血管周围间隙的危险因素及与脑小血管病标志物的相关性研究

发布时间：2018-04-24 21:37

本文选题：血管周围间隙 + MRI　；参考：《北京协和医学院》2016年博士论文

【摘要】：目的血管周围间隙(Perivascular space, PVS)是在脑穿通血管周围的潜在腔隙。近些年的研究发现,基底节区、皮层下白质的血管周围间隙在人群中普遍存在。且不同部位的血管周围间隙的产生机制可能不同。血管周围间隙也是脑小血管病的标志物。本研究通过研究社区人群中血管周围间隙的严重程度,探究不同部位血管周围间隙发现率及严重程度分布情况,并研究不同部位血管周围间隙的心脑血管危险因素及与其他脑小血管病标记物的相关性。方法研究纳入北京市顺义地区大孙各庄镇5个自然村村民1786人,完整记录了一般情况和主要心血管危险因素,并最终收集到头颅核磁成像质量清楚、完成MMSE评分且无认知功能低下、无脑肿瘤、无卒中史的村民共701位。通过对基底节区(上2/3、下1/3)、皮层下白质、中脑(中脑间脑连接、桥脑中脑连接)、海马的血管周围间隙分别进行分级,评估血管周围间隙的严重程度,并记录大PVS (≥3mm)的数目和分布情况,最终使用多变量Logistic回归分析各部位血管周围间隙的危险因素及与其他脑小血管病标记物的相关性。结果1)基底节与皮层下白质的PVS可见于每个个体,海马区见于67.9%的人群,桥脑中脑连接见于50.2%,中脑间脑连接见于14.4%。大PVS发现率为21.8%,其中基底节15.4%,白质4.0%,中脑1%,海马3.3%。2)经调整年龄和性别后,总基底节区PVS严重程度与年龄相关(OR 1.81,p0.01),而与高脂血症负相关(OR 0.55,p0.01),其中基底节上2/3与年龄(OR 2.38,p0.01)、高血压用药史(OR 2.26,p0.01)相关；基底节下1/3与年龄相关(OR 1.35,p0.01),而高脂血症(OR 0.53,p=0.04)、高血压用药史(OR 0.43,p=0.03)为保护性因素；皮层下白质PVS严重程度与年龄(OR1.39,p0.01)、高血压用药史(OR 1.65,p=0.03)相关。桥脑中脑连接PVS严重程度仅与年龄相关(OR 134,p0.01)。海马PVS严重程度与女性(OR 1.53,p=0.04)、高血压(OR 1.68,p=0.01)相关。3)总基底节区PVS严重程度与白质高信号存在相关性(脑室旁部白质高信号OR 1.87,p0.01：深部白质高信号OR 1.98,p0.01),下1/3基底节区PVS与脑实质分数存在负相关(OR 0.88,p=0.05)。皮层下白质、桥脑中脑连接的PVS严重程度与其他脑小血管性标记物均无相关性。海马区严重程度与深部白质高信号、腔隙相关(OR 1.49, p0.01; OR 1.82, p=0.04)结论1)该社区人群中基底节区、皮层下白质的血管周围间隙发现率为100%,严重程度较轻；而海马区严重程度较重。2)总基底节区PVS严重程度与年龄、白质高信号相关,皮层下白质PVS与年龄、高血压用药史相关,海马区与女性、高血压、腔隙性梗死相关。3)不同部位的血管周围间隙形成机制不同。基底节上2/3区的血管周围间隙与高血压相关的血管性和血管通透性增加有关；白质区的血管周围间隙可能由组织间液引流障碍引起,与淀粉样脑血管病相关；而基底节区下1/3的PVS可能是由于老年人脑萎缩和脑穿支动脉在前穿质部位的弯曲走形和挤压导致。因此在评估脑小血管疾病时应重点关注基底节上2/3区域的血管周围间隙情况。
[Abstract]:Objective To study the relationship between peripheral blood vessels and peripheral blood vessels of cerebral vascular diseases . p0.01 ) ;
Under the basal ganglia , 1 / 3 was related to age ( OR 1.35 , p0.01 ) , while hyperlipemia ( OR 0.53 , p = 0.04 ) , the history of hypertension medication ( OR 0.43 , p = 0.03 ) were protective factors ;
Compared with age ( OR 1.65 , p = 0.03 ) , the degree of severity and age ( OR 1.65 , p = 0.03 ) were related to age ( OR 1.65 , p = 0.03 ) . ( 3 ) There was a negative correlation between the severity and the high signal of white matter in the basal ganglia ( OR 1.87 , p0.01 : high white matter high signal OR 1.98 , p0.01 ) , and there was a negative correlation with the cerebral parenchyma score ( OR 0.88 , p = 0.05 ) in the lower 1 / 3 basal ganglia region . There was no correlation between the severity of the hippocampal area and the deep white matter high signal and the lacunar gap ( OR 1.49 , p0.01 ; OR 1.82 , p = 0.04 ) Conclusion 1 ) The peripheral clearance of the basal ganglia and subcortical white matter in the community population was found to be 100 % and the severity was lighter ;
( 2 ) The severity of the basal ganglia was significantly higher than that of age , white matter high signal , the level of white matter in the cortex was correlated with age , the history of hypertension medication , the hippocampus area was related to female , hypertension , lacunar infarction . 3 ) The peripheral blood vessel gap in the 2 / 3 area of basal ganglia was related to hypertension - related vascular and vascular permeability .
The perivascular gap in the white matter area may be caused by interstitial fluid drainage disorder , which is related to amyloid - like cerebrovascular disease ;
The 1 / 3 in basal ganglia area may be due to the atrophy of the elderly and the curved shape and extrusion of the cerebral artery in the anterior wearing parts . Therefore , the perivascular gap should be focused on the 2 / 3 region of the basal ganglia in the assessment of cerebral vascular disease .

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R743;R445.2

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