Chinese Journal of Contemporary Neurology and Neurosurgery ›› 2025, Vol. 25 ›› Issue (5): 390-395. doi: 10.3969/j.issn.1672-6731.2025.05.005

• Neuroimaging • Previous Articles     Next Articles

Imaging characteristics of cerebral small vessel disease in high-altitude plateau

Jun-shan WANG1, Wei-wei ZHAO2, Ma ZHUO2, Yu-xiu CHEN2, Yu-hua ZHAO2,*(), Jing YUAN1,*()   

  1. 1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
    2. Department of Neurology, People's Hospital of Xizang Autonomous Region, Lhasa 850000, Xizang, China
  • Received:2025-04-21 Online:2025-05-25 Published:2025-06-05
  • Contact: Yu-hua ZHAO, Jing YUAN
  • Supported by:
    Xizang Autonomous Region Natural Science Foundation Group Medical Aid Project(XZ2024ZR-ZY022(Z))

高原地区脑小血管病影像学特征分析

王俊山1, 赵伟伟2, 卓玛2, 陈玉秀2, 赵玉华2,*(), 袁晶1,*()   

  1. 1. 100730 中国医学科学院 北京协和医学院 北京协和医院神经科
    2. 850000 拉萨, 西藏自治区人民医院神经内科
  • 通讯作者: 赵玉华, 袁晶
  • 基金资助:
    西藏自治区自然科学基金组团式医学援藏项目(XZ2024ZR-ZY022(Z))

Abstract:

Objective: To analyze the distribution characteristics of imaging biomarkers in cerebral small vessel disease (CSVD) in high - altitude plateau, investigate interrelationships among imaging features, and identify influencing risk factors for high CSVD burden. Methods: A total of 131 CSVD patients diagnosed and treated at People's Hospital of Xizang Autonomous Region between January 2021 and December 2022 were enrolled. Clinical data were collected, and brain MRI was performed to assess white matter hyperintensity (WMH), lacunar infarcts (LACI), cerebral microbleeds (CMBs), and enlarged perivascular space (EPVS), with subsequent calculation of the total CSVD burden score. The distribution patterns of CSVD imaging markers were analyzed. Spearman rank correlation analysis was used to investigate the association among imaging biomakers, including WMH, LACI, CMBs and EPVS. Univariate and multivariate Logistic regression analyses were applied to examine risk factors for high CSVD burden. Results: Total 131 patients with CSVD were divided into high CSVD burden group (1-4 points, n = 85) and low CSVD burden group (0 point, n = 46) according to total CSVD burden score. Compared to the low CSVD burden group, the high CSVD burden group exhibited significantly older age (t = - 5.410, P = 0.000) and a higher prevalence of hypertension (χ2 = 14.853, P = 0.000). Among patients with CSVD in high-altitude plateau, the prevalence of WMH was 95.42% (125/131); LACI accounted for 34.35% (45/131), and were commonly located in the basal ganglia region; CMBs were predominantly of the mixed type (40.54%, 15/37); the prevalence of EPVS was 54.96% (72/131). Spearman rank correlation analysis revealed that CMBs were positively correlated with WMH (rs = 0.255, P = 0.003) and LACI (rs = 0.289, P = 0.001). Logistic regression analysis revealed that older age (OR = 1.056, 95%CI: 1.026- 1.088; P = 0.000) and hypertension (OR = 2.482, 95%CI: 1.071 -5.753; P = 0.034) were risk factors for high CSVD burden. Conclusions: Prevention and management strategies for CSVD in these populations should prioritize elderly individuals and hypertensive patients. While high-altitude environment may exacerbate cerebrovascular pathology, their specific mechanistic roles require further investigation.

Key words: Cerebral small vessel diseases, Magnetic resonance imaging, Risk factors, Logistic models, Altitude

摘要:

目的: 总结高原地区脑小血管病影像学标志物分布特征,探究各影像学特征之间的关系以及脑小血管病高负荷的危险因素。方法: 纳入2021年1月至2022年12月在西藏自治区人民医院诊断与治疗的131例脑小血管病患者,均行头部MRI检查评估脑白质高信号、腔隙性梗死、脑微出血和扩大的血管周围间隙的严重程度、数目、部位,计算脑小血管病总负荷。Spearman秩相关分析探究各影像学标志物(脑白质高信号、腔隙性梗死、脑微出血、扩大的血管周围间隙)之间的相关性;单因素和多因素Logistic回归分析筛查脑小血管病高负荷的危险因素。结果: 共131例脑小血管病患者根据总负荷评分分为高负荷组(1 ~ 4分,85例)和低负荷组(0分,46例),高负荷组年龄大于(t = - 5.410,P = 0.000)、高血压比例高于(χ2 = 14.853,P = 0.000)低负荷组。高原地区脑小血管病患者脑白质高信号发生率为95.42%(125/131),腔隙性梗死发生率为34.35%(45/131)且常见于基底节区,脑微出血以混合型微出血为主(40.54%,15/37),扩大的血管周围间隙发生率为54.96%(72/131)。Spearman偏相关分析显示,脑微出血与脑白质高信号(rs = 0.255,P = 0.003)和腔隙性梗死(rs = 0.289,P = 0.001)呈正相关。Logistic回归分析显示,年龄较大(OR = 1.056,95%CI:1.026 ~ 1.088;P = 0.000)和高血压(OR = 2.482,95%CI:1.071 ~ 5.753;P = 0.034)是脑小血管病高负荷的危险因素。结论: 针对高原地区脑小血管病的预防与治疗策略应重视高龄及高血压患者的管理。尽管高原环境可能增加脑小血管病风险,但其具体作用机制尚待进一步研究。

关键词: 大脑小血管疾病, 磁共振成像, 危险因素, Logistic模型, 高海拔