近期皮质下小梗死患者深髓静脉可见性与血管周围间隙扩大及认知功能的相关性研究

Correlation between visibility of deep medullary vein and enlarged perivascular space and cognitive function in patients with recent small subcortical infarct

目的探讨近期皮质下小梗死(RSSI)患者颅内深髓静脉(DMV)可见性与不同区域血管周围间隙扩大(EPVS)及认知功能的相关性。方法回顾性连续纳入南京医科大学附属常州市第二人民医院神经内科自2022年10月至2023年10月收治的RSSI患者,所有患者入院后3 d内完成MR的常规及磁敏感加权成像(SWI)序列扫描。所有RSSI患者发病7 d内进行蒙特利尔认知评估(MoCA)量表评分。对所有患者基底节区(BG)和半卵圆中心区的EPVS进行分级评估和体积测量,使用DMV视觉评分对患者SWI幅度图或最小强度投影图上的DMV可见性进行评估,并将患者分为可见性较高的DMV低-中分组(评分0~12分,104例)及可见性较低的DMV高分组(评分13~18分,47例),采用单因素分析比较两组患者的临床和影像学资料,采用多因素Logistic回归和Spearman相关分析方法分析DMV可见性与BG-EPVS分级及体积的关系以及其与患者认知功能的关系。结果共纳入RSSI患者151例,平均年龄(69±10)岁,其中男92例(60.9%),女59例(39.1%)。DMV高分组RSSI患者的年龄[(76±5)岁比(65±10)岁,t=-10.875]、高血压病患者比例[78.7%(37/47)比54.8%(57/104),χ^(2)=7.879]、BG-EPVS分级、BG-EPVS体积[5.67(5.30,5.81)ln mm 3比4.61(3.66,5.30)ln mm 3,Z=-6.772]、脑白质高信号体积[7.67(6.23,8.43)ln mm 3比4.31(3.53,5.89)ln mm 3,Z=-6.501]均明显高于DMV低-中分组,差异均有统计学意义(均P<0.05)。DMV高分组RSSI患者的总胆固醇[3.74(3.20,4.39)mmol/L比4.09(3.47,4.96)mmol/L,Z=-2.082]、三酰甘油[1.20(0.78,1.86)mmol/L比1.53(1.05,1.99)mmol/L,Z=-2.343]、MoCA量表评分[21.0(20.0,22.0)分比24.0(22.0,25.0)分,Z=-9.862]均低于DMV低-中分组(均P<0.05)。其余基线资料差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,较高的年龄(OR=1.181,95%CI:1.070~1.304,P=0.001)、中重度BG-EPVS(OR=2.441,95%CI:1.186~5.024,P=0.015)、较高的BG-EPVS体积(OR=4.987,95%CI:1.218~19.350,P=0.020)和较高的WMH体积(OR=1.285,95%CI:1.044~1.582,P=0.018)与较高的DMV评分相关。Spearman相关性分析结果显示,DMV评分与RSSI患者的BG-EPVS分级呈正相关(r=0.613,P<0.01),与BG-EPVS体积呈正相关(r=0.549,P<0.01),与RSSI患者的MoCA量表评分呈负相关(r=-0.449,P<0.01)。结论年龄、BG-EPVS分级、BG-EPVS体积和WMH体积与RSSI患者的DMV可见性相关;RSSI患者DMV的可见性越差,认知功能损伤越严重。

Objective To explore the correlation between the visibility of intracranial deep medullary vein(DMV)and the enlarged perivascular space(EPVS)in different regions and cognitive function in patients with recent small subcortical infarct(RSSI).Methods This study retrospectively analyzed RSSI patients in the Department of Neurology,Changzhou Second People′s Hospital Affiliated to Nanjing Medical University from October 2022 to October 2023,all of whom completed MRI and susceptibility-weighted imaging(SWI)sequence scans within 3 days after admission.Montreal cognitive assessment(MoCA)score of RSSI patients were evaluated within 7 days after onset.The EPVS grade and volume were evaluated for basal ganglia(BG)and centrum semiovale in all patients.The visibility of DMV on the patient′s SWI magnitude images or minimum intensity projection map was evaluated.Patients were divided into low to medium DMV group with higher visibility(0-12 points,104 cases)and high DMV group with lower visibility(13-18 points,47 cases).Univariate analysis was used to compare clinical and imaging data between two groups of patients.Multivariate Logistic regression and Spearman correlation analysis were used to examine the relationship between the visibility of DMV and BG-EPVS grade and volume,as well as the relationship with patients′cognitive function.Results A total of 151 RSSI patients were included,with an average age of(69±10)years,including 92 males(60.9%)and 59 females(39.1%).The age of RSSI patients in the high DMV group([76±5]years vs.[65±10]years,t=-10.875),as well as the proportion of hypertension(78.7%[37/47]vs.54.8%[57/104],χ^(2)=7.879),BG-EPVS grade,BG-EPVS volume(5.67[5.30,5.81]ln mm 3 vs.4.61[3.66,5.30]ln mm 3,Z=-6.772)and white matter hyperintensity(WMH)volume(7.67[6.23,8.43]ln mm 3 vs.4.31[3.53,5.89]ln mm 3,Z=-6.501)were significantly higher than those in the low to medium DMV group,and the differences were statistically significant(all P<0.05).The total cholesterol(3.74[3.20,4.39]mmol/L vs.4.09[3.47,4.96]mmol/L,Z=-2.082),triglyceride(1.20[0.78,1.86]mmol/L vs.1.53[1.05,1.99]mmol/L,Z=-2.343),MoCA scores(21.0[20.0,22.0]points vs.24.0[22.0,25.0]points,Z=-9.862)of RSSI patients in the high DMV group were all lower than those in the low to medium DMV group(all P<0.05).The differences in other baseline data were not statistically significant(all P>0.05).The results of multivariate Logistic regression analysis showed that higher age(OR,1.181,95%CI 1.070-1.304,P=0.001),moderate to severe BG-EPVS(OR,2.441,95%CI 1.186-5.024,P=0.015),larger BG-EPVS volume(OR,4.987,95%CI 1.218-19.350,P=0.020)and larger WMH volume(OR,1.285,95%CI 1.044-1.582,P=0.018)was related to high DMV score.Spearman correlation analysis showed that DMV score was positively correlated with BG-EPVS grade in RSSI patients(r=0.613,P<0.01),positively correlated with BG-EPVS volume(r=0.549,P<0.01),and negatively correlated with MoCA score in RSSI patients(r=-0.449,P<0.01).Conclusion Age,BG-EPVS grade,BG-EPVS volume and WMH volume are related to DMV visibility in RSSI patients;RSSI patients with lower visibility of DMV had more severe cognitive impairment.