The Study Of Risk Factors For Enlarged Perivascular Spaces In Cerebral Small Vessel Disease

Objective To investigate the relationship between the enlarged perivascular spaces and its severity and the risk factors such as hyperlipidmia,abnormal renal function and hyperericemia in patients with cerebral small vascular disease.Methods A total of 523 consecutive patients with brain MRI which met 2 or more neuroimaging features of cerebral small vessel disease were enrolled in this crosssectional study,who received treatment in the Department of Neurology,the First Affiliated Hospital of Fujian Medical University(From January 2014 to December 2018).All patients perfected the head MRI and relevant clinical data were complete,and assessed the severity of 4 major neuroimaging features of cerebral small vessel disease.According to the number of lesions,EPVS(Enlarged Perivascular Spaces,EPVS)were graded in different sites,and divided into mild group and moderate-severe group according to the severity.The differences in age,sex,hypertension,diabetes,blood lipid levels,estimated glomerular filtration rate,and uric acid levels were compared between each EPVS and subgroups.Single factor analysis of variance and multivariate factor Logistic regression models were used to analyze the risk factors for the enlarged perivascular spaces in patients with cerebral small vessel disease.Results A total of 523 patients were enrolled in this study,with an average of 63.5 years(SD 11.9 years).In the basal ganglia,the average age(P<0.001),hypertension(P<0.001),diabetes(P=0.037),triglyceride(P=0.002),uric acid level(P=0.001),hypertriglyceridemia(P=0.003),estimated glomerular filtration rate decline(P=0.001)and hyperuricemia(P=0.037)were higher in the EPVS moderate-severe group than in the EPVS mild group,the average estimated glomerular filtration rate(P<0.001)was lower than in the EPVS mild group.In the semiovale center,the average uric acid level(P=0.003)in the EPVS moderate-severe group was higher than in the mild group.In the midbrain,the triglyceride level.(P=0.003)and hypertriglyceridemia(P=0.019)in EPVS group was higher than in the group without EPVS,the high density lipoprotein-cholesterol level(P=0.029)was lower than in the non EPVS group.Multivariate factor Logistic regression showed that age(OR=1.551,95% CI 1.291-1.863,P<0.001),hypertension(OR=1.681,95% CI 1.129-2.503,P=0.010),hypertriglyceridemia(OR=2.161,95% CI 1.405-3.325,P<0.001)was significantly associated with moderate-severe EPVS in basal ganglia,hypertriglyceridemia(OR=1.573,95% CI 1.052-2.352,P=0.027)was significantly associated with EPVS in the midbrain area.The correlation between EPVS and white matter hyperintensity and lacune in different sites showed: in basal ganglia,the periventricular hyperintensity score(P<0.001),deep white hyperintensity score(P<0.001),the total Fazekas score(P<0.001)and the total number of lacune(P<0.001)in EPVS moderate-severe group was higher than in the mild group.In the midbrain,the total number of lacune in EPVS group was higher than in the group without EPVS.Multivariate factor Logistic regression showed that the total number of lacune was closely related with basal ganglia EPVS(OR=1.136,95% CI 1.072-1.203,P<0.001),and midbrain EPVS(OR=1.077,95% CI 1.022-1.134,P=0.005).Conclusion 1.Age,hypertension and hypertriglyceridemia are the independent risk factors for moderate to severe EPVS in the basal ganglia.Hypertriglyceridemia are the independent risk factor for EPVS in midbrain.The risk factors of EPVS in different parts were not identical.2.The severity of EPVS in basal ganglia is positively correlated with the number of lacune.The severity of EPVS in centrum semiovale is positively correlated with the number of lacune..