颅内动脉重塑与脑小血管病患者影像学标志物的关系

Relationship between intracranial arterial remodeling and imaging markers in patients with cerebral small vessel disease

目的探讨颅内动脉重塑与脑小血管病(CSVD)患者影像学标志物的关系。方法选取2020年1月至2022年5月在郑州大学第二附属医院或新郑市公立人民医院神经内科住院的CSVD患者共156例, 计算其脑动脉重塑(BAR)评分, 将BAR评分≤-1倍标准差的患者定义为颅内动脉缩窄性重塑的个体, BAR评分≥1倍标准差的患者为定义颅内动脉扩张性重塑的个体。对CSVD影像学标志物[脑白质高信号(WMHs)、腔隙、脑微出血、扩大的血管周围间隙和脑萎缩]进行量化, 计算出CSVD总负荷评分并根据评分结果将所有患者分为低负荷组(0~2分, 91例)和高负荷组(3~4分, 65例)。采用单因素分析、二元Logistic回归分析探讨颅内动脉重塑与CSVD各影像学标志物及总负荷的关系, 建立列线图预测模型并绘制受试者工作特征曲线(ROC)以评估颅内动脉重塑对高CSVD总负荷的预测价值。结果颅内动脉扩张性重塑是严重WMHs(OR=3.66, 95%CI 1.38~9.72, P=0.009)、腔隙(OR=3.78, 95%CI 1.17~12.19, P=0.026)、脑萎缩(OR=3.11, 95%CI 1.10~8.81, P=0.033)、高CSVD总负荷(OR=6.66, 95%CI 2.14~20.77, P=0.001)的独立影响因素。年龄是高CSVD总负荷的独立影响因素(OR=1.12, 95%CI 1.07~1.16, P<0.01)。以年龄及BAR评分≥1倍标准差为因变量建立高CSVD总负荷的列线图预测模型, 该模型有较好的效应(C指数=0.826)及校准度(P=0.024)。ROC曲线的最佳截断点是0.50, 曲线下面积为0.83(95%CI 0.76~0.89, P<0.01), 敏感度和特异度分别为0.72和0.82。结论颅内动脉扩张性重塑的患者可能有较高的CSVD负荷。颅内动脉扩张性重塑可作为一种新的评估CSVD负荷生物标志物, 但两者间联系的机制需进一步研究。

Objective To investigate the relationship between intracranial arterial remodeling and imaging markers in patients with cerebral small vessel disease(CSVD).Methods One hundred and fifty-six patients with CSVD who were admitted to the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University or the Public People′s Hospital of Xinzheng from January 2020 to May 2022 were selected,and their brain artery remodeling(BAR)score was calculated.The patients with BAR score≤-1 standard deviation(SD)were defined as individuals with constrictive remodeling of intracranial arteries,and the patients with BAR score≥1 SD were defined as individuals with dilated remodeling of intracranial arteries.Imaging markers of CSVD[white matter hyperintensities(WMHs),lacune,cerebral microbleeds,enlarged perivascular spaces,and cerebral atrophy]were quantified,total CSVD load was calculated and patients were divided into low load group(0-2 points,n=91)and high load group(3-4 points,n=65)according to the total CSVD load scores.The correlation between intracranial artery remodeling and various imaging markers of CSVD and total load was analyzed by using univariate analysis and binary Logistic regression analysis.A nomogram prediction model was established and a receiver operating characteristic curve(ROC)was drawn to assess the predictive value of intracranial artery remodeling on high total CSVD load.Results Dilated intracranial arterial remodeling was an independent influence factor on severe WMHs(OR=3.66,95%CI 1.38-9.72,P=0.009),lacune(OR=3.78,95%CI 1.17-12.19,P=0.026),cerebral atrophy(OR=3.11,95%CI=1.10-8.81,P=0.033),and high total CSVD load(OR=6.66,95%CI=2.14-20.77,P=0.001).Age was an independent influencing factor for high total CSVD load(OR=1.12,95%CI 1.07-1.16,P<0.01).A nomogram prediction model for high total CSVD load with age and BAR score≥1 SD as dependent variables had a good effect(C-index=0.826)and calibration(P=0.024).The best cut-off point of ROC curve was 0.50,with an area under the curve of 0.83(95%CI 0.76-0.89,P<0.01),the sensitivity and specificity of 0.72 and 0.82.Conclusions Patients with dilated intracranial arterial remodeling may have a heavier CSVD load.Dilated intracranial arterial remodeling may serve as a new biomarker for assessing CSVD,but the mechanism of the association needs further study.