Zhongguo cuzhong zazhi (Aug 2025)
扩大的血管周围间隙对脑小血管病患者白质高信号及认知障碍的影响（Effects of Enlarged Perivascular Spaces on White Matter Hyperintensities and Cognitive Impairment in Patients with Cerebral Small Vessel Disease）
Abstract
目的 探讨扩大的血管周围间隙（enlarged perivascular space，EPVS）对脑小血管病（cerebral small vessel disease，CSVD）患者白质高信号（white matter hyperintensity，WMH）及认知障碍的影响。 方法 回顾性连续纳入2022年10月—2024年6月在河北医科大学第三医院神经内科经神经影像学检查确诊为CSVD的患者。根据患者的MoCA评分将其分为认知障碍组（0～25分）和认知正常组（26～30分）。比较两组的临床基线资料差异，并通过多因素logistic回归分析CSVD患者认知障碍的影响因素。采用Spearman相关性分析评估基底节区扩大的血管周围间隙（basal ganglia enlarged perivascular space，BG-EPVS）与MoCA不同认知域评分的关系。采用偏相关分析评估WMH体积与BG-EPVS、MoCA总分的相关性，并进一步应用中介分析评估WMH体积在BG-EPVS与认知障碍之间的作用。 结果 本研究共纳入CSVD患者207例，其中认知障碍组143例，认知正常组64例。多因素logistic回归分析显示，校正年龄、脑微出血、高同型半胱氨酸血症等混杂因素后，患高血压（OR 2.208，95%CI 1.070～4.555，P=0.032）、BG-EPVS数量（OR 1.060，95%CI 1.011～1.111，P=0.016）、WMH体积（OR 1.044，95%CI 1.008～1.082，P=0.016）与认知障碍独立相关。Spearman相关性分析显示，BG-EPVS数量与视觉空间和执行功能（r=－0.388，P＜0.001）、注意力（r=－0.319，P＜0.001）、延迟回忆（r=－0.302，P＜0.001）均呈负相关。偏相关分析显示，WMH体积与BG-EPVS数量呈正相关（r=0.260，P＜0.001），与整体认知功能呈负相关（r=-0.338，P＜0.001）。进一步进行中介分析，结果显示，BG-EPVS对认知功能的影响部分由WMH体积介导，中介效应占比为33.3%。 结论 高血压、BG-EPVS数量、WMH体积与CSVD患者认知障碍独立相关。BG-EPVS对认知功能的影响部分是由WMH体积介导的。（Abstract: Objective To explore the effects of enlarged perivascular spaces (EPVS) on white matter hyperintensity (WMH) and cognitive impairment in patients with cerebral small vessel disease (CSVD). Methods Consecutive patients with CSVD confirmed by neuroimaging examinations were retrospectively enrolled at the Department of Neurology, Hebei Medical University Third Hospital from October 2022 to June 2024. Patients were divided into the cognitive impairment group (0-25 points) and the cognitively normal group (26-30 points) according to their MoCA scores. The clinical baseline data were compared between the two groups, and the influencing factors of cognitive impairment in CSVD patients were analyzed by multivariate logistic regression. Spearman correlation analysis was used to evaluate the relationship between basal ganglia enlarged perivascular space (BG-EPVS) and scores of different cognitive domains of MoCA. Partial correlation analysis was applied to assess the correlations of WMH volume with BG-EPVS and the total score of MoCA. Furthermore, mediation analysis was used to explore the role of WMH volume in the relationship between BG-EPVS and cognitive impairment. Results A total of 207 patients with CSVD were enrolled in this study, including 143 patients in the cognitive impairment group and 64 patients in the cognitively normal group. Multivariate logistic regression analysis revealed that after adjusting for confounding factors such as age, cerebral microbleeds, and hyperhomocysteinemia, hypertension (OR 2.208, 95%CI 1.070-4.555, P=0.032), the numbers of BG-EPVS (OR 1.060, 95%CI 1.011-1.111, P=0.016), and WMH volume (OR 1.044, 95%CI 1.008-1.082, P=0.016) were independently correlated with cognitive impairment. Spearman correlation analysis showed that the numbers of BG-EPVS were negatively correlated with visuospatial and executive function (r=－0.388, P<0.001), attention (r=－0.319, P<0.001), and delayed recall (r=－0.302, P<0.001). Partial correlation analysis showed that WMH volume was positively correlated with the numbers of BG-EPVS (r=0.260, P<0.001) and negatively correlated with global cognitive function (r=-0.338, P<0.001). Further mediation analysis showed that the effect of BG-EPVS on cognitive function was partially mediated by WMH volume, with a mediation effect of 33.3%. Conclusions Hypertension, the numbers of BG-EPVS, and WMH volume are independently correlated with cognitive impairment in CSVD patients. The effect of BG-EPVS on cognitive function is partially mediated by WMH volume.）
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