椎-基底动脉延长扩张症及3种血管内皮损伤因子与脑小血管病患者脑白质高信号和腔隙性梗死的相关性研究  

Relationship of vertebrobasilar dolichoectasia and three vascular endothelial injury factors to white matter hyperintensity and lacunar infarction in patients with cerebral small vessel disease

作　　者：李玺 吴兆鑫 张道培 张永辉 张怀亮[1] Li Xi;Wu Zhaoxin;Zhang Daopei;Zhang Yonghui;Zhang Huailiang(Brain Disease Center,First Affiliated Hospital of Henan University of Chinese Medicine,Center for Diagnosis and Treatment of Vertigo in Henan Province,Zhengzhou,Henan 450099,China)

机构地区：[1]河南中医药大学第一附属医院脑病中心,河南省眩晕病诊疗中心,郑州450099

出　　处：《中国脑血管病杂志》2025年第3期188-198,共11页Chinese Journal of Cerebrovascular Diseases

基　　金：河南省高等学校重点科研项目(22A320036)。

摘　　要：目的探讨椎-基底动脉延长扩张症(VBD)及3种血管内皮损伤因子与脑小血管病(CSVD)患者脑白质高信号(WMH)和腔隙性梗死的相关性。方法前瞻性连续纳入2023年3月至2024年3月入住河南中医药大学第一附属医院脑病中心的CSVD患者,收集患者临床基线资料,包括性别、年龄及体质量指数、高血压病、糖尿病、冠心病、心房颤动、高脂血症、高同型半胱氨酸血症、高尿酸血症、颈动脉斑块、既往卒中史、吸烟史、饮酒史等血管危险因素。根据患者是否合并VBD分为CSVD合并VBD组和CSVD不合并VBD组。患者入组后24 h内完成影像学评估,包括WMH严重程度(Fazekas量表评分1~2分为轻度WMH,3~4分为中度WMH,5~6分为重度WMH)、腔隙性梗死影像学特征及基于三维时间飞跃法MR血管成像测量的椎-基底动脉影像学参数(双侧椎动脉直径、基底动脉直径、基底动脉标准长度、基底动脉弯曲长度),将基底动脉直径≥4.5 mm或椎动脉直径≥4.0 mm定义为扩张,基底动脉标准长度≥29.5 mm定义为延长,基底动脉弯曲长度≥10.0 mm定义为弯曲,符合扩张、延长、弯曲中的至少一项者纳入CSVD合并VBD组。患者入组第2天检测血液白细胞介素6(IL-6)、可溶性细胞间黏附分子1(sICAM-1)、血管性血友病因子(vWF)水平。采用多因素Logistic回归分析CSVD患者合并VBD的影响因素,及椎-基底动脉影像学参数和3种血管内皮损伤因子(IL-6、sICAM-1、vWF)对CSVD患者不同严重程度WMH和腔隙性梗死的影响。结果共纳入88例CSVD患者,年龄40~80岁,平均(64±10)岁,其中CSVD合并VBD组50例,CSVD不合并VBD组38例。(1)单因素分析显示,CSVD合并VBD组与CSVD不合并VBD组患者临床基线资料及3种血管内皮损伤因子水平差异均无统计学意义(均P>0.05)。在调整年龄和性别后,将单因素分析中P<0.1的变量(男性、吸烟史)纳入多因素Logistic回归分析,结果显示,男性(OR=2.656,95%CI:0.647~10.907Objective To investigate whether vertebrobasilar dolichoectasia(VBD)and three vascular endothelial injury factors correlate with white matter hyperintensity(WMH)and lacunar infarction(LI)in patients with cerebral small vessel disease(CSVD).Methods Patients with CSVD hospitalized at the Brain Disease Center of the First Affiliated Hospital of Henan University of Chinese Medicine from March 2023 to March 2024 were prospectively and consecutively included in this study.Baseline clinical data,including gender,age,body mass index,hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,hyperlipidemia,hyperhomocysteinemia,hyperuricemia,carotid plaque,history of previous stroke,smoking,alcohol consumption,and other vascular risk factors.The patients were categorized into CSVD with VBD group and CSVD without VBD group.Imaging assessments were performed within 24 h of enrollment,including evaluating the WMH severity using Fazekas scale score(mild WMH:1-2,moderate WMH:3-4,severe WMH:5-6),imaging characteristics of LI and vertebrobasilar artery parameters on three dimensional time of flight magnetic resonance angiography images(including bilateral vertebral artery diameters,basilar artery diameters,standard basilar artery length[BAL],and bending length of the basilar artery).A basilar artery diameter≥4.5 mm or vertebral artery diameter≥4.0 mm was defined as dilatation.BAL≥29.5 mm was defined as elongation,and a basilar artery bending length≥10.0 mm was defined as curvature.Patients meeting at least one of these criteria(dilatation,elongation,and curvature)were included in the CSVD with VBD group.Levels of interleukin-6(IL-6),soluble intercellular adhesion molecule-1(sICAM-1),and von Willebrand factor(vWF)levels were measured on the second day of enrollment.To analyze the influencing factors of VBD in CSVD patients and examine the correlation between vertebrobasilar artery imaging parameters,the levels of three vascular endothelial injury factors(IL-6,sICAM-1,vWF),and the severities of WMH and LI in

关 键 词：脑小血管病 椎-基底动脉延长扩张症 内皮功能障碍 

分 类 号：R743[医药卫生—神经病学与精神病学]