颅内动脉迂曲扩张与颅内动脉粥样硬化的关系。
The relationship between intracranial arterial dolichoectasia and intracranial atherosclerosis.
机构信息
Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Department of Neurology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China; Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
出版信息
Clin Neurol Neurosurg. 2021 Jan;200:106408. doi: 10.1016/j.clineuro.2020.106408. Epub 2020 Dec 4.
OBJECTIVE
We aimed to investigate the relationship between intracranial arterial dolichoectasia (IADE) and intracranial atherosclerosis (ICAS).
METHODS
Patients with acute ischemic stroke were screened via the Nanjing Stroke Registry Program. Patients were diagnosed with IADE (diameter, height of bifurcation, and laterality of basilar artery) based on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) results. Intracranial atherosclerosis was defined as a ≥50 % diameter reduction in internal carotid artery, middle cerebral artery, posterior cerebral artery, or anterior cerebral artery on MRA, computed tomography angiography, or digital subtraction angiography. We also evaluated the presence and degree of white matter changes and lacuna infarctions on MRI.
RESULTS
Of the 469 enrolled patients, 61 (13 %) had IADE. Patients with IADE were older (64.1 ± 9.9 vs. 59.6 ± 11.4 years, P = 0.004) and had a higher prevalence of hypertension (78.7 % vs. 61.0 %, P = 0.008) than patients without IADE. Patients with ICAS were older (62.6±10.5 vs 58.1±11.6 years, P < 0.001), had higher prevalence of hypertension (72.9 % vs. 55.0 %, P < 0.001) and a previous history of stroke (21.6 % vs. 9.2 %, P < 0.001), had higher levels of serum low-density lipoprotein cholesterol (2.57±0.82 vs. 2.31±0.86mmol/l P = 0.002), and had high counts of white blood cells (7.90±3.29 vs 7.10±2.44, P = 0.004). No association was detected between IADE and extracranial carotid atherosclerosis [odds ratio (OR)=0.618; 95 % confidence interval (CI), 0.280-1.367; P = 0.235]. After adjusting for age, sex, hypertension, and ischemic heart disease, patients with IADE had a lower ICAS rate than that in those without IADE (OR 0.417, 95 % CI, 0.213-0.816, P = 0.011). Unlike patients with ICAS, patients with IADE were more likely to have infratentorial stroke lesions (OR=2.952, 95 % CI, 1.207-7.223, P = 0.018), multi-lacuna (OR=2.142, 95 % CI, 1.158-3.964, P = 0.015), and white matter changes (OR = 2.782; 95 % CI, 1.522-5.085, P = 0.001).
CONCLUSIONS
IADE was associated with advanced age, hypertension, multi-lacuna, and white matter changes but was not associated with ICAS.
目的
本研究旨在探讨颅内动脉迂曲（IADE）与颅内动脉粥样硬化（ICAS）之间的关系。
方法
通过南京卒中登记项目筛选急性缺血性脑卒中患者。根据磁共振成像（MRI）/磁共振血管造影（MRA）结果诊断 IADE（分叉处直径、分叉高度和基底动脉偏侧性）。颅内动脉粥样硬化定义为颈内动脉、大脑中动脉、大脑后动脉或大脑前动脉的 MRA、计算机断层血管造影或数字减影血管造影显示≥50%的直径狭窄。我们还评估了 MRI 上的脑白质改变和腔隙性梗死的存在和程度。
结果
469 例患者中，61 例（13%）存在 IADE。IADE 患者年龄更大（64.1±9.9 岁 vs. 59.6±11.4 岁，P=0.004），高血压患病率更高（78.7% vs. 61.0%，P=0.008）。ICAS 患者年龄更大（62.6±10.5 岁 vs. 58.1±11.6 岁，P<0.001），高血压患病率更高（72.9% vs. 55.0%，P<0.001），卒中病史更高（21.6% vs. 9.2%，P<0.001），血清低密度脂蛋白胆固醇水平更高（2.57±0.82 vs. 2.31±0.86mmol/L，P=0.002），白细胞计数更高（7.90±3.29 vs. 7.10±2.44，P=0.004）。IADE 与颅外颈动脉粥样硬化之间无相关性（比值比（OR）=0.618；95%置信区间（CI）：0.280-1.367；P=0.235）。在校正年龄、性别、高血压和缺血性心脏病后，IADE 患者的 ICAS 发生率低于无 IADE 患者（OR 0.417，95%CI：0.213-0.816，P=0.011）。与 ICAS 患者不同，IADE 患者更可能出现幕下卒中病灶（OR=2.952，95%CI：1.207-7.223，P=0.018）、多发性腔隙性梗死（OR=2.142，95%CI：1.158-3.964，P=0.015）和脑白质改变（OR=2.782；95%CI：1.522-5.085，P=0.001）。
结论
IADE 与高龄、高血压、多发性腔隙性梗死和脑白质改变有关，但与 ICAS 无关。
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