大血管病变与脑小血管病相关性研究

发布时间：2018-06-14 11:04

本文选题：动脉粥样硬化 + 动脉弹性　；参考：《北京协和医学院》2017年博士论文

【摘要】：第一部分大动脉病变危险因素研究研究背景和目的:目前对大动脉病变的研究多关注动脉粥样硬化,而对其他类型血管壁病理改变(如动脉弹性减低、动脉迂曲扩张)的研究相对较少。本研究在社区人群中研究多部位动脉(包括主动脉、颈动脉、颅内动脉)、多种动脉结构和功能指标(包括动脉粥样硬化、动脉弹性、迂曲扩张)与传统血管病危险因素的相关性。研究方法:本研究基于顺义地区社区人群研究。对动脉结构和功能评估包括:动脉粥样硬化病变用颈动脉内-中膜厚度(IMT)、颈动脉斑块和颅内动脉狭窄评估;动脉弹性用肱-踝脉搏波速度(baPWV)和颈动脉脉搏波速度评估;动脉迂曲扩张用颈总动脉外径(CCA-IAD)、基底动脉(BA)管腔直径、颈内动脉(ICA)颅内段直径、基底动脉分叉高度及侧方偏移评估。纳入研究的血管病危险因素包括年龄、性别、体重指数、收缩压、降压药治疗、糖尿病、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、降脂药物治疗、同型半胱氨酸浓度。采用多因素线性模型及多因素logistic回归模型评估这些动脉病变指标与年龄、性别及传统血管病危险因素的相关性。研究结果:本研究共1787人入组,平均年龄56.4岁(标准差10.6岁)。1.对于动脉粥样硬化,年龄、高血压、糖尿病、LDL-C升高、HDL-C降低与颈动脉内-中膜厚度、颈动脉斑块、颅内动脉狭窄均独立相关(p均0.05)。2.对于动脉弹性,年龄、收缩压、糖尿病与主动脉弹性(baPWV)和颈动脉弹性(carotid PWV)下降相关(p均0.05),但血脂异常(LDL-C、HDL-C)与动脉弹下降无明显相关性;传统血管病危险因素可以解释baPWV 41.1%的变异,但仅能解释颈动脉PWV 19.8%的变异。3.对于动脉迂曲扩张,年龄、脑体积与CCA外径、BA和ICA内径呈正相关,收缩压升高与CCA外径扩张相关,但收缩压升高、糖尿病与ICA内径狭窄相关,而且LDL-C和TG升高是BA内径狭窄的危险因素。基底动脉延长扩张(BADE)的主要危险因素是年龄,与其他血管病危险因素无明显相关性。传统血管病危险因素共可以解释大血管病变约8%-42%的变异。结论:年龄、高血压是颅内、外动脉粥样硬化、动脉弹性下降、颈总动脉扩张的主要危险因素,血脂异常与动脉粥样硬化相关,但与动脉弹性、动脉延长扩张无明显相关性。基底动脉延长扩张的主要危险因素是年龄,与其他血管病危险因素无明显相关性。年龄和传统血管病危险因素对不同部位动脉、不同病变类型的贡献不同。第二部分大血管病变与脑小血管病相关性研究研究背景和目的:大动脉结构和功能改变与脑小血管病相关。但既往研究大多只关注某一级动脉、某一种类型血管病变与脑小血管病某些影像学指标的相关性,本研究系统性评估多级血管(主动脉、颈动脉、颅内动脉)、多种病变类型(动脉粥样硬化、弹性下降、迂曲扩张)与多种脑小血管病影像学改变(腔隙、白质高信号、微出血、血管周围间隙、脑萎缩)之间的相关性。研究方法:本研究基于顺义地区社区人群研究。对大动脉结构和功能评估包括以下指标:用内-中膜厚度(IMT)、颈动脉斑块和颅内动脉狭窄评估颈颅内、外动脉粥样硬化,用肱-踝脉搏波速度(baPWV)、颈动脉脉搏波速度等评估主动脉和颈动脉弹性,用颈总动脉外径(CCA-IAD)、基底动脉(BA)管腔直径、颈内动脉(ICA)颅内段直径、基底动脉分叉高度及侧方偏移评估颈动脉和颅内动脉迂曲扩张。在头核磁共振成像(MRI)上评估腔隙、脑白质高信号体积(WMHV)、微出血、血管周围间隙和脑实质分数(BPF),作为脑小血管病影像学指标。采用多因素线性回归模型及多因素logistic回归模型评估大动脉结构和功能指标与脑小血管病的相关性。研究结果:共有1323人完成头MRI检查,平均年龄55.5岁(SD,9.7岁)。腔隙、局限脑叶微出血、深部或幕下微出血、严重基底节区和白质区血管周围间隙的患病率分别是 17.9%、5.2%、6.6%、13.4%、14.3%,WMHV 中位数 0.9ml(四分位数间距,0.3-2.9),脑实质分数平均值0.76(SD,0.03)。1.动脉粥样硬化性改变:颈动脉斑块、颅内动脉狭窄与腔隙、WMHV、脑萎缩相关,且颈动脉斑块和颅内动脉狭窄与脑萎缩的相关性独立于腔隙和WMHV;颈动脉IMT与WMHV相关。2.动脉弹性参数:主动脉弹性(baPWV)与腔隙和WMHV相关;颈动脉弹性与所有脑小血管病标志物均无明显相关性。3.动脉迂曲扩张参数:颅内动脉迂曲扩张(颈内动脉颅内段和基底动脉)主要与深部或幕下微出血、基底节区血管周围间隙扩张相关;颈总动脉外径扩张与腔隙、WMHV、深部或幕下微出血、基底节区血管周围间隙扩张均相关,而且这些相关性独立于血管病危险因素和IMT增厚。结论:大动脉不同结构和功能特征与脑小血管病相关性不同。大动脉粥样硬化、弹性下降主要与腔隙和白质高信号相关,颅内动脉迂曲扩张与深部微出血和血管周围间隙扩张相关。这提示小血管病不同影像学表现的机制存在差异。
[Abstract]:Research background and purpose of the first part of the study of the risk factors for major artery lesions: the current study of major arterial lesions is mainly concerned with atherosclerosis, and the study of other types of vascular wall pathological changes (such as arterial elasticity and arterial circuitous dilatation) is relatively less. Arterial, intracranial artery), a variety of arterial structure and functional indicators (including atherosclerosis, arterial elasticity, tortuous dilation) and the risk factors of traditional vascular disease. Methods: This study was based on community population studies in Shunyi. Arterial structure and function assessment included carotid artery and middle membrane thickness (I MT) assessment of carotid artery plaque and intracranial artery stenosis; arterial elasticity with brachial ankle pulse wave velocity (baPWV) and carotid pulse wave velocity assessment; arterial external diameter (CCA-IAD), basilar artery (BA) diameter of the basilar artery (BA), intracranial diameter of the internal carotid artery (ICA), the bifurcation height of the basilar artery and lateral migration assessment. Risk factors for vascular disease include age, sex, body mass index, systolic pressure, antihypertensive therapy, diabetes, low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), lipid lowering drug therapy, homocysteine concentration. The multifactor linear model and multiple factor Logistic regression model were used to evaluate these arteries. The correlation between pathological changes and age, sex and risk factors of traditional vascular disease. Results: a total of 1787 people were enrolled in this study, with a mean age of 56.4 years (10.6 years of standard deviation).1. for atherosclerosis, age, hypertension, diabetes, LDL-C, HDL-C reduction and carotid artery and middle membrane thickness, carotid plaque, and intracranial artery stenosis. The correlation (P 0.05).2. was associated with arterial elasticity, age, systolic pressure, diabetes and the decrease of aortic elasticity (baPWV) and carotid elasticity (carotid PWV) (P 0.05), but blood lipid abnormalities (LDL-C, HDL-C) had no significant correlation with the decline of arterial elasticity; the risk factors for traditional vascular disease could explain the variation of baPWV 41.1%, but only the carotid artery PWV 19. could be explained. 8% of the variant.3. was associated with arterial circuitous dilatation. Age, brain volume was positively correlated with the diameter of CCA, BA and ICA diameter, the increase of systolic pressure was associated with the expansion of the outer diameter of CCA, but the systolic pressure increased, and diabetes was associated with the narrowing of the diameter of ICA, and the increase of LDL-C and TG was a risk factor for the stenosis of the inner diameter of BA. The major risk factors for extending the dilatation of the basilar artery (BADE) were the main risk factors Age, there is no significant correlation between the risk factors of other vascular diseases. The risk factors of traditional vascular disease can explain the variation of 8%-42% in large vascular lesions. Conclusion: age, hypertension is the intracranial, external atherosclerosis, arterial elasticity decline, the main risk factor for the expansion of the common carotid artery, blood lipid abnormality associated with atherosclerosis, but with the artery There is no significant correlation between elasticity and extension of artery dilatation. The main risk factor for extended dilatation of the basilar artery is age. There is no significant correlation between the risk factors of other vascular diseases. The contribution of risk factors of age and traditional vascular disease to different parts of the arteries and types of lesions is different. The correlation of second parts of large vascular lesions and small cerebrovascular diseases Study background and purpose: the changes in the structure and function of the large arteries are associated with cerebral microvascular disease. However, most of the previous studies only focus on a certain primary artery, the correlation of certain types of vascular lesions and some imaging indexes of cerebral small vascular disease, and the systematic assessment of multilevel vessels (main artery, carotid artery, intracranial artery), and multiple pathological types (movement) The correlation between angiosclerosis, elastic decline, tortuous dilation) and the imaging changes of various cerebral microvascular diseases (lacunar, white matter high signal, microhaemorrhage, perivascular space, atrophy of the brain). Methods: This study was based on community population studies in the Shunyi region. The structure and function assessment of the large arteries included the following indicators: the internal and medium thickness (IMT), Carotid artery and intracranial artery stenosis were used to assess the intracranial and external carotid artery atherosclerosis. The elasticity of the aorta and carotid artery was evaluated with the brachial ankle pulse wave velocity (baPWV), the carotid artery pulse wave velocity, and the external diameter of the common carotid artery (CCA-IAD), the diameter of the basilar artery (BA), the diameter of the intracranial segment of the internal carotid artery (ICA), the bifurcation height of the basilar artery and the lateral deviation. Carotid artery and intracranial artery dilatation were evaluated. The lacunar, high signal volume (WMHV), micro hemorrhage, perivascular space and brain parenchyma fraction (BPF) were evaluated on head NMR imaging (MRI) as the imaging index of cerebral small vascular disease. Multifactor linear regression model and multiple factor Logistic regression model were used to evaluate the structure of the large artery. A total of 1323 people completed head MRI examination, with an average age of 55.5 years (SD, 9.7 years), lacunar, limited cerebral lobes, deep or sub episodes of microbleeding, and the incidence of the severe basal ganglia and white matter peripheral space were 17.9%, 5.2%, 6.6%, 13.4%, 14.3%, and WMHV median 0.9ml (four). Quantile spacing, 0.3-2.9), 0.76 (SD, 0.03).1. atherosclerotic changes in the average brain fraction (SD, 0.03): carotid plaque, intracranial artery stenosis and lacunar, associated with cerebral atrophy, and the correlation between carotid plaque and intracranial artery stenosis and brain atrophy independent of the cavity and WMHV; the elastic parameters of the carotid artery IMT and WMHV related.2. arteries: Initiative Pulse elasticity (baPWV) is associated with lacunar and WMHV; carotid elasticity has no significant correlation with all the markers of cerebral microvascular disease..3. artery circuitous dilatation parameters: intracranial artery circuitous dilation (internal carotid artery and basilar artery) mainly with deep or sub episodes of microhemorrhage, dilatation of the perivascular space in the basal ganglia; external diameter expansion of the common carotid artery Lacunar, WMHV, deep or sub episodes of microhaemorrhage were correlated with the diffusion of the perivascular space in the basal ganglia, and these correlations were independent of the risk factors of vascular disease and the thickening of the IMT. Conclusion: the different structural and functional characteristics of the large arteries are related to the cerebral small vascular disease. In conclusion, the tortuous expansion of intracranial arteries is associated with deep micro bleeding and perivascular space expansion. This suggests that there are differences in the mechanism of different imaging findings of small vessel 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】：2017
【分类号】：R743

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