缺血性脑血管病患者脑白质高信号与侧支循环之间的关系

Relationship between High White Matter Signal and Collateral Circulation in Patients with Ischemic Cerebrovascular Disease

目的 探讨脑白质高信号(WMH)与缺血性脑血管病(ICVD)患者侧支循环的相关性。方法选取2020年10月至2022年3月我院神经内科接受治疗的ICVD患者108例,依据ASITN/SIR系统将患者分为则支循环不良组和侧支循环良好组,比较两组患者的临床资料,影响WMH与ICVD患者侧支循环情况的因素采用多元Logistic回归分析,并建立贝叶斯网络预测模型,并进行贝叶斯网络推理以及模型效能评价。结果108名患者中WMH1、WMH2、WMH3级患者分别为58、32、18人,且WMH1级患者在深部/皮层占比较多,WMH 2、3级患者中各部位相差不大,108名患者中单支狭窄61例(56.48%),多支狭窄47例(43.52%),血管狭窄程度≥85%为51例(47.22%),<85%为57例(52.78%),Willis环侧支循环代偿50例(46.30%),皮层支代偿31例(28.70%),新生血管代偿9例(8.33%),无任何侧支代偿18例(16.67%);两组患者在高血压、吸烟史、基线NIHSS评分分类、糖尿病、基线NIHSS评分、Fazekas总分、Fazekas总分0~1分、脑室周围Fazekas评分、脑室周围Fazekas评分0~1分、深部白质Fazekas评分0~1分、狭窄血管数量、血管狭窄程度、Hcy水平方面差异具有统计学意义(P<0.05);多元Logistic回归分析表明高血压、吸烟史、血管狭窄数量、糖尿病、血管狭窄程度、 Hcy、Fazekas总分及脑室周围Fazekas评分是ICVD患者侧支循环形成不良的独立危险因素(P均<0.05);Logistic回归显示,调整后WMH评分(OR=2.41,95%CI:2.18~2.72,P<0.001)仍是ICVD患者侧支循环建立不良的危险因素,且随着WMH评分的升高,其关联效应值也相应增高(P趋势<0.05)。并基于此构建的贝叶斯网络模型,准确率为88.9%,AUC为0.807(95%CI:0.781~0.874)),具有较高的区分度。结论ICVD患者侧支循环建立受多种因素影响,且WMH严重程度与ICVD患者侧支循环不良密切相关,临床可通过WMH严重程度来评估ICVD患者侧支循环建立情况,以期为患者神经功能缺损情况评估进一步提供参考依据。

Objective To investigate the correlation between white matter hyperintensities a nd collateral circulation in patients with ischemic cerebrovascular disease.Methods According to the ASITN/SIR,108 patients with ischemic cerebrovascular disease treated in the Department of Neurology of our hospital from October 2020 to March 2022 were divided into good collateral circulation group and poor collateral circulation group.Comparison of clinical data of two groups of patients,Multivariate Logistic regression analysis affected the independent correlation between white matter hypersignal and collateral circulation in patients with ischemic cerebrovascular disease.Based on this,a Bayesian network model was constructed,and Netica software was used for Bayesian network inference,and the model performance was evaluated.Results Among the 108 patients,58 patients with WMH1,32 patients with WMH2 and 18 patients with WMH3 were found respectively,and the number of patients with WMH1 was more in deep/subcortical distribution.The number of patients with WMH2and 3 was basically the same in different parts.Among the 108 patients,61 patients with single vessel stenosis(56.48%),47 patients with multiple vessel stenosis(43.52%),51 patients with vascular stenosis ≥85%(47.22%),57 patients with<85%(52.78%),and 50 patients with Willis ring collateral circulation compensation(46.30%),31 cases(28.70%) were compensated by cortical bra nches,9 cases(8.33%) by neovascularization,and 18 cases(16.67%) without any collateral branches;there were significant differences in smoking history,baseline NIHSS score,hypertension,baseline NIHSS score classification,diabetes,Fazekas total score,Fazekas total score 0~1,periventricular Fazekas score 0~1,deep white matter Fazekas score 0~1,the number of stenotic vessels,the degree of vascular stenosis,and Hcy in patients with collateral circulation disorder(P<0.05);Multivariate Logistic regression analysis showed that smoking history,hypertension,diabetes,the number of vascular stenosis,the degree of vascular stenosis,Hcy,Fazekas total score and periventricular Fazekas score were the key factors for poor collateral circulation in ICVD patients(P<0.05);Logistic regression showed that the adjusted WMH score(OR=2.41,95%CI:2.18~2.72,P<0.001) remained a risk factor for poor collateral circulation establishment in ICVD patients.With the increase of WMH score,its associated effect size also increased(Ptrend<0.05).The accuracy rate was 88.9% and the AUC of the constructed Bayesian network model was 0.807(95%CI:0.781~0.874),which had a high degree of discrimination.Condusion The esta blishment of collateral circulation in patients with ischemic cere b rovascula r disease is affected by many factors,the severity of high white matter signal is related to poor collateral circulation in patients with ischemic cerebrovascular disease.The severity of WMH can be used to evaluate the establishment of collateral circulation in ICVD patients in clinical practice,in order to provide further reference for the evaluation of neu rological deficits in patients.