急性轻型脑梗死患者颅内动脉延长扩张症与脑小血管病总负荷的相关性研究

Correlation between intracranial arterial dolichoectasia and total cerebral small vessel disease burden in patients with acute mild cerebral infarction

目的探讨急性轻型脑梗死患者颅内动脉延长扩张症(IADE)与脑小血管病(CSVD)总负荷的相关性。方法回顾性连续纳入2021年4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的急性轻型脑梗死患者。所有患者完成头部MRI和CT血管成像(CTA)检查,采用CTA和MRI测量颈内动脉海绵窦段直径、大脑中动脉M1段直径、大脑前动脉直径、基底动脉直径、基底动脉分叉高度及基底动脉侧移程度以诊断IADE,同时对每个动脉直径进行标准化Z转换获得Z分数,再将每个动脉的Z分数相加除以动脉总数,得到脑动脉重构(BAR)评分,采用Spearman相关分析方法分析BAR评分与CSVD总负荷的相关性。应用MRI评估腔隙、血管周围间隙扩大(EPVS)、脑微出血(CMBs)及脑白质高信号(WMHs)4种影像学标记物,并测定CSVD总负荷评分。根据脑梗死患者有无IADE,将所有患者分为IADE组与非IADE组;依据CSVD总负荷评分,将0~1分患者纳入CSVD总负荷无-轻度组,2~4分患者纳入中重度组,分别比较各组患者的基线和影像学资料,采用多因素Logistic回归分析IADE与CSVD总负荷之间的关系。结果(1)共纳入290例患者,其中IADE患者41例,非IADE患者249例。无-轻度CSVD总负荷患者189例,中重度CSVD总负荷患者101例。(2)IADE组患者的年龄[(72±10)岁比(66±12)岁,t=-3.440]、男性比例[85.4%(35/41)比69.5%(173/249),χ^(2)=4.382]、腔隙[48.8%(20/41)比28.5%(71/249),χ^(2)=6.715]、半卵圆形中心区EPVS(χ^(2)=7.596)、CSVD总负荷(χ^(2)=34.989)及WMHs评分[4(3,5)分比2(1,4)分,Z=-4.053]均高于非IADE组,差异均有统计学意义(均P<0.05)。(3)中重度CSVD总负荷组患者年龄[(70±11)岁比(65±12)岁,t=-3.460]、男性比例[79.2%(80/101)比67.7%(128/189),χ^(2)=4.280]、既往卒中史[38.6%(39/101)比23.3%(44/189),χ^(2)=7.576]、血清肌酐水平[73.00(63.30,84.00)μmol/L比67.00(58.40,79.00)μmol/L,Z=-2.250]、同型半胱氨酸水平[13.00(10.00,17.50)μmol/L比11.40(9.10,15.05)μmol/L,Z=-2.590]、入院前抗血小板聚集药物治疗比例[26.7%(27/101)比12.2%(23/189),χ^(2)=9.784]、降脂药物治疗比例[21.8%(22/101)比12.2%(23/189),χ^(2)=4.640]、IADE比例[30.7%(31/101)比5.3%(10/189),χ^(2)=34.989]及BAR评分[0.60(0.22,1.07)分比-0.34(-0.58,-0.83)分,Z=-9.632]均高于无-轻度CSVD总负荷组,差异均有统计学意义(均P<0.05)。(4)Spearman相关分析发现,BAR评分与CSVD总负荷呈正相关(r=0.567,P<0.01)。(5)多因素二元Logistic回归分析结果表明,IADE(OR=5.950,95%CI:2.678~13.222,P<0.01)及年龄(OR=1.030,95%CI:1.005~1.056,P=0.020)是中重度CSVD总负荷的独立影响因素。结论在急性轻型脑梗死患者中,IADE是中重度CSVD总负荷的独立危险因素。

Objective To investigate the relationship between intracranial arterial dolichoectasia(IADE)and the total cerebral small vessel disease(CSVD)burden in patients with acute mild cerebral infarction.Methods Patients with acute mild cerebral infarction who were hospitalized in the Department of Neurology of Changzhou Second People′s Hospital Affiliated to Nanjing Medical University from April to October 2021 were included consecutively.All patients underwent cerebral MRI and CT angiography(CTA)examination.CTA and MRI were used to measure the diameter of cavernous sinus segment of internal carotid artery,diameter of M1 segment of middle cerebral artery,diameter of anterior cerebral artery,diameter of basilar artery,bifurcation height of basilar artery and lateral displacement of basilar artery to diagnose IADE.The Z-score of each individual was added and divided by the total number of arteries to obtain the average Z-score of each individual,also known as brain arterial remodeling(BAR)score.Spearman correlation analysis was used to further explore the correlation between BAR score and CSVD total burden.Four imaging markers including lacunar infarcts(LIs),enlarge perivascular spaces(EPVS),cerebral microbleeds(CMBs)and white matter hyperintensities(WMHs)were evaluated by MRI and the total CSVD score was measured.Patients with cerebral infarction were divided into IADE group and non IADE group according to whether they had IADE or not.According to the CSVD total load score,0-1 points was included in the no-mild CSVD total burden group and 2-4 points was included in the moderate-severe CSVD total burden group.The baseline and imaging data of each group were compared,and the relationship between IADE and CSVD total burden was further analyzed by multivariate Logistic regression.Results(1)A total of 290 patients were enrolled,including 41 IADE patients and 249 non-IADE patients.There were 189 patients with no-mild burden of CSVD and 101 patients with moderate-severe burden of CSVD.(2)Age([72±10]years vs.[66±12]years,t=-3.440),male proportion(85.4%[35/41]vs.69.5%[173/249],χ^(2)=4.382),LIs(48.8%[20/41]vs.28.5%[71/249],χ^(2)=6.715),basal ganglia EPVS(χ^(2)=7.596),burden of CSVD(χ^(2)=34.989)and WMHs score(4[3,5]score vs.2[1,4]score,Z=-4.053)in IADE group were higher than those in non-IADE group,and the differences were statistically significant(all P<0.05).(3)Further comparison found that age([70±11]years vs.[65±12]years,t=-3.460),male proportion(79.2%[80/101]vs.67.7%[128/189],χ^(2)=4.280),past history of stroke(38.6%[39/101]vs.23.3%[44/189],χ^(2)=7.576),serum creatinine level(73.00[63.30,84.00]μmol/L vs.67.00[58.40,79.00]μmol/L,Z=-2.250),homocysteine(13.00[10.00,17.50]μmol/L vs.11.40[9.10,15.05]μmol/L,Z=-2.590),use of antiplatelet aggregation drugs(26.7%[27/101]vs.12.2%[23/189],χ^(2)=9.784)and lipid-lowering drugs(21.8%[22/101]vs.12.2%[23/189],χ^(2)=4.640)before admission,proportion of IADE(30.7%[31/101]vs.5.3%[10/189],χ^(2)=34.989)and BAR score(0.60[0.22,1.07]vs.-0.34[-0.58,-0.83],Z=-9.632)in moderate-severe burden of CSVD group were higher than those in no-mild CSVD total burden group,and the differences were statistically significant(all P<0.05).(4)Spearman correlation analysis found that BAR scores was positively correlated with total CSVD burden(r=0.567,P<0.01).(5)Multivariate binary Logistic regression analysis indicated IADE(OR,5.950,95%CI 2.678-13.222,P<0.01)and age(OR,1.030,95%CI 1.005-1.056,P=0.020)were independent influencing factors for moderate-severe burden of CSVD.Conclusion In patients with acute mild cerebral infarction,IADE was an independent risk factor for moderate-severe CSVD total burden.