飞行员脑小血管病临床特征的回顾性分析

Risk factors for cerebral small vessel disease in pilots:a retrospective analysis

目的探讨飞行员脑小血管病(cerebral small vessel disease,CSVD)整体相关危险因素。方法纳入2019年1月—2022年12月在空军特色医学中心住院经头颅核磁检查诊断为CSVD的飞行员72例为CSVD病例组,按照1:1的比例随机抽取头颅核磁检查无异常的飞行员为对照组,比较2组飞行员脑血管病危险因素及飞行时间和机种的差异,并采用Logistic回归分析飞行员CSVD的独立危险因素。结果飞行员CSVD群体中脑白质高信号和血管周围间隙多见,并且存在多种影像分型联合的表现,CSVD病例组危险因素数量高于对照组,且总飞行时间和年飞行时间均高于对照组[1875.00(517.50,2975.00)h vs 1000.00(368.50,2200.00)h,P=0.027]、[126.83(104.55,153.35)h vs 115.77(90.50,136.46)h,P=0.021],CSVD病例组吸烟和高性能战斗机比例均高于对照组[22%vs 5.6%(χ^(2)=8.36,P=0.004)]、[29.2%vs 13.9%(χ^(2)=7.05,P=0.029)],Logistic回归分析显示吸烟史(OR=3.304,95%CI:1.172~9.317,P=0.024)、飞行机种(OR=4.607,95%CI:1.596~13.298,P=0.005)、年飞行时间(OR=2.699,95%CI:1.085~6.716,P=0.033)是飞行员的独立危险因素。结论飞行员患CSVD与吸烟、脑血管病危险因素数量、高性能战斗机及年飞行时间相关。

Objective To investigate the risk factors of cerebral small vessel disease(CSVD)in pilots.Methods The clinical data of pilots who were hospitalized at the Air Force Characteristic Medical Center between January 2019 and December 2022 was retrospectively analyzed.The case group consisted of 72 pilots who were diagnosed with CSVD by MRI(n=72),while the control group was composed of 72 pilots who were selected randomly at the ratio of 1:1 and showed no abnormality as confirmed by MRI(n=72).The differences in risk factors of CSVD and in flight factors between the two groups were studied.Logistic regression analysis was used to explore the risk factors of small cerebral vascular disease in pilots.Results White matter hypertensity(WMH)and enlarged perivascular space(EPVS)were more common in the CSVD group of pilots.There was a combination of multiple imaging subtypes,and there were far more risk factors in the CSVD group than in the control group.Single factor analysis showed that the total flight time and annual flight time in the CSVD group were longer than in the control group[1875.00(517.50,2975.00)h vs 1000.00(368.50,2200.00)h,P=0.027],[126.83(104.55,153.35)h vs 115.77(90.50,136.46)h,P=0.021].The proportion of smoking pilots and those of high-performance fighters in the CSVD group was higher than in the control group[22%vs 5.6%(χ^(2)=8.36,P=0.004)],[29.2%vs 13.9%(χ^(2)=7.05,P=0.029)].Binary logistic regression analysis showed that smoking(OR=3.304,95%CI:1.172~9.317,P=0.024),types of aircraft(OR=4.607,95%CI:1.596~13.298,P=0.005)and annual flight time(OR=2.699,95%CI:1.085~6.716,P=0.033)were risk factors for CSVD.Conclusion Smoking,types of high performance fighters and average annual flight time can impact the occurrence of CSVD in pilots.