缺血性脑卒中脑皮层胆碱能通路受损的临床及影像学相关因素分析

Clinical and imaging correlates of involving in cortical cholinergic pathways in patients with acute ischemic stroke

目的探讨缺血性脑卒中患者脑皮层胆碱能通路(cortical cholinergic pathways,CCP)受损的临床及影像学相关因素。方法纳入473例起病7 d内的急性缺血性脑卒中患者,收集患者的临床资料及影像学资料。CCP的损害程度采用胆碱能通路高信号量表(cholinergic pathways hyperintensities scale,CHIPS)进行评估。采用相关分析筛选与CHIPS评分相关的临床及颅脑MRI变量,并应用线性回归方程探讨CCP的相关危险因素。结果本组患者年龄(60.31±14.19)岁,男334例(70.6%),CHIPS评分(17.31±17.72)分。相关分析显示,CHIPS评分与年龄(r=0.356,P<0.001)、男性(r=0.131,P=0.004)、高血压史(r=0.188,P<0.001)、心房纤颤病史(r=0.109,P=0.018)、既往卒中史(r=0.201,P<0.001)、入院时NIHSS评分(r=0.159,P=0.001)以及脑梗死病因分型(r=0.092,P=045)相关。同时,CHIPS评分与双侧皮层下区域的脑梗死(左侧:r=0.113,P=0.014;右侧:r=0.098,P=0.033)、脑干梗死(r=—0.116,P=0.012)、脑梗死体积(r=0.131,P=0.004)、侧脑室旁白质病变(r=0.652,P<0.001)、深部脑白质病变(r=0.67,P<0.001)和内侧颞叶萎缩(r=0.545,P<0.001)相关。建立线性回归模型,采用共线性分析排除存在共线性的变量,结果显示,CHIPS评分与入院时NIHSS评分及深部脑白质病变相关,方程的校正决定系数为0.513。结论缺血性脑卒中患者常合并CCP损害,较严重的CCP损害可能与更严重的脑梗死及深部脑白质病变相关。

Objective To explore the relationship between the clinical and imaging factors and cortical cholinergic pathways(CCP)damage in patients with ischemic stroke.Methods The present study included 473 patients with acute ischemic stroke within 7 days of onset.We collected the clinical and imaging data of the pa⁃tients.The severity of involvement of CCP was evaluated by Cholinergic Pathways Hyperintensities Scale(CHIPS).Correlation analysis was used to screen the clinical and brain MRI variables related to CHIPS score,and the linear regression equation was used to explore the putative related factors of CCP.Results The age of the pa⁃tients was(60.3±14.19)years old,with 334(70.6%)male patients and the CHIPS score was 17.31±17.72.Correla⁃tion analysis showed that CHIPS score was correlated with age(r=0.356,P<0.001),male patients(r=0.131,P=0.004),hypertension history(r=0.188,P<0.001),atrial fibrillation history(r=0.109,P=0.018),previous stroke(r=0.201,P<0.001),NIHSS score at admission(r=0.159,P=0.001)and stroke subtype(r=0.092,P=045).Meanwhile,CHIPS score was correlated with bilateral subcortical infarction(left:r=0.113,P=0.014;Right:r=0.098,P=0.033),brainstem infarction(r=—0.116,P=0.012),infarct volume(r=0.131,P=0.004),PVH(r=0.652,P<0.001),DWMH(r=0.67,P<0.001)and MTLA(r=0.545,P<0.001).The linear regression model was established,and the collin⁃earity of the variables were tested.The results showed that the CHIPS score was related to NIHSS score at admis⁃sion,brain stem infarction and deep white matter lesions,adjusted R2 was 0.513.Conclusion CCP damage was comment in patients with acute ischemic stroke.The more severe CCP damage may be related to more severe cere⁃bral infarction and deep white matter lesions.