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

涂宇<sup>1</sup>; 彭芥微<sup>1</sup>; 张城滔<sup>1</sup>; 李百株<sup>1</sup>; 刘雨琦<sup>1</sup>; 黄蓉<sup>1</sup>; 朱培培<sup>1</sup>; 曾秀丽<sup>2</sup>; 卓文燕<sup>1</sup>

文章摘要

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.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[J].神经损伤功能重建,2023,(9):502-507

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 Enlargementof Left Atrium and Left Ventricle in Large Artery Atherosclerosis and Penetrating ArteryDisease-type Strokes

DOI：

中文关键词: 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

英文关键词: enlarged perivascular spaces acute ischemic stroke Chinese Ischemic Stroke Subtype left atrium enlargement left ventricle enlargement left ventricular dysfunction correlation

基金项目:珠海市科技计划项目（No. 20191208E 030034）；珠海市人民医院临床科研提升计划项目（No. 2023LCTS- 32）

作者	单位
涂宇¹ ，彭芥微¹ ，张城滔¹ ，李百株¹ ，刘雨琦¹ ，黄蓉¹ ，朱培培¹ ，曾秀丽² ，卓文燕¹	1. 珠海市人民医院（暨南大学附属珠海医院）神经内科 2. 暨南大学附属第一医院神经内科

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中文摘要:

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EPVS Ⅱ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EPVS Ⅰ主型的独立危险因素。结果：EPVS Ⅱ主型组的左心房内径指数（left atrial diameter index，LADI）低于 EPVS Ⅰ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 EPVS Ⅰ主型组[66.00 (63.00, 70.00) vs. 64.00 (61.00, 68.00)，Z=－2.914，P=0.004]。EPVS Ⅰ主型组和 EPVS Ⅱ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）。EPVS Ⅱ主型组的左心室肥厚发生率显著低于EPVS Ⅰ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、左心室增大和左心功能不全与CISS分型的LAA型或PAD型无关。

英文摘要:

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 as II-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-I as the main type in AIS patients. Results: The left atrial diameter index (LADI) of patients with EPVS-II as 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-II as 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-II as the main type group (9.2%) (χ 2 =7.130, P=0.008). Multivariate logistic regression analysis indicated that LVMI (OR 0.99, 95% CI 0.98～1.00, P=0.038) and LVEF% (OR 1.08, 95%CI 1.01～1.17, P=0.032) were independent risk factors for EPVS-I as the main type in AIS patients. Based on the grouping and classification of CISS, there was no significant difference in LADI, LVMI, and LVEF% between LAA type and PAD type (P>0.05). Conclusion: For LAA- and PAD-type stroke based on CISS classification, patients with the most severe distribution of EPVS in the basal ganglia are more likely to have left ventricular enlargement and left ventricular dysfunction. However, the location with the most severe distribution of EPVS, left ventricular enlargement and left ventricular dysfunction are not related to the LAA or PAD type of CISS classification.

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