短暂性脑缺血发作和轻型卒中患者血管周围间隙扩大和眼底血管病变的相关性研究

目的:探讨轻型卒中和短暂性脑缺血发作(transient ischemic attacks,TIA)患者血管周围间隙扩大(enlarged perivascular space,EPVS)与眼底血管病变之间的关系。方法:连续收集2019年3—8月在常州市第二人民医院住院治疗的TIA或轻型卒中患者(美国国立卫生研究院卒中量表评分≤3分)。对每例患者完善磁共振成像和眼底照相检查,半自动测量视网膜动静脉直径,评估视网膜动脉硬化程度、血管弯曲度,观察眼底出血、微血管瘤、硬性渗出、软性渗出、动静脉交叉、静脉串珠的情况。根据TIA和轻型卒中患者有无EPVS分成两组,比较两组患者的基线资料,使用多因素Logistic回归分析眼底病变与EPVS之间的关系。对TIA和轻型卒中患者的EPVS进行计数及程度分级,并对EPVS的数量进行ln对数转换为正态分布数据,进一步分析EPVS的等级及数量与眼底血管病变之间的关系。结果:共纳入123例患者,其中脑梗死患者99例,TIA患者24例;无EPVS组52例,EPVS组71例。EPVS组患者在年龄(68.61±12.71)岁与(63.37±13.53)岁,t=-2.198,P=0.030]、高血压病史52例(73.2%)与25例(48.1%),χ2=8.118,P=0.004]、眼底血管瘤17例(23.9%)与5例(9.6%),χ2=4.196,P=0.041]、眼动静脉交叉征比例50例(70.4%)与8例(15.4%),χ2=36.488,P<0.05]、眼底动脉硬化程度1(1,2)级与0(0,1)级,Z=-7.454,P<0.05]方面均高于非EPVS组;EPVS组患者视网膜中央动脉直径central retinal artery equivalent,CRAE;(106.31±15.02)mm与(113.89±11.86)mm,t=3.014,P=0.003]、视网膜动静脉直径比值(arteriole-to-venule ratio,AVR;0.54±0.07与0.59±0.05,t=4.553,P<0.05)均小于非EPVS组。回归分析发现眼底动脉硬化程度(OR=7.781,95%CI 2.876~21.055,P<0.05)和高血压病(OR=3.203,95%CI 1.049~9.777,P=0.041)是TIA和轻型卒中患者有无EPVS的独立相关因素。EPVS的严重程度与眼底动脉硬化程度呈正相关(r=0.764,P<0.05),与CRAE呈负相关(r=-0.287,P<0.05),与AVR呈负相关(r=-0.422,P<0.05)。ln转换后的EPVS数量与EPVS严重程度高度相关(r=0.972,P<0.05)。进一步校正年龄、性别、高血压病、糖尿病等因素后,ln转换后的EPVS数量与动静脉交叉征呈正相关(B=0.556,95%CI 0.203~0.910,P=0.003),与眼底动脉硬化呈正相关(B=0.417,95%CI 0.259~0.576,P<0.05),与AVR呈负相关(B=-4.213,95%CI-6.712^-1.714,P=0.001)。结论:高血压病和眼底动脉硬化是TIA和轻型卒中患者EPVS的独立相关因素;TIA和轻型卒中患者EPVS的等级及数量与眼底病变有相关性,EPVS的数量越多,动静脉交叉征出现比例越高,眼底动脉硬化程度越严重,CRAE越小,AVR越小。

Correlation between the severity of enlarged perivascular space and retinal vessel abnormalities in mild stroke and transient ischemic attack

Objective To investigate the relationship between enlarged perivascular space(EPVS)and retinal vessel abnormalities in transient ischemic attack(TIA)and mild stroke patients.Methods TIA and mild cerebral infarction(National Institutes of Health Stroke Scale score≤3)patients were enrolled from March to August 2019 in Changzhou Second People′s Hospital.Magnetic resonance imaging and retinal fundus photography were performed in all patients.Retinal arteriovenous diameter was semi-automatically measured,and retinal arteriosclerosis grades,vascular curvature,hemorrhages,microangioma,hard exudation,soft exudation,arteriovenous nicking and venous beads were assessed.Patients were divided into two groups according to the existence of EPVS:EPVS group and non-EPVS group.The baseline data of the two groups were compared and further multivariate Logistic regression was carried out.After normal transformation of the number of EPVS,the correlation between the grades of EPVS and converted EPVS was analyzed.The relationship between the number of converted EPVS and the grades and retinal fundus vascular lesions was further analyzed.Results A total of 123 patients were included,including 99 patients with cerebral infarction,24 patients with TIA;52 patients without EPVS and 71 patients with EPVS.The EPVS group was more than the non-EPVS group in age((68.61±12.71)years and(63.37±13.53)years,t=-2.198,P=0.030),history of hypertension(52(73.2%)and 25(48.1%),χ2=8.118,P=0.004),hemangioma(17(23.9%)and 5(9.6%),χ2=4.196,P=0.041),arteriovenous nicking(50(70.4%)and 8(15.4%),χ2=36.488,P<0.05)and arteriosclerosis grades(1(1,2)and 0(0,1),Z=-7.454,P<0.05),and less than the non-EPVS group in central retinal artery equivalent(CRAE;(106.31±15.02)mm and(113.89±11.86)mm,t=3.014,P=0.003)and arteriole-to-venule ratio(AVR;0.54±0.07 and 0.59±0.05,t=4.553,P<0.05).Multivariate Logistic regression analysis showed arteriosclerosis grades(OR=7.781,95%CI 2.876-21.055,P<0.05)and hypertension(OR=3.203,95%CI 1.049-9.777,P=0.041)were related factors for EPVS.Adjusting for age,sex,hypertension and diabetes,the normally transformed EPVS was found positively correlated with arteriovenous nicking(B=0.556,95%CI 0.203-0.910,P=0.003)and arteriosclerosis grade(B=0.417,95%CI 0.259-0.576,P<0.05),and negatively correlated with AVR(B=-4.213,95%CI-6.712--1.714,P=0.001).The grades of EPVS were positively correlated with arteriosclerosis(r=0.764,P<0.05),and negatively correlated with CRAE(r=-0.287,P<0.05)and AVR(r=-0.422,P<0.05).Conclusions Hypertension and retinal arteriosclerosis are related factors of EPVS in mild stroke and TIA patients.EPVS is correlated with retinal vessel abnormalities.The more serious of EPVS is,the more serious of retinal arteriosclerosis is,the higher ratio of arteriovenous nicking is,the smaller of CRAE and AVR are.