Neurology：血管周围间隙扩大的分布情况或可预测不同类型小血管病

血管周围间隙扩大与小血管病密切相关，来自曼彻斯特神经研究所的Sergi Martinez-Ramirez等学者研究了脑内DPVS的不同分布情况，结果发表在2013年4月23日的Neurology杂志上。本研究目的为评估脑血管周围间隙扩大(DPVS)是否为脑淀粉样血管病和高血压血管病等小血管疾病的标识。结果发现：血管周围间隙扩大的分布情况或可用于预测不同类型的脑小血管病。
该研究的患者招募人群为一记忆门诊的的单中心前瞻性队列研究。所有患者均进行结构性高分辨MRI检查，并在扫描检查1年内进行临床特征评估。DPVS的评估采用T1序列分别监测基底节区及脑白质去的血管周围间隙的扩大情况，利用4分半定量（即大于或小于2分）评分系统。DPVS分为高度组（评分大于2分）及低度组（评分小于或等于2分）。分别研究基底节区和白质区DPVS高度组的独立危险因素。
研究共纳入89例患者，平均年龄为72.7 ± 9.9岁，57%为女性患者。脑白质区DPVS高度组与低度组相比，脑叶微出血的发生率更高（45.5%比28.4%）。基底节区DPVS高度组患者与年龄增大、高血压和脑白质高信号区域增大相关。多元分析显示，脑叶微出血数量的增加为白质区高度DPVS的独立预测因素（优势比为1.53,95%可信区间为1.06–2.21，p = 0.02）；与此类似，高血压是基底节区高度DPVS的独立危险因素（优势比为9.4，95%可信区间 CI为1–85.2, p = 0.04）。
结果显示利用白质区DPVS与微出血的相关性及基底节区DPVS与高血压的相关性，血管周围间隙扩大或可以用来预测认知损伤患者潜在小血管病（如脑淀粉样血管病和高血压血管病）的发病情况。
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Topography of dilated perivascular spaces in subjects from a memory clinic cohort.
OBJECTIVE
To investigate whether the topography of dilated perivascular spaces (DPVS) corresponds with markers of particular small-vessel diseases such as cerebral amyloid angiopathy and hypertensive vasculopathy.
METHODS
Patients were recruited from an ongoing single-center prospective longitudinal cohort study of patients evaluated in a memory clinic. All patients underwent structural, high-resolution MRI, and had a clinical assessment performed within 1 year of scan. DPVS were rated in basal ganglia (BG-DPVS) and white matter (WM-DPVS) on T1 sequences, using an established 4-point semiquantitative score. DPVS degree was classified as high (score > 2) or low (score ≤ 2). Independent risk factors for high degree of BG-DPVS and WM-DPVS were investigated.
RESULTS
Eighty-nine patients were included (mean age 72.7 ± 9.9 years, 57% female). High degree of WM-DPVS was more frequent than low degree in patients with presence of strictly lobar microbleeds (45.5% vs 28.4% of subjects). High BG-DPVS degree was associated with older age, hypertension, and higher white matter hyperintensity volumes. In multivariate analysis, increased lobar microbleed count was an independent predictor of high degree of WM-DPVS (odds ratio [OR] 1.53 [95% confidence interval (CI) 1.06-2.21], p = 0.02). By contrast, hypertension was an independent predictor of high degree of BG-DPVS (OR 9.4 [95% CI 1-85.2], p = 0.04).
CONCLUSIONS
The associations of WM-DPVS with lobar microbleeds and BG-DPVS with hypertension raise the possibility that the distribution of DPVS may indicate the presence of underlying small-vessel diseases such as cerebral amyloid angiopathy and hypertensive vasculopathy in patients with cognitive impairment.