Yang Shuna, Yuan Junliang, Zhang Xiaoyu, Fan Huimin, Li Yue, Yin Jiangmei, Hu Wenli
a Department of Neurology , Beijing Chaoyang Hospital Affiliated to Capital Medical University , Beijing , China.
b Department of Neurology , Qianfoshan Hospital Affiliated to Shandong University , Jinan , China.
Neurol Res. 2017 Sep;39(9):787-794. doi: 10.1080/01616412.2017.1324552. Epub 2017 May 5.
Enlarged perivascular spaces (EPVS) have been identified as a marker of cerebral small vessel diseases (CSVD). Ambulatory blood pressure (ABP) is the strongest predictor of hypertension-related brain damage. However, the relationship between ABP levels and EPVS is unclear.
This study aimed to investigate the association between ABP levels and EPVS by 24-hour ambulatory blood pressure monitoring (ABPM).
We prospectively recruited inpatients for physical examinations in our hospital from May 2013 to Jun 2016. 24-hour ABPM data and cranial magnetic resonance imaging information were collected. EPVS in basal ganglia (BG) and centrum semiovale (CSO) were identified and classified into three categories by the severity. White matter hyperintensities were scored by Fazekas scale. Spearman correlation analysis and multiple logistic regression analysis were used to determine the relationship between ABP levels and EPVS.
A total of 573 subjects were enrolled in this study. 24-hour, day and night systolic blood pressure (SBP) levels were positively related to higher numbers of EPVS in BG (24-hour SBP: r = 0.23, p < 0.01; day SBP: r = 0.25, p < 0.01; night SBP: r = 0.30, p < 0.01). The association was unchanged after controlling for confounders by multiple logistic regression analysis. 24-hour and day diastolic blood pressure (DBP) levels increased with an increasing degree of EPVS in CSO (p = 0.04 and 0.049, respectively). But the association disappeared after adjusting for confounders. Spearman correlation analysis indicated that ABP levels were not associated with higher numbers of EPVS in CSO (p > 0.05). DBP levels were not independently associated with the severity of EPVS in BG and CSO.
Higher SBP levels were independently associated with EPVS in BG, but not in CSO, which supported EPVS in BG to be a marker of CSVD. Pathogenesis of EPVS in BG and CSO might be different.
血管周围间隙扩大（EPVS）已被确定为脑小血管病（CSVD）的一个标志物。动态血压（ABP）是高血压相关脑损伤的最强预测指标。然而，ABP水平与EPVS之间的关系尚不清楚。
本研究旨在通过24小时动态血压监测（ABPM）调查ABP水平与EPVS之间的关联。
我们前瞻性地招募了2013年5月至2016年6月在我院进行体检的住院患者。收集24小时ABPM数据和头颅磁共振成像信息。识别基底节（BG）和半卵圆中心（CSO）的EPVS，并根据严重程度分为三类。白质高信号采用Fazekas量表评分。采用Spearman相关性分析和多元逻辑回归分析来确定ABP水平与EPVS之间的关系。
本研究共纳入573名受试者。24小时、日间和夜间收缩压（SBP）水平与BG中EPVS数量较多呈正相关（24小时SBP：r = 0.23，p < 0.01；日间SBP：r = 0.25，p < 0.01；夜间SBP：r = 0.30，p < 0.01）。通过多元逻辑回归分析控制混杂因素后，这种关联不变。24小时和日间舒张压（DBP）水平随着CSO中EPVS程度的增加而升高（分别为p = 0.04和0.049）。但在调整混杂因素后，这种关联消失。Spearman相关性分析表明，ABP水平与CSO中EPVS数量较多无关（p > 0.05）。DBP水平与BG和CSO中EPVS的严重程度无独立关联。
较高的SBP水平与BG中的EPVS独立相关，但与CSO中的EPVS无关，这支持BG中的EPVS作为CSVD的一个标志物。BG和CSO中EPVS的发病机制可能不同。
