大动脉粥样硬化型和穿支动脉疾病型卒中扩大的血管周围间隙主要部位与左心房、左心室增大的相关性  

Correlation between the Main Location of Enlarged Perivascular Space and the Enlargement of Left Atrium and Left Ventricle in Large Artery Atherosclerosis and Penetrating Artery Disease-type Strokes

作　　者：涂宇 彭芥微 张城滔 李百株 刘雨琦 黄蓉 朱培培 曾秀丽 卓文燕 TU Yu;PENG Jiewei;ZHANG Chengtao;LI Baizhu;LIU Yuqi;HUANG Rong;ZHU Peipei;ZENG Xiuli;ZHUO Wenyan(Department of Neurology,Zhuhai People’s Hospital(Zhuhai hospital affiliated with Jinan University),Guangdong 519000,China;Department of Neurology,The First Affiliated Hospital,Jinan University,Guangzhou 510630,China)

机构地区：[1]珠海市人民医院(暨南大学附属珠海医院)神经内科,广东珠海519000 [2]暨南大学附属第一医院神经内科,广州510630

出　　处：《神经损伤与功能重建》2023年第9期502-507,共6页Neural Injury and Functional Reconstruction

基　　金：珠海市科技计划项目(No.20191208E030034);珠海市人民医院临床科研提升计划项目(No.2023LCTS-32)。

摘　　要：目的:探讨基于中国缺血性卒中亚型(Chinese ischemic stroke subclassification,CISS)分型的大动脉粥样硬化(large artery atherosclerosis,LAA)型卒中和穿支动脉疾病(penetrating artery disease,PAD)型卒中扩大的血管周围间隙(enlarged perivascular spaces,EPVS)与左心房、左心室增大的相关性。方法:前瞻性收集176例急性缺血性卒中(acute ischemic stroke,AIS)患者的临床资料。所有入组患者完善颅脑磁共振成像和B型彩色超声心动图检查。以EPVS在脑内分布的严重部位不同分为2组,最严重部位在基底节区(basal ganglia,BG)的被认为EPVSⅠ型为主型,共67例;最严重部位在半卵圆中心(centrum semiovale,CSO)的被认为EPVSⅡ型为主型,共109例。比较两组患者的基线资料和超声心动图参数。采用多因素Logistic回归分析AIS患者EPVSⅠ主型的独立危险因素。结果:EPVSⅡ主型组的左心房内径指数(left atrial diame-ter index,LADI)低于EPVSⅠ主型组[18.48(17.15,20.60)vs.19.43(18.44,21.17),Z=-2.113,P=0.035];左心室质量指数(left ventricular mass index,LVMI)低于EPVSⅠ主型组[92.92(82.16,109.08)vs.102.61(85.15,121.32),Z=-2.342,P=0.019];左心室射血分数(left ventricular ejection fractions,LVEF)%显著高于EPVSⅠ主型组[66.00(63.00,70.00)vs.64.00(61.00,68.00),Z=-2.914,P=0.004]。EPVSⅠ主型组和EPVSⅡ主型组的左房肥大发生率差异无统计学意义(4.5%vs.3.67%,χ^(2)=0.070,P=0.079)。EPVSⅡ主型组的左心室肥厚发生率显著低于EPVSⅠ主型组(9.2%vs.23.9%,χ^(2)=7.13,P=0.008)。Logistic回归分析结果提示,LVMI(OR 0.99,95%CI 0.98~1.00,P=0.038)和LVEF%(OR 1.08,95%CI 1.01~1.17,P=0.032)为AIS患者EPVSⅠ主型的独立危险因素。基于CISS分型分组,LAA型的LADI、LVMI、LVEF%与PAD型组间差异无统计学意义(P>0.05)。结论:基于CISS分型的LAA型卒中和PAD型卒中,EPVS分布最严重部位在基底节区的患者更容易出现左心室增大、左心功能不全。但EPVS分布最严重部位、左心室增�Objective:To investigate the correlation between the main location of enlarged perivascular space(EPVS)and the enlargement of left atrium and left ventricle in stroke types of large artery atherosclerosis(LAA)and penetrating artery disease(PAD),based on the Chinese Ischemic Stroke Subtype(CISS)typology.Methods:Clinical data were prospectively collected from 176 patients with acute ischemic stroke(AIS).All patients underwent brain magnetic resonance imaging(MRI)and B-type color echocardiographic examination.The patients were divided into two groups according to the severity location of EPVS.The patients showing the most severe location in basal ganglia(BG)were considered as Ⅰ-type of EPVS(EPVS-Ⅰ)(n=67)while those patients showing the most severe location in the center of semioval were considered asⅡ-type of EPVS(EPVS-Ⅱ)(n=109).The relevant baseline clinical data and B-type color echocardiographic data were compared between two groups.Multivariate logistic regression was used to analyze the independent risk factors of EPVS-Ⅰas the main type in AIS patients.Results:The left atrial diameter index(LADI)of patients with EPVS-Ⅱas the main type group was 18.48(17.15,20.60),which was significantly lower than that in patients with EPVS-Ⅰ[19.43(18.44,21.17)](P<0.05).The left ventricular mass index(LVMI)of patients with EPVS-Ⅱ[92.92(82.16,109.08)]was significantly lower than that in patients with EPVS-Ⅰ[102.61(85.15,121.32)](P<0.05).The left ventricular ejection fractions(LVEF)%of patients with EPVS-Ⅱ[66.00(63.00,70.00)]was significantly higher than that in patients with EPVS-I[64.00(61.00,68.00)](P<0.01).There was no statistical significance(P>0.05)in the incidence of left atrial hypertrophy between patients with EPVS-I as the main type group(4.5%)and EPVS-Ⅱas the main type group(3.67%)(χ^(2)=0.070,P=0.0790).The incidence of left ventricular hypertrophy in patients with EPVS-I as the main type group(23.9%)was significantly higher than that in patients with EPVS-Ⅱas the main type group(9.2%)(χ^(2)=7

关 键 词：扩大的血管周围间隙 急性缺血性卒中 中国缺血性卒中亚型 左房增大 左室增大 左心功能不全 相关性 

分 类 号：R741[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]