Study On The Relationship Between Intracranial Arterial Dolichoectasia And TOAST Classification Of Cerebral Infarction And Beta-2 Microglobulin

Objective:Intracranial arterial dolichoectasia(IADE)is characterized by an increase in the diameter and length of the main intracranial arteries.This study aimed to explore the relationship between IADE and TOAST classification of cerebral infarction and beta-2 microglobulin(β2M).Methods:1.Patients with first acute cerebral infarction who were hospitalized in the Department of Neurology of Changzhou Second People’s Hospital from October 2021 to February 2022 were consecutively collected.Each patient completed serum and urineβ2M measurement and cranial magnetic resonance imaging(MRI),computerized tomography angiography(CTA)or magnetic resonance angiography(MRA),and then IADE was determined by measuring the diameters of bilateral internalcarotid artery,bilateral middle cerebral artery,basilar artery and bilateral vertebral artery,and evaluating the lateral displacement and bifurcation height of basilar artery,and each patient’s brain arterial remodeling score(BAR)was calculated.IADE includes intracranial dolichoectasic carotid and middle cerebral artery(ICDA),and vertebrobasilar artery dolichoectasia(VBD).ICDA was defined as internal carotid artery diameter>7mm and middle cerebral artery diameter>4mm.VBD was defined if the vertebral artery or basilar artery diameter was greater than 4.5mm and basilar artery’s lateral displacement and bifurcation height reached grade two or higher.2.Cerebral infarction patients were divided into two groups according to the existence of IADE:IADE group and non-IADE group.The general clinical data were compared between the two groups,including:gender,age,hypertension,H-type hypertension,diabetes,ischemic heart disease,hyperlipidemia,previous cerebral infarction,smoking,drinking,atrial fibrillation,tumor,aneurysm,admission systolic and diastolic blood pressure and other traditional risk factors,glycosylated hemoglobin,fasting blood glucose,total cholesterol,low-density lipoprotein,high-density lipoprotein,triglyceride,uric acid,creatinine,urea nitrogen,estimated glomerular filtration rate(e GFR)and head imaging data.3.To analyze the correlation between IADE and TOAST classification of cerebral infarction and serumβ2M level.Multivariate logistic regression were used.Further use Spearman correlation analysis to explore the correlation between serumβ2M level and BAR score.Results:1.225 patients with cerebral infarction were enrolled,51 had IADE,and 174 had non-IADE.Compared with the non-IADE group,the male[40(78.4%)and 108(62.1%),P=0.030],h-type hypertension[38(74.5%)and 99(56.9%),P=0.023],serumβ2M level[2.96(2.51,3.83)mg/L and 2.23(1.92,2.63)mg/L,P<0.001],serumβ2M elevation level[16(31.4%)and 13(7.5%),P<0.001],BAR score[(0.55±0.06)mm and(-0.16±0.03)mm,P<0.001],basilar artery diameter[4.70(4.60,5.20)mm and 3.50(3.10,3.90)mm,P<0.001],left vertebral artery diameter[4.40(3.70,5.00)mm and 3.40(2.70,4.00)mm,P<0.001],right vertebral artery diameter[3.40(2.90,4.00)mm and 3.10(2.60,3.70)mm,P=0.041],left internal carotid artery diameter[6.30(5.30,7.30)mm and 5.50(4.98,5.90)mm,P<0.001],right internal carotid artery diameter[6.10(5.40,6.80)mm and 5.30(4.90,5.80)mm,P<0.001],vertebrobasilar artery tortuosity[30(58.8%)and 59(39.9%),P=0.001]significantly increased in the IADE group.There were statistically significant differences in the proportion distribution of TOAST classification(Χ~2=7.059,P=0.029),BAR score grade(Χ~2=27.610,P<0.001),basilar artery lateral displacement grade(Χ~2=21.371,P<0.001)and basilar artery bifurcation height grade(Χ~2=27.837,P<0.001)between the two groups.2.After controlling for sex,hypertension and H-type hypertension,multivariate binary logistic regression analysis indicated that arteriolar occlusive cerebral infarction(OR=2.063,95%CI:1.179～5.746,P<0.005)and serumβ2M were the independent risk factor for IADE patients(OR=3.519,95%CI:2.093～5.918,P<0.005).3.Spearman correlation analysis found that serumβ2M level was positively correlated with BAR score(r=0.146,P=0.029).Conclusions:Arteriolar occlusive cerebral infarction and serumβ2M are closely related to IADE and are the independent related risk factor of IADE.