基于磁共振成像老年人脑白质损伤与脑血管储备功能的相关性  

Relationship between cerebrovascular reserve capacity and white matter lesions in the elderly based on magnetic resonance imaging

作　　者：罗丽红 宫文儒 李梅 邢希子 张华 LUO Lihong;GONG Wenru;LI Mei;XING Xizi;ZHANG Hua(School of Clinical and Basic Medicine,Shandong First Medical University,Jinan 250117 China;Department of Radiology,Qilu Hospital of Shandong University,Jinan 250112 China)

机构地区：[1]山东第一医科大学(山东省医学科学院)临床与基础医学院(基础医学研究所),山东济南250117 [2]山东大学齐鲁医院放射科,山东济南250012

出　　处：《中国辐射卫生》2024年第1期101-105,110,共6页Chinese Journal of Radiological Health

基　　金：国家自然科学基金项目(81973139)。

摘　　要：目的 探讨脑血管储备(CVR)功能与老年人脑白质损伤的相关性。方法 选择2018年5月—2019年7月山东省济南地区年龄≥60岁的老年人315例,进行经颅多普勒(TCD)超声检查脑血流检测并计算CVR、屏气指数(BHI)、动脉搏动指数(PI)。根据CVR分为CVR正常组(CVR≥20%)206例、CVR受损组(CVR <20%)109例。受试者进行头颅MRI扫描,评估脑室周围、皮质下和总脑白质高信号(WMH)体积,并进行Fazekas评分。结果 与CVR正常组相比,受损组脑室周围、皮质下和总WMH体积及Fazekas评分≥2分患病率均显著升高(P <0.01)。脑室周围、皮质下和总WMH体积分别与CVR(r=-0.70、-0.66、-0.73,P <0.01)、BHI(r=-0.64、-0.65、-0.68,P <0.01)负相关;与PI正相关(r=0.60、0.65、0.65,P <0.01)。校正混杂因素后,脑室周围、皮质下和总WMH体积仍分别与CVR、BHI显著负相关(P <0.01);与PI显著正相关(P <0.01)。Logistic回归分析显示,与正常组相比,受损组脑室周围、皮质下和总Fazekas评分≥2发生的风险分别是1.96倍(95%CI:1.17~3.27,P <0.01)、1.84倍(95%CI:1.11~3.05,P <0.05)和2.33倍(95%CI:1.30~4.18,P <0.01)。结论 CVR受损是老年人脑白质损伤的独立危险因素。Objective To investigate the relationship between cerebrovascular reserve(CVR)capacity and white matter lesions in elderly people.Methods We included 315 participants aged≥60 years in Jinan area of Shandong Province from May 2018 to July 2019.They underwent transcranial Doppler ultrasonography for assessing CVR,breath holding index(BHI),and arterial pulsatility index(PI).According to CVR capacity,they were divided into normal CVR group(CVR≥20%,n=206)and impaired CVR group(CVR<20%,n=109).Magnetic resonance imaging was performed to evaluate periventricular,subcortical,and total white matter hyperintensity(WMH)volumes and Fazekas scores.Results Compared with the normal CVR group,the impaired CVR group showed significantly higher volumes of periventricular,subcortical,and total WMHs and significantly higher proportions of Fazekas scores≥2(P<0.01).Periventricular,subcortical,and total WMH volumes were negatively correlated with CVR(r=−0.70,−0.66,−0.73,P<0.01)and BHI(r=−0.64,−0.65,−0.68,P<0.01)and positively correlated with PI(r=0.60,0.65,0.65,P<0.01).After adjusting for confounding factors,periventricular,subcortical,and total WMH volumes were still negatively correlated with CVR and BHI(P<0.01)and positively correlated with PI(P<0.01).The logistic regression analysis showed that the risks of periventricular,subcortical,and total Fazekas score≥2 in the impaired CVR group were 1.96 times(95% confidence interval[CI]:1.17−3.27,P<0.01),1.84 times(95%CI:1.11−3.05,P<0.05),and 2.33 times(95%CI:1.30−4.18,P<0.01)that of the normal CVR group,respectively.Conclusion Impaired CVR is an independent risk factor for white matter lesions in the elderly.

关 键 词：脑白质损伤 脑血管储备功能 脑白质高信号 Fazekas评分 

分 类 号：R445.2[医药卫生—影像医学与核医学]