β2微球蛋白与小动脉闭塞型卒中患者血管周围间隙扩大的相关性研究

Study on the correlation between beta-2 microglobulin and enlarged perivascular spaces in patients with small-artery occlusion stroke

目的探讨β2微球蛋白(β2M)水平与小动脉闭塞型卒中患者血管周围间隙扩大(EPVS)之间的关系。方法连续纳入2020年6月至10月南京医科大学附属常州市第二人民医院神经内科住院治疗的小动脉闭塞型卒中患者,每例患者入院后均完成血清及尿液β2M测定和头部MRI检查。采用视觉量化评估法对EPVS程度进行分级(无EPVS为0级;≤10个为1级;11~20个为2级;21~40个为3级;>40个为4级)。将基底节区EPVS(BG-EPVS)和半卵圆中心区的EPVS(CSO-EPVS)分级均0~1级者纳入无-轻度EPVS组,基底节区或半卵圆中心区任意部位的EPVS分级2~4级者纳入中重度EPVS组;不同EPVS发生部位(BG-EPVS和CSO-EPVS)依据EPVS的病变程度均分为无-轻度组(EPVS分级0~1级)和中重度组(EPVS分级2~4级),分别比较各组患者的基线和临床资料[如年龄、性别、体质量指数、吸烟、饮酒、高血压病、糖尿病、相关实验室指标如总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、糖化血红蛋白、尿素氮、肌酐、估计的肾小球滤过率(eGFR)以及头部MRI资料],并采用多因素Logistic回归模型分析血清β2M水平与不同程度BG-EPVS之间的关系。结果共纳入142例患者,其中无-轻度EPVS组63例,中重度EPVS组79例。无-轻度EPVS组与中重度EPVS组在年龄[61(51,70)岁比71(61,78)岁,Z=-4.721]、吸烟[9.5%(6/63)比26.6%(21/79),χ^(2)=6.623]、高血压病[46.0%(29/63)比81.0%(64/79),χ^(2)=18.978]、总胆固醇[(4.1±0.9)mmol/L比(3.7±1.0)mmol/L,t=2.607]、低密度脂蛋白胆固醇[2.43(1.94,2.71)mmol/L比2.02(1.49,2.49)mmol/L,Z=-2.725]、肌酐[63.00(55.00,72.00)μmol/L比69.00(56.00,85.00)μmol/L,Z=-2.121]、eGFR[(97±29)ml·min^(-1)·1.73 m^(-2)比(80±27)ml·min^(-1)·1.73 m^(-2),t=3.513]、血清β2M[1.83(1.62,2.14)mg/L比2.32(1.97,2.80)mg/L,Z=-5.345]及血清β2M水平升高患者比例[3.2%(2/63)比17.7%(14/79),χ^(2)=7.418]等方面差异均有统计学意义(均P<0.05)。进一步对不同部位EPVS患者分析发现,BG-EPVS中重度组(75例)血清β2M水平高于BG-EPVS无-轻度组(67例),差异有统计学意义[2.33(1.99,2.81)mg/L比1.83(1.62,2.14)mg/L,Z=-5.701,P<0.05];而在CSO-EPVS无-轻度组(88例)与中重度组(54例)两组中,血清β2M水平差异无统计学意义[1.96(1.69,2.42)mg/L比2.14(1.84,2.66)mg/L,Z=-1.876,P=0.061]。多因素二元Logistic回归分析显示,年龄(OR=1.064,95%CI:1.011~1.120,P=0.017)及血清β2M水平(OR=3.883,95%CI:1.566~9.627,P=0.003)是中重度BG-EPVS的独立影响因素。Spearman相关性分析显示,血清β2M水平与BG-EPVS等级呈正相关(r=0.487,P<0.05)。结论血清β2M与小动脉闭塞型卒中患者BG-EPVS的严重程度相关。

Objective To investigate the relationship between beta-2 microglobulin and enlarged perivascular spaces(EPVS)in patients with small-artery occlusion stroke.Methods From June 2020 to October 2020,patients with small-artery occlusion stroke and hospitalized in the Department of Neurology,Changzhou Second People′s Hospital,Nanjing Medical University were recruited consecutively.Each patient completed serum and urineβ2M measurement and cranial MRI examination.Visual quantitative assessment method was used to grade EPVS(no EPVS,grade 0;≤10,grade 1;11-20,grade 2;21-40,grade 3;>40,grade 4).Patients with EPVS grade 0-1 in basal ganglia(BG)and centrum semiovale(CSO)were included in the non-mild EPVS group,and patients with EPVS grade 2-4 in BG or CSO region were included in the moderate-severe EPVS group.Patients with different EPVS sites[BG-EPVS and CSO-EPVS]were divided into non-mild group(EPVS grade 0-1)and moderate-severe group(EPVS grade 2-4)according to the degree of EPVS.Baseline and clinical data were compared between groups,such as age,gender,body mass index,smoking,drinking,hypertension,diabetes,and related laboratory indexes including triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,glycosylated hemoglobin,urea nitrogen,creatinine,glycosylated hemoglobin,and estimated glomerular filtration rate(eGFR)and cranial MRI.The relationship between serumβ2M level and different levels of BG-EPVS was analyzed by multivariate Logistic regression model.Results A total of 142 patients were included,including 63 in non-mild EPVS group and 79 in moderate-severe EPVS group.The analysis indicated that age(61[51,70]years vs.71[61,78]years,Z=-4.721),smoking(9.5%[6/63]vs.26.6%[21/79],χ^(2)=6.623),hypertension(46.0%[29/63]vs.81.0%[64/79],χ^(2)=18.978),total cholesterol([4.1±0.9]mmol/L vs.[3.7±1.0]mmol/L,t=2.607),low-density lipoprotein cholesterol(2.43[1.94,2.71]mmol/L vs.2.02[1.49,2.49]mmol/L,Z=-2.725),creatinine(63.00[55.00,72.00]μmol/L vs.69.00[56.00,85.00]μmol/L,Z=-2.121),eGFR([97±29]ml·min^(-1)·1.73 m^(-2) vs.[80±27]ml·min^(-1)·1.73 m^(-2),t=3.513),serumβ2M(1.83[1.62,2.14]mg/L vs.2.32[1.97,2.80]mg/L,Z=-5.345),and the rate of patients with high serumβ2M(3.2%[2/63]vs.17.7%[14/79],χ^(2)=7.418)between non-mild EPVS group and moderate-severe EPVS group were significantly different(all P<0.05).Furthermore,according to the location comparison,the level of serumβ2M in BG-EPVS moderate-severe group was higher than that in BG-EPVS non-mild group(2.33[1.99,2.81]mg/L vs.1.83[1.62,2.14]mg/L,Z=-5.701,P<0.05),and the difference was statistically significant.Between CSO-EPVS non-mild group(88 cases)and moderate-severe group(54 cases),serumβ2M level was not significant different(1.96[1.69,2.42]mg/L vs.2.14[1.84,2.66]mg/L,Z=-1.876,P=0.061).Multivariate binary Logistic regression analysis showed that age(OR,1.064,95%CI 1.011-1.120,P=0.017)and serumβ2M level(OR,3.883,95%CI 1.566-9.627,P=0.003)were independent influence factors for the moderate-severe degree of BG-EPVS.Spearman correlation analysis showed that serumβ2M level was positively correlated with the grade of BG-EPVS(r=0.487,P<0.05).Conclusion Serumβ2M is related with the degree of BG-EPVS in patients with small-artery occlusion stroke.