Ma Jiangping, Xu Linghao, Xie Yuanjie
Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University, School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
Department of Endocrinology and Metabolism, the Affiliated Hospital of Southwest Medical University, 1 Xianglin Road, Luzhou, 646000, Sichuan, China.
Ann Phys Rehabil Med. 2025 Aug 1;68(8):102005. doi: 10.1016/j.rehab.2025.102005.
Enlarged perivascular spaces (EPVS) are commonly observed in individuals with cerebral small vessel disease (CSVD) and have been associated with gait impairments in older adults and are also linked to post-stroke disability. Among individuals with mild stroke, persistent gait disturbance limitations often pose significant challenges to the resumption of daily activities. The relationship between EPVS and gait disturbance and gait recovery in individuals with mild stroke, remains poorly understood.
This study aimed to examine the hypothesis that EPVS are associated with gait disturbance and delayed gait recovery in individuals with mild stroke.
Between May and November 2023, 164 participants with small ischemic hemisphere strokes were enrolled within one week of stroke onset. EPVS were assessed using magnetic resonance imaging (MRI), while gait disturbance was measured by gait velocity, cadence, and stride length, with metrics extracted using the BlazePose architecture. Gait recovery was monitored by tracking the return to independent gait over time. Linear and logistic regression models were used to explore the relationship between EPVS and gait disturbance, while multifactorial Cox regression models were employed to assess the impact of EPVS on gait recovery.
The mean [SD] age of the participants was 66.8 [9.7] years, with 72 % of the cohort being male. In multiple linear regression analyses, the presence of EPVS in the basal ganglia (BG-EPVS) was found to be a significant predictor of reduced gait velocity (β= -0.06; [95 % CI, -0.09 to -0.03]). In the multifactorial Cox regression model, moderate to severe BG-EPVS were significantly associated with delayed recovery of independent gait among participants with stroke, adjusted hazard ratio (aHR) 0.55 [95 % CI, 0.38 to 0.79].
The presence of BG-EPVS was found to be significantly associated with gait disturbance and delayed recovery of independent gait in individuals with mild stroke, indicating the potential role of EPVS as a predictor of gait recovery.
血管周围间隙扩大（EPVS）在脑小血管病（CSVD）患者中普遍存在，与老年人的步态障碍有关，也与中风后残疾相关。在轻度中风患者中，持续的步态障碍限制常常给日常活动的恢复带来重大挑战。轻度中风患者中EPVS与步态障碍及步态恢复之间的关系仍知之甚少。
本研究旨在检验EPVS与轻度中风患者的步态障碍和步态恢复延迟相关这一假设。
2023年5月至11月期间，164例缺血性半球小中风患者在中风发作后一周内入组。使用磁共振成像（MRI）评估EPVS，通过步态速度、步频和步幅测量步态障碍，使用BlazePose架构提取指标。通过跟踪随时间恢复到独立步态来监测步态恢复情况。使用线性和逻辑回归模型探索EPVS与步态障碍之间的关系，使用多因素Cox回归模型评估EPVS对步态恢复的影响。
参与者的平均[标准差]年龄为66.8[9.7]岁，队列中72%为男性。在多元线性回归分析中，发现基底节区存在EPVS（BG-EPVS）是步态速度降低的显著预测因素（β=-0.06；[95%置信区间，-0.09至-0.03]）。在多因素Cox回归模型中，中度至重度BG-EPVS与中风患者独立步态恢复延迟显著相关，校正风险比（aHR）为0.55[95%置信区间，0.38至0.79]。
发现BG-EPVS的存在与轻度中风患者的步态障碍和独立步态恢复延迟显著相关，表明EPVS作为步态恢复预测指标的潜在作用。
