壹生资讯-沿血管周围间隙的低弥散率证实的类淋巴系统受损与脑小血管病相关：一项基于人群的研究

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沿血管周围间隙的低弥散率证实的类淋巴系统受损与脑小血管病相关：一项基于人群的研究

2023-05-09作者：论坛报沐雨资讯

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Stroke & Vascular Neurology（SVN）最新上线文章“Impaired glymphatic system as evidenced by low diffusivity along perivascular spaces is associated with cerebral small vessel disease: a population-based study”，来自首都医科大学附属北京天坛医院、国家神经系统疾病临床医学研究中心王伊龙教授、潘岳松教授团队等。

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本研究旨在调查社区人群中类淋巴系统与脑小血管病（cerebral small vessel disease, CSVD）的发生、严重程度和神经影像学表型的关系。

研究共纳入2219例年龄在50～75岁之间、参与了多血管床评估与认知损伤和血管事件社区人群队列研究（PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events, PRECISE）的社区居民。基于弥散张量成像测量沿血管周围间隙的弥散率（diffusivity along perivascular spaces based on diffusion tensor imaging, DTI-ALPS指数），以评估类淋巴通路。应用两种不同的CSVD评分（Wardlaw评分：0～4分；Rothwell评分：0～6分）来评估CSVD的发生及严重程度，这些评分综合了4个常见的CSVD神经影像学特征，包括白质高信号（white matter hyperintensity, WMH）、血管周围间隙扩大（enlarged perivascular spaces, EPVS）、腔隙、脑微出血；此外，评估了脑萎缩（Brain atrophy, BA）。采用二元或有序logistic回归分析探究DTI-ALPS指数与CSVD的关系。

研究结果显示，受试者平均年龄为61.3岁（SD 6.6），其中1019例（45.9%）为男性。平均DTI-ALPS指数为1.67（SD 0.14）。与第四四分位数（Q4）相比，DTI-ALPS指数位于第一四分位数（Q1）的个体发生CSVD（Wardlaw评分：OR 1.77, 95% CI 1.33-2.35, p<0.001；Rothwell评分：OR 1.80, 95% CI 1.38-2.34, p<0.001）、CSVD总负担（Wardlaw评分：common OR (cOR) 1.89, 95% CI 1.43-2.49, p<0.001；Rothwell评分：cOR 1.95, 95% CI 1.51-2.50, p<0.001）的风险更高。此外，DTI-ALPS指数位于Q1的个体发生WMH、腔隙、基底神经节EPVS和BA的风险均增加（所有p<0.05）。

Figure 1.The assessment of glymphatic system by calculating the DTI-ALPS index. DTI-ALPS, diffusivity along the perivascular spaces based on diffusion tensor imaging; FA, fractional anisotropy; FLAIR, fluid-attenuated inversion recovery; ROI, regions of interest; SWI, susceptibility-weighted imaging.

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Figure 3. The DTI-ALPS index in association with the presence and severity of CSVD. Forest plots present ORs/cORs for the associations of the DTI-ALPS index with the presence of CSVD (A), modified presence of CSVD (B), total CSVD burden (C) and modified total CSVD burden (D). The colourful lines indicate 95% CIs of ORs/cORs. Model 1 adjusted for age and sex; model 2, vascular risk factors; model 3, current medications. cOR, common OR; CSVD, cerebral small vessel disease; DTI-ALPS, diffusivity along the perivascular spaces based on diffusion tensor imaging.

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Figure 4. Restricted cubic spline plots for the associations of the DTI-ALPS index with the presence and severity of CSVD. Adjusted ORs/cOR for presence of CSVD (A), modified presence of CSVD (B), total CSVD burden (C) and modified total CSVD burden (D) based on restricted cubic spines with 5 knots at 5th, 25th, 50th, 75th and 95th percentiles of the DTI-ALPS index. The solid line indicates adjusted ORs/cORs, and the dashed lines the 95% CI bands. Reference is the first quartile of ALPS index. The vertical dashed lines indicate the 25th, 50th and 75th percentiles of DTI-ALPS index. Data were fitted using a binary/ordinal logistic regression model of restricted cubic spline with five knots (the 5th, 25th, 50th, 75th, 95th percentiles) for the DTI-ALPS index after adjusting for all potential confounders. The lowest 5% and highest 5% of participants are not shown. cOR, common OR; CSVD, cerebral small vessel disease; DTI-ALPS, diffusivity along the perivascular spaces based on diffusion tensor imaging.

Figure 5. The DTI-ALPS index in association with neuroimaging phenotypes of CSVD. Forest plots present ORs/cORs for the associations of the DTI-ALPS index with different neuroimaging marker of CSVD. The black lines indicate 95% CIs of ORs/cORs. Multivariable logistic regression model adjusted for all potential confounders. BG-EPVS, basal ganglia-EPVS; CSO-EPVS, centrum semiovale-EPVS; CMBs, cerebral microbleeds; cOR, common OR; CSVD, cerebral small vessel disease; DTI-ALPS, diffusivity along the perivascular spaces based on diffusion tensor imaging; EPVS, enlarged perivascular space; GCA, global cortical atrophy scale; WMH, whiter matter hyperintensity.