Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Division of Life Sciences and Medicine, Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China.
Sci Rep. 2021 Feb 2;11(1):2820. doi: 10.1038/s41598-021-82327-9.
Enlarged perivascular spaces (EPVS) are widely considered as a feature of cerebral small vessel diseases (SVD), but its underlying pathology is still under active investigation. The aim of this study was to explore the association between hemoglobin level and the severity of EPVS. Consecutive patients with acute ischemic stroke who underwent baseline MRI scan and hemoglobin testing were evaluated. EPVS in basal ganglia (BG) and central semiovale (CS) were rated with a validated 4-point semiquantitative scale (0 = none; 1 = 1-10; 2 = 11-20; 3 = 21-40; and 4 ≥ 40). Bivariate logistic regression models were used to identify the associations of hemoglobin with predefined high-degree (score > 1) CS-EPVS and BG-EPVS. Multinomial logistic regression models were used to analyze the associations between hemoglobin and CS-/BG-EPVS predominance patterns. A total of 401 patients were included in the final analysis, 94 patients (23.4%) had a high degree of CS-EPVS and 45 patients (11.2%) had a high degree of BG-EPVS. Compared with tertile 1 of hemoglobin, tertile 3 of hemoglobin was independently associated with high degree of CS-EPVS after adjusting for other features of SVD (odds ratio [OR] 2.399, 95% confidence interval [CI] 1.315-4.379, P = 0.004) and potential confounding factors (OR 2.611, 95% CI 1.346-5.066, P = 0.005). In multinomial logistic regression models, compared with tertile 1 of hemoglobin, tertile 2 (OR 2.463, 95% CI 1.195-5.075, P = 0.015) and tertile 3 (OR 2.625, 95% CI 1.102-6.251, P = 0.029) of hemoglobin were associated with higher odds of BG-EPVS = CS-EPVS pattern, and tertile 3 of hemoglobin (OR 2.576, 95% CI 1.004-6.608, P = 0.049) was associated with higher odds of BG-EPVS < CS-EPVS pattern. Elevated hemoglobin level was independently associated with high degree of CS-EPVS and higher odds of CS-EPVS predominance pattern, but not with BG-EPVS, which support that the topography of EPVS is characteristic. However, the pathogenesis linking hemoglobin and CS-EPVS is unclear and still needs further investigation.
扩大的血管周围空间 (EPVS) 被广泛认为是脑小血管疾病 (SVD) 的特征之一，但其潜在的病理学仍在积极研究中。本研究旨在探讨血红蛋白水平与 EPVS 严重程度之间的关系。对接受基线 MRI 扫描和血红蛋白检测的急性缺血性脑卒中连续患者进行评估。基底节 (BG) 和中央半卵圆区 (CS) 的 EPVS 采用经过验证的 4 分半定量评分系统进行评分（0=无；1=1-10；2=11-20；3=21-40；≥4=40）。使用双变量逻辑回归模型确定血红蛋白与预设的高程度 (评分>1) CS-EPVS 和 BG-EPVS 之间的关系。使用多项逻辑回归模型分析血红蛋白与 CS-/BG-EPVS 优势模式之间的关系。共有 401 例患者纳入最终分析，94 例患者 (23.4%) 存在高程度的 CS-EPVS，45 例患者 (11.2%) 存在高程度的 BG-EPVS。与血红蛋白的三分位 1 相比，在调整 SVD 的其他特征 (比值比 [OR] 2.399，95%置信区间 [CI] 1.315-4.379，P=0.004) 和潜在混杂因素后，血红蛋白的三分位 3 与高程度的 CS-EPVS 独立相关 (OR 2.611，95% CI 1.346-5.066，P=0.005)。在多项逻辑回归模型中，与血红蛋白的三分位 1 相比，三分位 2 (OR 2.463，95% CI 1.195-5.075，P=0.015) 和三分位 3 (OR 2.625，95% CI 1.102-6.251，P=0.029) 与更高的 BG-EPVS=CS-EPVS 模式几率相关，而血红蛋白的三分位 3 (OR 2.576，95% CI 1.004-6.608，P=0.049) 与更高的 BG-EPVS<CS-EPVS 模式几率相关。血红蛋白水平升高与高程度的 CS-EPVS 以及 CS-EPVS 优势模式的几率升高独立相关，但与 BG-EPVS 无关，这支持 EPVS 的分布是特征性的。然而，血红蛋白与 CS-EPVS 之间的发病机制尚不清楚，仍需要进一步研究。
