老年无症状颅内动脉延长扩张症与脑小血管病综合评分的相关性

Correlation between intracranial arterial dolichoectasia and total small vessel disease score in older asymptomatic patients

目的探讨老年无症状颅内动脉延长扩张症(IADE)与脑小血管病(CSVD)综合评分的相关性。方法回顾性分析2019年1月至2021年12月北京医院神经内科门诊查体或就诊且完成3 T头部磁共振成像(MRI)平扫、头部磁共振血管造影(MRA)和头部磁敏感加权成像(SWI)的CSVD患者。通过影像学诊断IADE并进行CSVD综合评分。根据有无IADE,将所有患者分为IADE组与非IADE组;依据CSVD综合评分,将患者分为CSVD无-轻度组与中-重度组,分别比较各组患者的基线资料和影像学资料,采用多因素Logistic回归分析IADE与CSVD总负荷之间的关系。结果共纳入230例CSVD患者,其中IADE组86例、非IADE组144例,CSVD综合评分无-轻度组157例、中-重度组73例。与非IADE组相比,IADE组患者的脑梗死史〔16例(18.6%)比13例(9.0%)〕、口服抗血小板聚集药物〔45例(52.3%)比51(35.4%)〕及CSVD综合评分为中-重度的患者〔36例(41.9%)比37例(25.7%)〕比例更高(均P<0.05)。230例患者中,CSVD综合评分中-重度组IADE患者比例高于无-轻度组〔36例(49.3%)比50例(31.8%),χ2=6.495,P值=0.011〕。多因素Logistic回归分析显示年龄〔OR(95%CI)=1.777(1.124~2.808),P=0.014〕、脑梗死史〔OR(95%CI)=15.481(4.565~52.496),P<0.001〕、颅内外动脉狭窄/闭塞〔OR(95%CI)=0.961(1.003~6.804),P=0.049〕和IADE〔OR(95%CI)=0.037(0.879~2.563),P=0.037〕是中-重度CSVD综合评分的独立危险因素,血红蛋白(≥135.5 g/L)〔OR(95%CI)=0.283(0.114~0.701),P<0.01〕是中-重度CSVD综合评分的保护因素。结论CSVD伴IADE患者在颅内影像表现上全脑受损更明显,且IADE、脑梗死史及颅内动脉狭窄/闭塞是CSVD严重程度的独立危险因素。

Objective To investigate the relationship between intracranial arterial dolichoectasia(IADE)and the total cerebral small vessel disease(CSVD)score in older asymptomatic patients.Methods A retrospective analysis was conducted on patients with CSVD who underwent physical examinations or consultations at the outpatient department of the Neurology Department of Beijing Hospital from January 2019 to December 2021,and who completed 3 T head magnetic resonance imaging(MRI),head magnetic resonance angiography(MRA),and head susceptibility-weighted imaging(SWI).IADE was diagnosed through imaging,and the total CSVD score was conducted.Patients were divided into IADE and non-IADE groups based on the presence or absence of IADE;they were also divided into no-mild and moderate-severe groups based on the total CSVD score.The baseline and imaging data of patients in each group were compared,and a multifactorial logistic regression analysis was used to analyze the relationship between IADE and the total CSVD score.Results A total of 230 patients with CSVD were included,with 86 cases in the IADE group and 144 cases in the non-IADE group.There were 157 cases in the no/mild CSVD total score group and 73 in the moderate/severe group.Compared with the non-IADE group,the IADE group had a higher proportion of patients with a history of cerebral infarction[16 cases(18.6%)vs.13 cases(9.0%)],those taking oral antiplatelet aggregation medication[45 cases(52.3%)vs.51(35.4%)],and patients with a moderate/severe CSVD total score[36 cases(41.9%)vs.37 cases(25.7%)].The differences were statistically significant(all P<0.05).The proportion of patients with a moderate/severe CSVD total score in the IADE group was 41.9%(36 cases),which was significantly higher than the 25.7%(37 cases)in the non-IADE group(P<0.05).Among the 230 patients,there were 157 in the no/mild CSVD total score group,and the proportion of IADE patients in the moderate/severe group was higher than that in the no/mild group[36 cases(49.3%)vs.50 cases(31.8%),χ2=6.495,P=0.011].Multivariate logistic regression analysis showed that age[OR(95%CI)=1.777(1.124-2.808),P=0.014],history of cerebral infarction[OR(95%CI)=15.481(4.565-52.496),P<0.001],stenosis/occlusion of intracranial and extracranial arteries[OR(95%CI)=0.961(1.003-6.804),P=0.049],and IADE[OR(95%CI)=0.037(0.879-2.563),P=0.037]were independent risk factors for moderate-severe total CSVD scores.Hemoglobin(≥135.5 g/L)[OR(95%CI)=0.283(0.114-0.701),P<0.01]was a protective factor for moderate-severe total CSVD scores.Conclusions Patients with CSVD accompanied by IADE exhibit more pronounced whole-brain damage in neuroimaging.In addition,IADE,history of cerebral infarction,and stenosis/occlusion of intracranial arteries are independent risk factors for the severity of CSVD.