急性脑梗死患者脑小血管病与主动脉粥样硬化的相关性研究

摘要

目的 评价急性缺血性脑梗死患者脑小血管病(SVDs)与主动脉粥样硬化(AA)的相关性.方法 123例急性脑梗死患者,入院后经食管超声心动图(TEE)和脑磁共振成像(MRI)对患者脑梗死进行评价.AA分为复杂主动脉斑块(CAP)和简单主动脉斑块(SAP)2个亚型.SVDs包括脑微出血(CMBs)、白质高信号(WMH)、血管周围间隙(PVSs)、无症状性腔隙性脑梗死(ALIs)和总SVD评分.结果 检测到60例(48.8％)脑梗死患者存在AA,其中11.6％是CAP,37.2％是SAP.45例(36.4％)患者有1种或以上SVDs症状.在多变量分析中,AA患者中CMBs(OR:4.68)、重度WMHs (OR:3.13)、重度PVSs (OR:3.35)和ALIs (OR:4.24)出现的频率高于无AA患者.SVDs评分每增加1分均可使CAP[OR:1.94,95％CI(1.44,1.85)]和SAP[OR:1.54,95％CI(1.35,1.75)]发生概率增加.结论 在本研究中,AA患者经常伴有大脑SVDs.而且急性脑梗死患者AA和大脑SVDs存在相关性.%Objective To evaluate the relationship between aortic atheroma (AA) and cerebral small vessel disease (SVDs) in patients with acute cerebral infarction.Methods We included 123 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute cerebral infarction.AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP).SVDs including cerebral microbleeds (CMBs),white matter hyperintensities (WMHs),perivascular spaces (PVSs),and symptomatic lacunar infarctions (ALIs),and total SVD score were investigated.Results AA was found by TEE in 60 (48.8％) patients including 11.6％ with CAP and 37.2％ with SAP.One or more types of SVDs were found in 45 (36.4％) patients.In multivariable analysis,presence of CMBs [odds ratio (OR)4.68),high-grade WMHs (OR 3.13),high-grade PVSs (OR 3.35),and ALIs (OR 4.24) were more frequent in patients with AA than those without AA.Each 1-point increase in total SVD score increased the odds of presence of CAP [OR 1.94,95％ confidence interval (CI)(1.44,1.85)] and SAP [OR 1.54,95％ CI (1.35,1.75)].Conclusion In this study,patients with AA frequently had cerebral SVDs.Our findings give additional information for positive relationship with systemic atherosclerosis and cerebral SVDs in acute cerebral infarction patients.