短暂性脑缺血发作患者脑血流量与脑小血管病的相关性研究

Study on the Correlation between Cerebral Blood Flow and Cerebral Small Vessel Disease in Patients with Transient Ischemic Attack

摘要: 目的：探讨亚急性期及慢性期短暂性脑缺血发作(Transient ischemic attack, TIA)患者脑血流量(Cerebral blood flow, CBF)与脑小血管病(Cerebral small vessel disease, CSVD)的相关性。方法：回顾性收集TIA患者的临床资料、实验室检查结果、CSVD评分及各脑区CBF数据。根据CSVD评分将患者分为无CSVD组(0分)与CSVD组(≥1分)，进一步将CSVD组分为轻度组(1~2分)与重度组(3~4分)，比较组间各脑区CBF的差异。采用二元Logistic回归分析CSVD发生的影响因素，通过Spearman相关性分析验证CSVD与各脑区CBF的关系。将基底节区CBF与CSVD各亚型进行Spearman相关分析。结果：无CSVD组与CSVD组比较，CSVD组各脑区CBF水平显著降低，差异均有统计学意义(P < 0.05)；二元Logistic回归分析显示，基底节区CBF是CSVD发生的独立影响因素。CSVD亚组分析显示，两组间基底节区CBF差异有统计学意义(P < 0.05)。Spearman相关分析显示，CSVD评分与各脑区CBF值均呈负相关(P < 0.05)，且与基底节区CBF相关性最强。基底节区CBF与CSVD各亚型Spearman相关分析显示，基底节区CBF与脑白质高信号(WMHs)评分、腔隙性梗死(LIs)数量、脑微出血数量(CMBs)均呈负相关(P < 0.05)。结论：TIA患者基底节区CBF水平与CSVD的发生及严重程度密切相关，其降低提示CSVD发生风险增高且病情更重，检测各脑区尤其是基底节区CBF对评估TIA患者合并CSVD的风险及病情分级具有重要临床价值。

Abstract: Objective: To investigate the correlation between cerebral blood flow (CBF) and cerebral small vessel disease (CSVD) in patients with Subacute phase and chronic phase transient ischemic attack (TIA), so as to provide a theoretical basis for clinical evaluation of CSVD comorbidity risk and disease severity in this patient population. Methods: Clinical data, laboratory test results, CSVD scores, and CBF data of each brain region were collected retrospectively from TIA patients admitted to our department. According to the established CSVD scoring criteria, all enrolled patients were divided into two groups: a CSVD-free group (patients with a CSVD score of 0) and a CSVD group (patients with a CSVD score ≥ 1). Furthermore, the CSVD group was subdivided into a mild subgroup (CSVD scores ranging from 1 to 2) and a severe subgroup (CSVD scores ranging from 3 to 4) based on the severity of the disease. Statistical analysis was performed to compare the differences in CBF levels of each brain region among the groups. Binary logistic regression analysis was applied to screen out the independent influencing factors for the occurrence of CSVD in TIA patients, while Spearman correlation analysis was conducted to clarify the correlation between CSVD scores and CBF values of each brain region. Spearman correlation analysis was performed between basal ganglia CBF and each subtype of CSVD. Result: Compared with the CSVD-free group, the CSVD group exhibited a significant reduction in CBF levels in all detected brain regions, and the differences between the two groups were statistically significant (P < 0.05). Binary logistic regression analysis further revealed that basal ganglia CBF was an independent influencing factor for the occurrence of CSVD in TIA patients (P < 0.05). Subgroup analysis of the CSVD group demonstrated that there was a statistically significant difference in basal ganglia CBF between the mild and severe subgroups, with the severe subgroup showing lower basal ganglia CBF levels (P < 0.05). Spearman correlation analysis indicated that CSVD scores were negatively correlated with CBF values in all brain regions (P < 0.05), and among these correlations, the association between CSVD scores and basal ganglia CBF was the strongest. Spearman correlation analysis between basal ganglia CBF and each subtype of CSVD showed that basal ganglia CBF was negatively correlated with White Matter Hyperintensities (WMHs) score, the number of Lacunar Infarcts (LIs), and the number of Cerebral Microbleeds (CMBs) (P < 0.05). Conclusion: Basal ganglia CBF in TIA patients is closely correlated with the occurrence and severity of CSVD. A decrease in basal ganglia CBF is associated with an increased risk of CSVD development and a more severe disease status in TIA patients. Therefore, the detection of CBF in all brain regions, especially the accurate measurement of basal ganglia CBF, possesses important clinical value for assessing the risk of CSVD comorbidity and grading the disease severity in TIA patients.