摘要
目的总结脑静脉反流(CVR)在新发皮质下小梗死(RSSI)人群中的发生率,并探讨其与扩大的血管周围间隙(EPVS)的相关性。方法收集2019年1月至2022年12月入住郑州大学第一附属医院神经内科且诊断为豆纹动脉区RSSI的住院患者。总结入组患者的基线人口学资料、既往史及实验室检查数据。在时间飞跃法磁共振血管成像序列上评估CVR,根据有无CVR将患者分为CVR组和无CVR组,比较两组间的基线资料及实验室检查结果。使用视觉评分量表对EPVS的部位和数量进行评估,将评分较高的EPVS定义为高级别EPVS(HEPVS);同时对脑白质高信号和腔隙性梗死进行评估,并进行组间比较。通过多因素Logistic回归分析研究EPVS与CVR的相关性。结果最终纳入豆纹动脉区RSSI患者571例,其中女性180例(31.5%);年龄(59.37±12.87)岁;共有73例(12.8%)患者影像学检查结果显示存在CVR,即发生率为12.8%。CVR组(n=73)与无CVR组(n=498)相比,女性比例更低[21.9%(16/73)比32.9%(164/498),χ2=3.578,P=0.059],既往有吸烟史比例更高[38.4%(28/73)比27.7%(138/498),χ2=3.499,P=0.061],但差异无统计学意义;CVR组既往有饮酒史[34.2%(25/73)比21.7%(108/498),χ2=5.621,P=0.018]及合并基底节区HEPVS[41.1%(30/73)比25.3%(126/498),χ2=7.999,P=0.005]的比例更高,差异有统计学意义。多因素Logistic回归分析结果显示,基底节区HEPVS与CVR相关(OR=1.988,95%CI 1.190~3.320,P=0.009)。结论在RSSI人群中,基底节区EPVS与CVR显著相关,提示静脉功能障碍可能与EPVS的形成关系密切。
Objective To summarize the incidence of cerebral venous reflux(CVR)in patients with recent small subcortical infarct(RSSI)and explore its correlation with enlarged perivascular spaces(EPVS).Methods Patients with RSSI in the lenticulostriate artery admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 were included.The baseline demographic data,medical history,and laboratory results of the patients were collected.CVR was assessed by time-of-flight magnetic resonance angiography.Patients were stratified into 2 groups based on the presence(CVR group)or absence of CVR(non-CVR group),and baseline characteristics as well as laboratory test results were compared between the 2 groups.The location and number of EPVS were evaluated using a visual grading scale,with EPVS with higher scores defined as high-grade EPVS(HEPVS).Simultaneous evaluation of cerebral white matter hyperintensities and lacunar infarctions was conducted,followed by intergroup comparisons.The relationship between EPVS and CVR was studied using multiple Logistic regression analysis.Results A total of 571 patients with RSSI in the lentiform artery area were ultimately included,including 180 females(31.5%).Their age was(59.37±12.87)years.Among them,73 patients(12.8%)exhibited CVR based on imaging findings,so the incidence of CVR was 12.8%.In comparison between the CVR group(n=73)and the non-CVR group(n=498),the proportion of females[21.9%(16/73)vs 32.9%(164/498),χ2=3.578,P=0.059]was lower and the proportion of history of smoking[38.4%(28/73)vs 27.7%(138/498),χ2=3.499,P=0.061]was higher in the CVR group,but without statistical significance.Additionally,the history of alcohol consumption[34.2%(25/73)vs 21.7%(108/498),χ2=5.621,P=0.018]and the proportion of patients with concomitant HEPVS in the basal ganglia area[41.1%(30/73)vs 25.3%(126/498),χ2=7.999,P=0.005]was higher in the CVR group with statistical significance.Multiple Logistic regression analysis showed that HEPVS in the basal ganglia region remained independently associated with CVR(OR=1.988,95%CI 1.190-3.320,P=0.009).Conclusion EPVS in the basal ganglia region is significantly associated with CVR in the RSSI population,suggesting that venous dysfunction may be closely related to the formation of EPVS.
作者
吴峥嵘
张珂
宗策
刘红兵
刘凯
王艳红
许予明
高远
Wu Zhengrong;Zhang Ke;Zong Ce;Liu Hongbing;Liu Kai;Wang Yanhong;Xu Yuming;Gao Yuan(Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2024年第3期241-247,共7页
Chinese Journal of Neurology
关键词
大脑梗死
基底神经节
脑静脉反流
血管周围间隙
Cerebral infarction
Basal ganglia
Cerebral venous reflux
Perivascular space