作者：沈娜1，牟英峰2，巩诗彤1，李晴晴1，孙浩1，耿德勤2

单位：

1.221004江苏省徐州市，徐州医科大学第一临床医学院　2.221002江苏省徐州市，徐州医科大学附属医院神经内科

Units：

1.The First Clinical Medical College of Xuzhou Medical University, Xuzhou 221004, China 2.Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China

关键词：

　大脑小血管病；深部髓质静脉；影像学标志物；脑小血管病总负荷

Keywords：

Cerebral small vessel diseases; Deep medullary vein; Imaging markers; Total burden of cerebral small vascular disease

CLC：

R 743.9

DOI：

10.12114/j.issn.1008-5971.2022.00.019

Funds：

国家卫健委脑防委“中国脑卒中高危人群干预适宜技术研究及推广项目”（GN-2018R0009）

摘要：

背景　深部髓质静脉（DMV）因具有便于观察和结构相对稳定的优势，已成为目前研究脑小血管病 （CSVD）与静脉之间关系的切入点。目的　分析DMV可见性与CSVD影像学标志物及总负荷评分的关系。方法　选 取2019年1月至2021年6月在徐州医科大学附属医院完成颅脑磁共振成像（MRI）、磁敏感加权成像（SWI）、头颈磁 共振血管成像（MRA）或CT血管造影（CTA）检查的住院患者为初筛对象，最终纳入 238 例CSVD患者。根据本组患 者DMV视觉评分中位数将其分为DMV低分组（DMV评分＜8分，n=114）和DMV高分组（DMV评分≥8分，n=124）。 比较两组患者临床资料、影像学标志物，CSVD患者DWV视觉评分与CSVD总负荷评分的相关性分析采用Spearman 秩相关分析，CSVD患者DWV视觉评分的影响因素分析采用多因素Logistic回归分析。结果　DMV高分组患者年龄大 于DMV低分组，有高血压病史、有糖尿病病史、有脑梗死病史、服用降压药者所占比例及同型半胱氨酸（Hcy）高 于DMV低分组，总胆固醇（TC）、载脂蛋白B（ApoB）低于DMV低分组（P＜0.05）。本组患者发生血管源性腔隙 107例（占45.1%）、白质高信号（WMH）223例（占93.7%）、血管周围间隙（PVS）190例（占79.8%）、脑微出 血（CMB）145例（占60.9%）、脑萎缩57例（占23.9%）。DWV高分组患者室旁WMH、深部WMH、脑叶CMB、幕 下/深部CMB发生率及基底核区PVS评分、CSVD总负荷评分高于DMV低分组（P＜0.05）。Spearman秩相关分析结果 显示，CSVD患者DMV视觉评分与CSVD总负荷评分呈正相关（rs=0.717，P＜0.001）。多因素Logistic回归分析结果显 示，年龄〔OR=1.045，95%CI（1.001，1.090）〕、室旁WMH〔OR=0.230，95%CI（0.077，0.699）〕、深部WMH 〔OR=0.323，95%CI（0.108，0.699）〕、CSVD总负荷评分〔OR=4.222，95%CI（1.977，9.016）〕是CSVD患者 DMV视觉评分的独立影响因素（P＜0.05）。结论　CSVD患者DWV可见性与CSVD总负荷评分呈正相关，而室旁 WMH、深部WMH及CSVD总负荷可能是其DMV可见性降低的因素。

Abstract：

Background Deep medullary vein (DMV) has become the entry point to study the relationship between cerebral small vessel disease (CSVD) and vein because of its advantages of easy observation and relatively stable structure. Objective To analyze the relationship between DMV visibility and imaging markers and total load of CSVD. Methods The inpatients who completed brain magnetic resonance imaging (MRI) , susceptibility-weighted imaging (SWI) , head and neck magnetic resonance angiography (MRA) or CT angiography (CTA) in the Affiliated Hospital of Xuzhou Medical University from January 2019 to June 2021 were selected as the primary screening objects, and 238 patients with CSVD were finally included. They were divided into DMV low score group (DMV score < 8, n=114) and DMV high score group (DMV score ≥ 8, n=124) according to the median DMV visual score. The clinical data and imaging markers were compared between the two groups. Spearman rank correlation analysis was used to analyze the correlation between DWV visual score and total burden score of CSVD in patients with CSVD, and multivariate Logistic regression analysis was used to analyze the influencing factors of DWV visual score in patients with CSVD. Results Age in DMV high score group was older than that of DMV low score group, the proportion of patients with hypertension history, diabetes history, cerebral infarction history, taking antihypertensive drugs and homocysteine (Hcy) were higher than those in DMV low score group, total cholesterol (TC) and apolipoprotein B (ApoB) were lower than those in DMV high score group (P < 0.05). In this group, there were 107 cases of angiogenic lacuna (45.1%) , 223 cases of white matter hyperintensity (WMH) (93.7%) , 190 cases of perivascular space (PVS) (79.8%) , 145 cases of cerebral microbleeds (CMB) (60.9%) and 57 cases of brain atrophy (23.9%) . The incidence of periventricular WMH, deep WMH, lobar CMB, infratentorial/deep CMB, PVS score of basal ganglia and total load score of CSVD in DWV high score group were higher than those in DMV low group group (P < 0.05) . Spearman rank correlation analysis showed that DMV visual score was positively correlated with total burden score of CSVD in patients with CSVD (rs=0.717, P < 0.001) . Multivariate Logistic regression analysis showed that age [OR=1.045, 95%CI (1.001, 1.090) ] , periventricular WMH [OR=0.230, 95%CI (0.077, 0.699) ] , deep WMH [OR=0.323, 95%CI (0.108, 0.699) ] and total burden score of CSVD [OR=4.222, 95%CI (1.977, 9.016) ] were independent influencing factors of DMV visual score in CSVD patients (P < 0.05) . Conclusion DWV visibility was positively correlated with the total burden score of CSVD in patients with CSVD, while periventricular WMH, deep WMH and total burden of CSVD may be the factors that reduce the DMV visibility.

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