Association Of 24-hour Ambulatory Blood Pressure Variability And Beta-2 Microglobulin With Enlarged Perivascular Spaces In Patients With Ischemic Stroke

Part Ⅰ Association between 24-hour ambulatory blood pressure variability and enlarged perivascular spaces in patients with mild stroke and transient ischemic attackObjective To investigate the relationship between 24h ambulatory blood pressure variability（24hABPV）and enlarged perivascular spaces（EPVS）in patients with mild stroke and transient ischemic attack.Methods A total of 124 patients with mild stroke and transient ischemic attack were collected.All patients underwent cranial MRI examination and 24h ambulatory blood pressure monitoring.Patients with different EPVS sites[BG-EPVS and CSO-EPVS]were divided into non-mild group（EPVS grade 0-1）and moderate-severe group（EPVS grade 2-4）according to the degree of EPVS.Mean systolic blood pressure（SBP）,mean diastolic blood pressure（DBP）,standard deviation（SD）and coefficient of variation（CV）of systolic blood pressure and diastolic blood pressure at 24h,daytime and night were recorded.The relationship between 24hABPV and EPVS was analyzed by multivariate Logistic regression model.Results The analysis indicated that age（[65±11]years vs.[69±10]years,t=-2.043）,hypertension（71.2%[42/59]vs.87.7%[57/65],χ2=5.235）,total cholesterol（[4.29 ±1.06]mmol/L vs.[3.83±0.93]mmol/L,t=-2.578）,low density lipoprotein cholesterol（[2.44±0.73]mmol/L vs.[2.18±0.71]mmol/L,t=-2.044）,creatinine（66.00[52.30,72.90]μmol/L vs.72.70[62.00,84.80]μmol/L,Z=-2.775）and eGFR（84.89[69.52,112.13]ml·min-1·1.73m-2vs.77.92[62.47,92.53]ml·min-1·1.73m-2,Z=-2.464）between BG-EPVS non-mild group and moderate-severe group were significantly different（all P<0.05）.24h and nighttime SBP,24h,daytime and nighttime SBPSD and SBPCV increased with the degree of BG-EPVS（all P<0.05）.Multivariate Logistic regression analysis showed that SD and CV were the independent risk factors for moderate-severe BG-EPVS after adjustment for gender,hypertension,low density lipoprotein cholesterol,creatinine,eGFR and SBP in the same period（all P<0.05）.There was no significant difference between 24hABPV and CSO-EPVS（P>0.05）.Conclusions 24hABPV is an independent risk factor for BG-EPVS in patients with mild stroke and transient ischemic attack.Part Ⅱ Study on the correlation between beta-2 microglobulin and enlarged perivascular spaces in patients with small-artery occlusion strokeObjective beta-2 microglobulin and enlarged perivascular spaces（EPVS）in patients with small-artery occlusion stroke.Methods Patients with small-artery occlusion stroke were pecruited consecutively.Easc patient completed serum and urine β2M measurement and cranial MRI examination.Patients with EPVS grade 0-1 in basal ganglia（BG）and centrum semiovale（CSO）were included in the non-mild EPVS group,and patients with EPVS grade 2-4 in BG or CSO region were included in the moderate-severe EPVS group.Patients with different EPVS sites[BG-EPVS and CSO-EPVS]were divided into non-mild group（EPVS grade 0-1）and moderate-severe group（EPVS grade 2-4）according to the degree of EPVS.Baseline and clinical data were compared between groups.The relationship between serum β2M level and different levels of BG-EPVS was analyzed by multivariate Logistic regression model.Results A total of 142 patients were included,the analysis indicated that age（61[51,70]years vs.71[61,78]years,Z=-4.721）,smoking（9.5%[6/63]vs.26.6%[21/79],χ2=6.623）,hypertension（46.0%[29/63]vs.81.0%[64/79],χ2=18.978）,total cholesterol（[4.1±0.9]mmol/L vs.[3.7±1.0]mmol/L,t=2.607）,low-density lipoprotein cholesterol（2.43[1.94,2.71]mmol/L vs.2.02[1.49,2.49]mmol/L,Z=-2.725）,creatinine（63.00[55.00,72.00]μmol/L vs.69.00[56.00,85.00]μmol/L,Z=-2.121）,eGFR（[97±29]ml·min-1·1.73m-2 vs.[80±27]ml·min-1·1.73m-2,t=3.513）,serumβ2M（1.83[1.62,2.14]mg/L vs.2.32[1.97,2.80]mg/L,Z=-5.345）,and the rate of patients with high serum β2M（3.2%[2/63]vs.17.7%[14/79],χ2=7.418）between non-mild EPVS group（63 case）and moderate-severe EPVS group（79 case）were significantly different（all P<0.05）.The level of serum β2M in BG-EPVS moderate-severe group was higher than that in BG-EPVS non-mild group（2.33[1.99,2.81]mg/L vs.1.83[1.62,2.14]mg/L,Z=-5.701,P<0.05）,and the difference was statistically significant.Between CSO-EPVS non-mild group（88 case）and moderate-severe group（54 case）,serum β2M level was no significant different（1.96[1.69,2.42]mg/L vs.2.14[1.84,2.66]mg/L,Z=-1.876,P=0.061）.Multivariate binary Logistic regression analysis showed that age（OR,1.064,95%CI 1.011-1.120,P=0.017）and serum β2M level（OR,3.883,95%CI 1.566～9.627,P=0.003）were independent influence factors for the moderate-severe degree of BG-EPVS.Conclusions Serum β2M is positively correlated with the degree of BG-EPVS in patients with small-artery occlusion stroke.