轻症急性脑梗死患者继发血管周围间隙扩大的影响因素及与眼底血管病变相关性研究

Risk Factors of Enlarged Perivascular Space and Its Association with Fundus Lesions in Patients with Mild Acute Cerebral Infarction

背景 血管周围间隙扩大(EPVS)出现与脑梗死、脑出血或认知功能障碍有关,而眼底血管病变已被证实与上述病变关系密切,但轻症急性脑梗死患者发生EPVS的危险因素,特别是眼底动静脉交叉征、眼底渗出等改变与EPVS的关系尚缺乏相关报道。目的 探讨轻症急性脑梗死患者继发EPVS的影响因素及与眼底血管病变的相关性。方法 回顾性选取平顶山市第五人民医院和第二人民医院2015年1月至2020年12月收治的轻症急性脑梗死患者266例为研究对象,根据是否继发EPVS分为继发EPVS组(114例)和未继发EPVS组(152例)。收集轻症急性脑梗死患者的一般资料、实验室检查及影像学检查资料,采用多因素Logistic回归分析探讨轻症急性脑梗死患者继发EPVS的独立影响因素,采用Spearman秩相关分析和多元线性回归分析探讨EPVS严重程度和数量与眼底血管病变间的相关性。结果 266例轻症急性脑梗死患者中,男178例、女88例,平均年龄(67.8±12.9)岁;两组患者年龄、高血压史、眼底动脉硬化程度、视网膜中央动脉直径、视网膜动静脉比值、血管瘤、视网膜动静脉交叉征比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压史[OR=3.127,95%CI(1.514,6.457),P=0.002]和眼底动脉硬化程度[OR=3.077,95%CI(2.289,4.137),P<0.001]是轻症急性脑梗死患者继发EPVS的独立影响因素。Spearman秩相关分析结果显示,EPVS严重程度与眼底动脉硬化程度(r_(s)=0.751,P<0.001)、血管瘤(r_(s)=0.644,P<0.001)、视网膜动静脉交叉征(r_(s)=0.589,P<0.001)呈正相关,与视网膜中央动脉直径(r_(s)=-0.342,P<0.001)、视网膜动静脉比值(r_(s)=-0.463,P=0.012)呈负相关。多元线性回归分析结果显示,EPVS数量与眼底动脉硬化程度[B=0.586,95%CI(0.345,0.827),P=0.016]和视网膜动静脉交叉征[B=0.472,95%CI(0.291,0.653),P=0.010]呈正相关,与视网膜动静脉比值[B=-3.974,95%CI(-5.548,-2.400),P=0.012]呈负相关。结论 合并高血压和眼底动脉硬化的轻症急性脑梗死患者更易出现EPVS;且EPVS病变严重程度与眼底动脉硬化程度、血管瘤、视网膜动静脉交叉征呈正相关,与视网膜中央动脉直径、视网膜动静脉比值呈负相关。

Background Enlarged perivascular spaces(EPVS)have been reported to be associated with cerebral infarction,cerebral hemorrhage or cognitive dysfunction. However,there is still a lack of relevant reports on the risk factors of EPVS,especially fundus arteriovenous crossing phenomenon and fundus exudation in patients with mild acute cerebral infarction.Objective To investigate the risk factors of EPVS and the association between EPVS and fundus lesions in patients with mild acute cerebral infarction. Methods Two hundred and sixty-six patients with mild acute cerebral infarction were retrospectively chosen from the Fifth People’s Hospital of Pingdingshan and Pingdingshan the Second People’s Hospital in the period from January 2015 to December 2020,including 114 with EPVS,and 152 without. General demographics,laboratory test and imaging data were collected. Multivariate Logistic regression was used to analyze the independent influencing factors of EPVS in mild acute cerebral infarction. Spearman’s rank correlation and multivariate linear regression were used to analyze the correlation between the severity and number of EPVS with fundus lesions. Results Among the 266 patients,178 were male and 88 were female,with a mean age of(67.8±12.9)years. Patients with and without EPVS had significant differences in mean age,prevalence of hypertension history,mean severity of fundus arteriosclerosis,diameter of the central retinal artery,retinal arteriovenous ratio,prevalence of hemangioma and retinal arteriovenous crossing phenomenon(P<0.05). Multivariate Logistic regression analysis showed that the history of hypertension[OR=3.127,95%CI(1.514,6.457),P=0.002]and the severity of fundus arteriosclerosis[OR=3.077,95%CI(2.289,4.137),P<0.001]were independent influencing factors of EPVS in mild acute cerebral infarction. Spearman’s rank correlation analysis showed that the severity of EPVS was positively correlated with the severity of fundus arteriosclerosis(r_(s)=0.751,P<0.001),hemangioma(r_(s)=0.644,P<0.001),retinal arteriovenous crossing phenomenon(r_(s)=0.589,P<0.001),and negatively correlated with the diameter of the central retinal artery(r_(s)=-0.342,P<0.001),and the retinal arteriovenous ratio(r_(s)=-0.463,P=0.012). Multivariate linear regression analysis showed that the number of EPVS was positively correlated with the severity of fundus arteriosclerosis[B=0.586,95%CI(0.345,0.827),P=0.016]and retinal arteriovenous crossing phenomenon[B=0.472,95%CI(0.291,0.653),P=0.010],and negatively correlated with the retinal arteriovenous ratio[B=-3.974,95%CI(-5.548,-2.400),P=0.012]. Conclusion EPVS may be more likely to occur in mild acute cerebral infarction patients with hypertension and fundus arteriosclerosis,and the severity of EPVS is positively correlated with the severity of fundus arteriosclerosis,hemangioma and retinal arteriovenous crossing phenomenon,and negatively correlated with the diameter of the central retinal artery and retinal arteriovenous ratio.