CAJ | 학술논문

目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者血管周围间隙扩大(enlarged perivascular space,EPVS)及其临床意义.方法收集2011年10月至2012年2月在南京军区南京总医院住院的CSVD患者174例和非CSVD患者86例.所有患者均行头颅MRI检查(包括弥散加权成像和液体翻转衰减恢复序列),分析两组患者EPVS数量和解剖学分布,应用受试者工作特征(receiver operator characteristic,ROC)曲线探讨其解剖学分布的诊断临界值.结果多变量logistic回归分析显示,基底节区EPVS(优势比1.491,95％可信区间1.165 ～1.909；P=0.002)和半卵圆中心EPVS(优势比1.279,95％可信区间1.022 ～1.601；P =0.032)与CSVD独立相关.CSVD患者基底节区和半卵圆中心EPVS均显著多于非CSVD患者(P均=0.001),其相应的CSVD诊断临界点分别为4个和6个,ROC曲线下面积以及诊断敏感性和特异性分别是0.859、72.4％、93.0％和0.808、65.5％、95.3％.结论 EPVS有助于CSVD的诊断,采用EPVS诊断CSVD时需区分解剖学部位,并确立相应的诊断临界值.
목적 탐토뇌소혈관병(cerebral small vessel disease,CSVD)환자혈관주위간극확대(enlarged perivascular space,EPVS)급기림상의의.방법 수집2011년10월지2012년2월재남경군구남경총의원주원적CSVD환자174례화비CSVD환자86례.소유환자균행두로MRI검사(포괄미산가권성상화액체번전쇠감회복서렬),분석량조환자EPVS수량화해부학분포,응용수시자공작특정(receiver operator characteristic,ROC)곡선탐토기해부학분포적진단림계치.결과 다변량logistic회귀분석현시,기저절구EPVS(우세비1.491,95％가신구간1.165 ～1.909；P=0.002)화반란원중심EPVS(우세비1.279,95％가신구간1.022 ～1.601；P =0.032)여CSVD독립상관.CSVD환자기저절구화반란원중심EPVS균현저다우비CSVD환자(P균=0.001),기상응적CSVD진단림계점분별위4개화6개,ROC곡선하면적이급진단민감성화특이성분별시0.859、72.4％、93.0％화0.808、65.5％、95.3％.결론 EPVS유조우CSVD적진단,채용EPVS진단CSVD시수구분해부학부위,병학립상응적진단림계치.
Objective To investigate the enlarged perivascular space (EPVS) and its clinical significance in patients with cerebral small vessel disease (CSVD).Methods One hundred seventy-four patients with CSVD and 86 patients without CSVD admitted to Jinling Hospital,Clinical School of Nanjing University School of Medicine from October 2011 to February 2012 were recruited.All patients underwent cranial MRI examination (including diffusion-weighted imaging and fluid attenuated inversion recovery sequences).The numbers of EPVS and anatomic distribution in all the subjects of both groups were analyzed.The receiver operator characteristic (ROC) curve was used to investigate its diagnostic critical value of anatomic distribution.Results Multivariate logistic regression analysis showed that EPVS in basal ganglia region (odds ratio [OR] 1.491,95％ confidence interval [CI] 1.165-1.909; P =0.002) and EPVS in centrum semiovale (OR 1.279,95％ CI 1.022-1.601;P=0.032) were independently associated with CSVD.EPVS in the basal ganglia region and the centrum semiovale in patients with CSVD was significantly more than that in patients with non-CSVD (all P ＜0.001).Its corresponding diagnosis cut-off points of CSVD were 4 and 6 respectively.The area under the ROC curve and the diagnostic sensitivity and specificity were 0.859,72.4％,93.0％ and 0.808,65.5％,95.3％,respectively.Conclusions EPVS contributes to the diagnosis of CSVD.When using EPVS to diagnose CSVD,the anatomical sites need to be distinguished and establish appropriate diagnostic critical value.