脑血流动力学与缺血性脑卒中患者脑白质病变严重程度的相关性研究

Correlation between cerebral hemodynamics and the severity of cerebral white matter lesions in patients with ischemic stroke

摘要:

目的 研究缺血性脑卒中患者脑血流动力学与脑白质病变严重程度之间相关性。方法 分析2015年7月至2019年8月收治的108例缺血性脑卒中患者资料，采用Fazekas量表对患者脑白质病变严重程度进行分级。比较不同脑白质病变严重程度、患者颅内大动脉硬化程度和脑血流动力学指标，进行患者脑血流动力学与脑白质病变严重程度之间相关性分析，并分析脑白质中重度病变的危险因素。结果 Fazekas量表<3分者61例纳入轻度病变组，≥ 3分者47例纳入中重度病变组。中重度病变患者颅内大动脉硬化严重程度高于轻度病变组（P<0.05）。中重度病变组脑部动脉搏动指数（PI）显著高于轻度病变组；收缩期峰值血流（Vs）、平均血流（Vm）以及舒张末期血流（Vd）等脑血流动力学指数显著低于轻度病变组（P<0.05）。颅内大动脉硬化程度、PI与脑白质病变严重程度正相关（r=0.416，0.527；P<0.05），Vs、Vm以及Vd等脑血流参数与脑白质病变严重程度负相关（r=-0.316，-0.524，-0.668；P<0.05）。颅内大动脉硬化程度与PI为脑白质中重度病变的危险因素（P<0.05）。结论 缺血性脑卒中患者脑白质病变严重程度与患者脑血流动力学指标异常有关，而颅内动脉硬化会加重患者脑白质病变严重程度。

Abstract:

Objective To investigate the correlation between cerebral hemodynamics and the severity of cerebral white matter (CWM) lesions in patients with ischemic stroke (IS).Methods A retrospective analysis was performed on the clinical data of 108 IS patients who were admitted to our hospital from July 2015 to August 2019. The Fazekas scale was used to grade the severity of their CWM lesions. The patients with different severities of CWM lesions were compared in terms of intracranial large artery sclerosis grading and cerebral hemodynamic parameters. An analysis was performed on the correlation between cerebral hemodynamics and the severity of CWM lesions, and on the risk factors for severe CWM lesions.Results Sixty-one patients with Fazekas score <3 were included in mild lesion group, and 47 patients with Fazekas score ≥ 3 were included in moderate-severe lesion group. The moderate-severe lesion group had significantly higher intracranial large artery sclerosis grade and cerebral artery pulsatility index (PI), and significantly lower cerebral hemodynamic parameters including peak systolic velocity (Vs), mean velocity (Vm), and end-diastolic velocity (Vd) than the mild lesion group (all P<0.05). The intracranial large artery sclerosis grade and PI were positively correlated with the severity of CWM lesions (r=0.416, 0.527, both P<0.05), while cerebral hemodynamic parameters including Vs, Vm, and Vd were negatively correlated with it (r=-0.316, -0.524, -0.668, all P<0.05). Intracranial large artery sclerosis grading and PI were risk factors for moderate-severe CWM lesions (P<0.05).Conclusions The severity of CWM lesions in IS patients is related to abnormal cerebral hemodynamic parameters. Intracranial arteriosclerosis can aggravate the severity of CWM lesions.