颅内动脉粥样硬化与皮质下缺血性脑血管病的相关性研究

Association between intracranial atherosclerosis and subcortical ischemic vascular disease

目的探讨颅内动脉粥样硬化与皮质下缺血性脑血管病(SIVD)主要病变类型脑白质病变、腔隙性脑梗死(LI)以及认知功能的相关性。方法纳入2018年6月~2020年7月广州医科大学附属第二医院神经内科住院治疗的SIVD患者391例,根据磁共振血管造影术检查分为轻度颅内动脉粥样硬化组(轻度组)47例、中度颅内动脉粥样硬化组(中度组)201例和重度颅内动脉粥样硬化组(重度组)143例,采用年龄相关性脑白质改变(ARWMC)量表评分评估脑白质病变严重程度,计算LI总分,采用简易智能状态检查量表(MMSE)评分评估认知功能。结果轻度组、中度组、重度组年龄、高血压及糖尿病比例比较,差异有统计学意义(P<0.05,P<0.01)。重度组ARWMC总分>20分、不同脑区的ARWMC评分>2分、LI总分>10分及不同脑区的LI评分>1分比例明显高于轻度组和中度组,MMSE总分明显低于轻度组和中度组(P<0.05)。中度组ARWMC总分>20分,额区、顶枕区和基底节区ARWMC评分>2分,LI总分>10分,额区、幕下区和基底节区LI评分>1分比例明显高于轻度组,MMSE总分明显低于轻度组,差异有统计学意义(P<0.05)。中、重度颅内动脉粥样硬化是SIVD患者脑白质病变(95%CI:1.343~6.561,P=0.007;95%CI:2.185~11.737,P=0.001)、LI(95%CI:1.434~8.765,P=0.006;95%CI:2.977~19.600,P=0.001)和认知功能障碍(95%CI:1.369~6.063,P=0.005;95%CI:2.851~14.670,P=0.001)的危险因素。结论颅内动脉粥样硬化与SIVD主要病变类型相关,可能是SIVD患者发生认知功能障碍的危险因素。

Objective To study the association of intracranial atherosclerosis with subcortical ischemic cerebrovascular disease(SIVD),including white matter lesion(WML),lacunar infarction(LI) and cognitive function.Methods Three hundred and ninety-one SIVD patients admitted to our hospital from June 2018 to July 2020 were divided into mild intracranial atherosclerosis group(n=47),moderate intracranial atherosclerosis group(n=201) and severe intracranial atherosclerosis group(n=143) according to their MRA image.The severity of WML was assessed according to the ARWMC score.The total score of LI was recorded.The cognitive function of SIVD patients was scored according to the MMSE scale.Results Significant difference was detected in age, incidence of hypertension and DM in 3 intracranial atherosclerosis groups(P<0.05).The ratio of ARWMC total score >20,ARWMC score >2 in different brain regions, LI total score >10 and LI score >1 in frontal region, subtentorial region and basal ganglia region was significantly higher while that of MMSE scale total score was significantly lower in severe intracranial atherosclerosis group than in mild and moderate intracranial atherosclerosis groups(P<0.05) and in moderate intracranial atherosclerosis group than in mild intracranial atheros-clerosis group(P<0.05).Moderate intracranial atherosclerosis and severe intracranial atheroclerosis were risk factors for WML,LI and cognitive impairment in SIVD patients(95%CI:1.343-6.561,P=0.007 and 95%CI:2.185-11.737,P=0.001 and 95%CI:1.434-8.765,P=0.006;95%CI:2.977-19.600,P=0.001 and 95%CI:1.369-6.063,P=0.005;95%CI:1.369-6.063,P=0.005 and 95%CI:2.851-14.670,P=0.001).Conclusion Intracranial atherosclerosis is associated with SIVD and is a risk factor for cognitive impairement in SIVD patients.