中国卒中杂志2025，Vol.20Issue(11)：1402-1410,9.DOI:10.3969/j.issn.1673-5765.2025.11.009
近期皮质下小梗死患者白质高信号与脑类淋巴系统功能的相关性研究
Correlation between White Matter Hyperintensities and Glymphatic System Function in Patients with Recent Small Subcortical Infarcts
摘要
Abstract
Objective To investigate the correlation between different regions and severities of white matterhyperintensities (WMH) and glymphatic system (GS) function in patients with recent smallsubcortical infarct (RSSI). Methods Patients with RSSI admitted consecutively to the Third Affiliated Hospital of NanjingMedical University (Changzhou Second People's Hospital), from December 2023 to December2024 were retrospectively enrolled. All patients completed cranial MRI examination within 3 daysafter admission, including diffusion tensor imaging sequences. The diffusion tensor image analysisalong the perivascular space (DTI-ALPS) technique was used to calculate the DTI-ALPS index forevaluating GS function. The volumes of total white matter hyperintensity (WMH), periventricularwhite matter hyperintensity (PWMH), and deep white matter hyperintensity (DWMH) were measured.WMH was scored and grouped using the Fazekas scale. According to the Fazekas scale scores,patients with PWMH or DWMH scores of 0-1 points were classified as the none-to-mild group, whilethose with scores of 2-3 points were classified as the moderate-to-severe group for the correspondingregion. The total WMH grade was determined by summing the scores of the two regions, and patientswere further grouped accordingly: grade 0-1 (0-2 points) were defined as the none-to-mild WMHgroup, and grade 2-3 (3-6 points) as the moderate-to-severe WMH group. Univariate analysis wasperformed to compare clinical data and the DTI-ALPS index among different groups. Multivariatelogistic regression analysis was used to identify independent influencing factors of WMH in differentregions. Spearman correlation analysis was conducted to assess the relationship between WMHvolume and the DTI-ALPS index, and mediation analysis was performed to examine the mediatingeffect of the DTI-ALPS index on the relationship between age and WMH volume. Results Univariate analysis showed that in the comparisons of WMH, PWMH, and DWMHgroups, significant differences in the DTI-ALPS index and age were observed between themoderate-to-severe and none-to-mild groups. The moderate-to-severe groups had lower DTIALPSindices and were older than the none-to-mild groups (both P <0.05). Multivariate logisticregression analysis indicated that the DTI-ALPS index was a independent influencing factor forWMH severity in different regions. In the WMH, PWMH, and DWMH groups, the OR of theDTI-ALPS index were 0.002 (95％CI 0.000-0.243, P =0.012), 0.009 (95％CI 0.000-0.779,P =0.038), and 0.002 (95％CI 0.000-0.223, P =0.011), respectively. Spearman correlation analysisfurther revealed that WMH volume was negatively correlated with the DTI-ALPS index in RSSIpatients (WMH: rs =−0.479, P <0.001; PWMH: rs =−0.355, P =0.004; DWMH: rs =−0.460, P <0.001).Mediation analysis demonstrated that age indirectly affected WMH volume through the DTI-ALPSindex, with a significant indirect effect accounting for 35.629％ of the total effect. Conclusions In RSSI patients, the DTI-ALPS index was an independent influencing factor forWMH severity, showed negative correlations with WMH volumes in all regions, and mediated therelationship between age and WMH volume.关键词
近期皮质下小梗死/白质高信号/类淋巴系统/沿血管周围间隙弥散张量成像分析Key words
Recent small subcortical infarct/White matter hyperintensity/Glymphatic system/Diffusion tensor image analysis along the perivascular space分类
医药卫生引用本文复制引用
张雪,张敏,吴鹏,恽文伟..近期皮质下小梗死患者白质高信号与脑类淋巴系统功能的相关性研究[J].中国卒中杂志,2025,20(11):1402-1410,9.基金项目
2023年度常州市卫健委科技项目(ZD202316) （ZD202316）
