Relationship of vertebrobasilar dolichoectasia and three vascular endothelial injury factors to white matter hyperintensity and lacunar infarction in patients with cerebral small vessel disease
10.3969/j.issn.1672-5921.2025.03.005
- VernacularTitle:椎-基底动脉延长扩张症及3种血管内皮损伤因子与脑小血管病患者脑白质高信号和腔隙性梗死的相关性研究
- Author:
Xi LI
1
;
Zhaoxin WU
1
;
Daopei ZHANG
1
;
Yonghui ZHANG
1
;
Huailiang ZHANG
1
Author Information
1. 450099 郑州,河南中医药大学第一附属医院脑病中心河南省眩晕病诊疗中心
- Publication Type:Journal Article
- Keywords:
Cerebral small vessel disease;
Vertebrobasilar dolichoectasia;
Endothelial dysfunction
- From:
Chinese Journal of Cerebrovascular Diseases
2025;22(3):188-198
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate whether vertebrobasilar dolichoectasia(VBD)and three vascular endothelial injury factors correlate with white matter hyperintensity(WMH)and lacunar infarction(LI)in patients with cerebral small vessel disease(CSVD).Methods Patients with CSVD hospitalized at the Brain Disease Center of the First Affiliated Hospital of Henan University of Chinese Medicine from March 2023 to March 2024 were prospectively and consecutively included in this study.Baseline clinical data,including gender,age,body mass index,hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,hyperlipidemia,hyperhomocysteinemia,hyperuricemia,carotid plaque,history of previous stroke,smoking,alcohol consumption,and other vascular risk factors.The patients were categorized into CSVD with VBD group and CSVD without VBD group.Imaging assessments were performed within 24 h of enrollment,including evaluating the WMH severity using Fazekas scale score(mild WMH:1-2,moderate WMH:3-4,severe WMH:5-6),imaging characteristics of LI and vertebrobasilar artery parameters on three dimensional time of flight magnetic resonance angiography images(including bilateral vertebral artery diameters,basilar artery diameters,standard basilar artery length[BAL],and bending length of the basilar artery).A basilar artery diameter ≥4.5 mm or vertebral artery diameter ≥4.0 mm was defined as dilatation.BAL ≥29.5 mm was defined as elongation,and a basilar artery bending length ≥ 10.0 mm was defined as curvature.Patients meeting at least one of these criteria(dilatation,elongation,and curvature)were included in the CSVD with VBD group.Levels of interleukin-6(IL-6),soluble intercellular adhesion molecule-1(sICAM-1),and von Willebrand factor(vWF)levels were measured on the second day of enrollment.To analyze the influencing factors of VBD in CSVD patients and examine the correlation between vertebrobasilar artery imaging parameters,the levels of three vascular endothelial injury factors(IL-6,sICAM-1,vWF),and the severities of WMH and LI in patients with CSVD.Results A total of 88 patients with CSVD,aged 40-80 years,with a mean age of(64±10)years,were included in this study,with 50patients in the CSVD with VBD group and 38patients in the CSVD without VBD group.(1)Univariate analysis showed no statistically significant differences in clinical baseline data or the three endothelial injury factor levels between the two groups(all P＞0.05).After adjusting for age and gender,variables with P＜0.1 in the univariate analysis(male,smoking history)were further examined using multivariate Logistic regression analysis,which showed that neither male gender(OR,2.656,95％CI 0.647-10.907,P=0.175)nor smoking history(OR,0.992,95％CI 0.255-3.866,P=0.991)significantly increased the risk of VBD in CSVD patients.(2)There were no statistically significant differences in bilateral vertebral artery diameters or BAL among different severity of WMH or between patients with or without LI(all P＞0.05).The basilar artery bending length was significantly smaller in patients with mild and moderate WMH CSVD than those with severe WMH CSVD(2.49[1.60,4.58]mm,5.24[2.28,6.02]mm,6.99[5.19,8.93]mm,respectively;both P＜0.05).(3)Univariate analysis showed that IL-6,sICAM-1,and vWF levels were significantly higher in patients with moderate and severe WMH CSVD compared to patients with mild WMH CSVD(all P＜0.05).IL-6 and sICAM-1 levels were significantly higher in patients with severe WMH CSVD compared to patients with moderate WMH CSVD(both P＜0.05).The levels of IL-6,sICAM-1,and vWF were significantly higher in CSVD patients with LI than those in CSVD patients without LI(all P＜0.05).(4)After adjusting for confounders such as gender,age,and smoking history,the multifactorial Logistic ordered regression analysis,using patients with mild WMH CSVD as the reference indicated that high IL-6(OR,2.358,95％CI 1.268-4.387,P=0.007),sICAM-1(OR,2.077,95％CI 1.430-3.016,P＜0.01),and vWF(OR,1.437,95％CI 1.058-1.951,P=0.020)levels were significant risk factors for the occurrence of moderate WMH in patients with CSVD,as well as significant risk factors for severe WMH in patients with CSVD(IL-6[OR,5.340,95％CI 2.555-11.163,P＜0.01],sICAM-1[OR,16.004,95％CI3.692-69.379,P＜0.01],and vWF[OR,1.748,95％CI 1.267-2.412,P=0.001]);a long basilar artery bending length was an risk factor for the development of moderate(OR,1.287,95％CI 1.032-1.603,P=0.025)and severe(OR,1.639,95％CI 1.280-2.099,P＜0.01)WMH in CSVD patients.(5)After adjusting for confounding factors such as gender,age,and smoking history,multifactorial Logistic ordered regression analysis identified that high IL-6(OR,1.536,95％CI 1.074-2.198,P=0.019),sICAM-1(OR,2.066,95％CI 1.465-2.913,P＜0.01),vWF(OR,1.423,95％CI 1.078-1.879,P=0.013)levels are significant influential factors for the development of LI in CSVD patients.Conclusions Longer basilar artery bending length was associated with more severe WMH in patients with CSVD.Elevated levels of IL-6,sICAM-1,and vWF were associated with development of LI and more severe WMH in patients with CSVD.
