Association of Blood Pressure Variability and Systemic Immune-inflammation Index with Intracranial Arterial Negative Remodeling in Patients with Cerebral Small Vessel Disease

doi:10.12114/j.issn.1007-9572.2024.0315

Abstract

Abstract:

Background

Intracranial arterial negative remodeling refers to stenotic changes in the large intracranial arteries and is a potential indicator of accelerated atherosclerosis in the vessel wall. If left untreated, this condition can lead to serious cardiovascular and cerebrovascular diseases such as stroke and myocardial infarction. However, research on the influencing factors of intracranial arterial negative remodeling is still limited.

Objective

To explore the relationship between blood pressure variability (BPV) , the systemic immune-inflammation index (SII) , and intracranial arterial negative remodeling in patients with cerebral small vessel disease (CSVD) , and to establish a predictive model.

Methods

A total of 110 patients with CSVD admitted to the Second Affiliated Hospital of Zhengzhou University between September 2022 and March 2024 were enrolled in the study. Based on imaging examinations, the brain arterial remodeling (BAR) score was calculated, and the patients were divided into two groups: the intracranial arterial negative remodeling group (BAR score <-1 standard deviation, 17 cases) and the non-negative remodeling group (BAR score ≥-1 standard deviation, 93 cases) . Clinical data were collected, and dynamic blood pressure monitoring was conducted. Multivariate Logistic regression analysis was performed to identify factors that may contribute to intracranial arterial negative remodeling in CSVD patients. The predictive value of these factors for intracranial arterial negative remodeling was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, a nomogram predictive model was constructed and its clinical utility was assessed.

Results

There were statistically significant differences between the intracranial arterial negative remodeling group and the non-negative remodeling group in terms of history of hypertension, SII, 24-hour systolic blood pressure standard deviation (24 hSSD) , and 24-hour systolic blood pressure coefficient of variation (24 hSCV) (P<0.05) . Multivariate Logistic regression analysis revealed that a history of hypertension (OR=23.192, 95%CI=1.029-522.644, P=0.048) , SII elevated (OR=1.005, 95%CI=1.000-1.010, P=0.041) , and 24 hSSD elevated (OR=3.510, 95%CI=1.155-10.671, P=0.027) were risk factors for intracranial arterial negative remodeling in CSVD patients. The area under the ROC curve (AUC) for SII and 24 hSSD in predicting intracranial arterial negative remodeling was 0.797 (95%CI=0.670-0.924, P<0.001) and 0.933 (95%CI=0.885-0.980, P<0.001) , respectively. Based on SII and 24 hSSD, a nomogram predictive model was developed to predict the occurrence of intracranial arterial negative remodeling in CSVD patients. Internal validation showed that the ideal curve closely matched the predictive curve.

Conclusion

Elevated SII and 24 hSSD are risk factors for intracranial arterial negative remodeling in CSVD patients and have a certain predictive value for its occurrence. Reducing SII and 24 hSSD may have clinical value in preventing the onset of intracranial arterial negative remodeling.

Key words: Cerebral small vessel diseases, Intracranial arterial negative remodeling, Blood pressure variability, Systemic immune-inflammation index, Nomogram

摘要：

背景

颅内动脉负性重塑是指颅内大血管的狭窄性改变，是血管壁加速动脉粥样硬化转化的一个潜在指标，如果不及时干预可导致脑卒中、心肌梗死等严重的心脑血管疾病。而关于颅内动脉负性重塑的影响因素研究尚少开展。

目的

探索血压变异性（BPV）、系统性免疫炎症指数（SII）与脑小血管病（CSVD）患者发生颅内动脉负性重塑的关系，并建立预测模型。

方法

选取2022年9月—2024年3月郑州大学第二附属医院收治的CSVD患者110例，根据影像学检查计算其脑动脉重塑（BAR）评分，并将患者分为颅内动脉负性重塑组（BAR评分<-1倍标准差，17例）和颅内动脉非负性重塑组（BAR评分≥-1倍标准差，93例）。收集患者临床基本资料并进行动态血压监测。对可能导致CSVD患者发生颅内动脉负性重塑的因素进行多因素Logistic回归分析。以受试者工作特征（ROC）曲线评估指标CSVD患者发生颅内动脉负性重塑的预测价值，建立列线图预测模型并评估临床价值。

结果

颅内动脉负性重塑组与颅内动脉非负性重塑组患者高血压史、SII、24 h收缩压标准差（24 hSSD）、24 h收缩压变异系数（24 hSCV）比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，合并高血压史（OR=23.192，95%CI=1.029~522.644，P=0.048）、SII升高（OR=1.005，95%CI=1.000~1.010，P=0.041）、24 hSSD升高（OR=3.510，95%CI=1.155~10.671，P=0.027）是CSVD患者发生颅内动脉负性重塑的危险因素。SII、24 hSSD预测CSVD患者发生颅内动脉负性重塑的ROC曲线下面积（AUC）分别为0.797（95%CI=0.670~0.924，P<0.001）、0.933（95%CI=0.885~0.980，P<0.001）。基于SII、24 hSSD建立CSVD患者发生颅内动脉负性重塑的列线图预测模型。对其进行内部验证，理想曲线与预测曲线相近。

结论

SII、24 hSSD升高是CSVD患者发生颅内动脉负性重塑的危险因素，并对颅内动脉负性重塑的发生有一定的预测作用，通过降低SII、24 hSSD对预防颅内动脉负性重塑发生有一定的临床价值。

关键词: 脑小血管病, 颅内动脉负性重塑, 血压变异性, 系统性免疫炎症指数, 列线图

CLC Number:

R 743

LI Bing,XI Zhi,WANG Yang, et al. Association of Blood Pressure Variability and Systemic Immune-inflammation Index with Intracranial Arterial Negative Remodeling in Patients with Cerebral Small Vessel Disease[J]. Chinese General Practice, 2025, 28(14): 1751-1757. DOI: 10.12114/j.issn.1007-9572.2024.0315.
李冰,奚志,王洋等. 血压变异性和系统性免疫炎症指数与脑小血管病患者发生颅内动脉负性重塑的相关性研究[J]. 中国全科医学, 2025, 28(14): 1751-1757. DOI: 10.12114/j.issn.1007-9572.2024.0315.

Figures/Tables 7

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组别	例数	年龄（±s，岁）	性别（男/女）	高血压史[例（%）]	糖尿病史[例（%）]	高脂血症史[例（%）]	吸烟史[例（%）]	饮酒史[例（%）]	总胆固醇[M（P₂₅，P₇₅），mmol/L]	三酰甘油[M（P₂₅，P₇₅），mmol/L]	高密度脂蛋白[M（P₂₅，P₇₅），mmol/L]
颅内动脉非负性重塑组	93	61±14	46/47	49（52.6）	22（23.6）	20（21.5）	20（21.5）	19（20.4）	4.43（3.59，5.08）	1.37（0.96，1.75）	1.29（1.13，1.44）
颅内动脉负性重塑组	17	60±16	8/9	15（88.2）	5（29.4）	7（41.2）	6（28.5）	6（35.3）	4.61（3.90，5.74）	1.42（1.16，2.26）	1.30（1.04，1.54）
检验统计量值		-0.201	<0.001^a	7.464^a	0.040^a	2.035^a	0.846^a	1.061^a	-1.162^b	-1.315^b	-0.314^b
P值		0.841	0.985	0.006	0.841	0.154	0.358	0.303	0.245	0.189	0.753
组别	低密度脂蛋白（±s，mmol/L）	Hcy [M（P₂₅，P₇₅），mmol/L]	SII [M（P₂₅，P₇₅），×10⁹/L]	24 hSBP（±s，mmHg）	24 hDBP（±s，mmHg）	24 hSSD（±s）	24 hSCV （±s，%）	24 hDSD [M（P₂₅，P₇₅）]	24 hDCV （±s，%）
颅内动脉非负性重塑组	2.73±0.83	11.20（9.30，11.70）	375.46（291.46，465.64）	138±14	80±11	12.09±1.44	8.86±1.40	10.00（8.10，12.00）	0.13±0.03
颅内动脉负性重塑组	3.10±0.96	12.36（9.70，15.63）	633.63（439.08，786.30）	138±15	82±13	14.94±1.70	10.91±1.79	8.00（7.91，11.00）	0.12±0.03
检验统计量值	1.650	-0.645^b	-3.887^b	0.212	0.634	7.289	5.289	-1.611^b	-1.588
P值	0.102	0.519	<0.001	0.832	0.527	<0.001	<0.001	0.107	0.112

组别	例数	年龄（±s，岁）	性别（男/女）	高血压史[例（%）]	糖尿病史[例（%）]	高脂血症史[例（%）]	吸烟史[例（%）]	饮酒史[例（%）]	总胆固醇[M（P₂₅，P₇₅），mmol/L]	三酰甘油[M（P₂₅，P₇₅），mmol/L]	高密度脂蛋白[M（P₂₅，P₇₅），mmol/L]
颅内动脉非负性重塑组	93	61±14	46/47	49（52.6）	22（23.6）	20（21.5）	20（21.5）	19（20.4）	4.43（3.59，5.08）	1.37（0.96，1.75）	1.29（1.13，1.44）
颅内动脉负性重塑组	17	60±16	8/9	15（88.2）	5（29.4）	7（41.2）	6（28.5）	6（35.3）	4.61（3.90，5.74）	1.42（1.16，2.26）	1.30（1.04，1.54）
检验统计量值		-0.201	<0.001^a	7.464^a	0.040^a	2.035^a	0.846^a	1.061^a	-1.162^b	-1.315^b	-0.314^b
P值		0.841	0.985	0.006	0.841	0.154	0.358	0.303	0.245	0.189	0.753
组别	低密度脂蛋白（±s，mmol/L）	Hcy [M（P₂₅，P₇₅），mmol/L]	SII [M（P₂₅，P₇₅），×10⁹/L]	24 hSBP（±s，mmHg）	24 hDBP（±s，mmHg）	24 hSSD（±s）	24 hSCV （±s，%）	24 hDSD [M（P₂₅，P₇₅）]	24 hDCV （±s，%）
颅内动脉非负性重塑组	2.73±0.83	11.20（9.30，11.70）	375.46（291.46，465.64）	138±14	80±11	12.09±1.44	8.86±1.40	10.00（8.10，12.00）	0.13±0.03
颅内动脉负性重塑组	3.10±0.96	12.36（9.70，15.63）	633.63（439.08，786.30）	138±15	82±13	14.94±1.70	10.91±1.79	8.00（7.91，11.00）	0.12±0.03
检验统计量值	1.650	-0.645^b	-3.887^b	0.212	0.634	7.289	5.289	-1.611^b	-1.588
P值	0.102	0.519	<0.001	0.832	0.527	<0.001	<0.001	0.107	0.112

变量	β	SE	Wald χ²值	P值	OR（95%CI）
高血压史	3.144	1.589	3.913	0.048	23.192（1.029~522.644）
SII	0.005	0.002	4.190	0.041	1.005（1.000~1.010）
24 hSSD	1.256	0.567	4.899	0.027	3.510（1.155~10.671）
24 hSCV	0.247	0.480	0.266	0.606	1.281（0.500~3.278）

变量	β	SE	Wald χ²值	P值	OR（95%CI）
高血压史	3.144	1.589	3.913	0.048	23.192（1.029~522.644）
SII	0.005	0.002	4.190	0.041	1.005（1.000~1.010）
24 hSSD	1.256	0.567	4.899	0.027	3.510（1.155~10.671）
24 hSCV	0.247	0.480	0.266	0.606	1.281（0.500~3.278）