The total CSVD burden was compared between the two groups,including WMH,PVS,CMB,LI.Results The age was significantly older while the serum levels of TC,LDL-C and hemoglobin were significantly lower,the rate of past history of smoking and alcohol consumption and the incidence of extracranial and intracranial artery stenosis were significantly lower in SDSI group than in SPSI group(74.4±8.0 years vs 70.2±8.0 years,P=0.002;3.6±0.9 mmol/L vs 4.1±0.3 mmol/L,P=0.005;2.3±0.7 mmol/L vs 2.6±0.9 mmol/L,P=0.032;128.6±16.9 g/L vs 136.8±12.9 g/L,P=0.001;26.5%vs 55.2%,P=0.001;25.3%vs 46.3%,P=0.007;36.1%vs 53.7%,P=0.031).The scores of moderate-severe PVS,CMB,deep WMH score and total WMH score were significantly higher in SDSI group than in SPSI group(P<0.05,P<0.01).Significant difference was detected in total CSVD burden score between the two groups(P=0.001).Binary logistic regression analysis showed that the total CSVD burden,extracranial and intracranial artery stenosis were independently related with the distal infarction(OR=1.756,95%CI:1.128-2.734,P=0.013;OR=0.376,95%CI:0.178-0.794,P=0.010).Conclusion Total CSVD burden in MCA is higher in SDSI patients than in SPSI patients,indicating that the pathogenesis of SDSI is associated with CSVD in patients with single small subcortical infarction in MCA.