摘要目的:探讨脑小血管病（cerebral small vessel disease, CSVD）患者不同部位脑血流量（cerebral blood flow, CBF）与步态障碍（gait disorder, GD）的相关性。方法:前瞻性纳入2023年11月至2024年10月期间在徐州医科大学第二附属医院神经内科就诊的CSVD患者，根据步速分为GD组（<0.8 m/s）和非GD组（≥0.8 m/s）。采用三维准连续动脉自旋标记（3D pseudo-continuous arterial spin labeling, 3D-pCASL）灌注成像测定CBF，应用可穿戴步态分析仪量化评估步态参数。采用多变量 logistic回归分析确定CSVD患者发生GD的独立相关因素。应用偏相关性分析确定步态参数与不同脑区CBF的相关性。 结果:共纳入52例CSVD患者，男性26例，女性26例，年龄（67.00±6.84）岁。轻度CSVD总体负担38例（73.1%），中重度CSVD总体负担14例（26.9%）；GD组17例（32.7%），非GD组35例（67.3%）。与非GD组比较，GD组体重指数显著更高，左侧枕叶和双侧小脑CBF显著下降，步速、步长、跨步长、步频、摆动相、手臂角速度峰值、手臂摆动幅度、小腿前/后摆角度最大值、小腿角速度峰值、脚摆动速度、躯干矢状面角速度峰值显著下降，而步数、支撑相、步长不对称性、跨步长和步长变异度显著增加（ P均<0.05）。多变量 logistic回归分析显示，左侧小脑CBF是CSVD患者发生GD的独立保护因素（优势比0.902，95%置信区间0.827~0.982； P=0.019）。左侧小脑CBF每下降1 ml/(100 g·min)，CSVD患者发生GD步态障碍的风险增高约9.8%。偏相关性分析显示，左侧枕叶CBF与步速（ r=0.305， P=0.032）、小腿后摆角度最大值（ r=0.314， P=0.026）、小腿角速度峰值（ r=0.356， P=0.011）显著正相关；左侧小脑CBF与步速显著正相关（ r=0.295， P=0.037），与步长变异度显著负相关（ r=-0.335， P=0.017）；右侧小脑CBF与步速显著正相关（ r=0.309， P=0.029），与步长变异度显著负相关（ r=-0.344， P=0.014）。 结论:CSVD患者GD与左侧枕叶及双侧小脑CBF下降相关，左侧小脑CBF下降会显著增高CSVD患者发生GD的风险。

abstractsObjective:To investigate the correlation between cerebral blood flow (CBF) in different brain regions and gait disorder (GD) in patients with cerebral small vessel disease (CSVD).Methods:Patients with CSVD visited the Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from November 2023 to October 2024 were included prospectively. They were divided into GD group (<0.8 m/s) and non-GD group (≥0.8 m/s) based on their step speed. CBF was measured using 3D pseudo-continuous arterial spin labeling (3D-pCASL) perfusion imaging. Gait parameters were quantitatively evaluated using a wearable gait analyzer. Multivariate logistic regression analysis was used to determine independent factors associated with GD in patients with CSVD. Partial correlation analysis was used to determine the correlation between gait parameters and CBF in different brain regions. Results:A total of 52 patients with CSVD were enrolled, including 26 males and 26 females, aged 67.00±6.84 years. Thirty-eight cases (73.1%) had mild overall burden of CSVD, and 14 cases (26.9%) had a moderate to severe overall burden of CSVD. There were 17 patients (32.7%) in the GD group and 35 (67.3%) in the non-GD group. Compared with the non-GD group, the body mass index was significantly higher, the CBF of the left occipital lobe and bilateral cerebellum decreased significantly, the step speed, step length, stride length, step frequency, swing phase, peak arm angular velocity, arm swing amplitude, maximum calf anterior/posterior swing angle, peak calf angular velocity, foot swing speed, and peak sagittal plane angular velocity in the torso decreased significantly, while the number of steps, stance phase, step length asymmetry, stride length, and step length variability increased significantly in the GD group (all P<0.05). Multivariate logistic regression analysis showed that left cerebellar CBF was an independent protective factor for GD in patients with CSVD (odds ratio 0.902, 95% confidence interval 0.827-0.982; P=0.019). For every 1 ml/(100 g.min) decreased in left cerebellar CBF, the patients with CSVD had an increased risk of developing GD by approximately 9.8%. Partial correlation analysis showed that left occipital lobe CBF was significantly positively correlated with step speed ( r=0.305, P=0.032), maximum calf back swing angle ( r=0.314, P=0.026), and peak calf angular velocity ( r=0.356, P=0.011). The left cerebellar CBF was significantly positively correlated with step speed ( r=0.295, P=0.037) and significantly negatively correlated with step length variability ( r=-0.335, P=0.017); the right cerebellar CBF was significantly positively correlated with step speed ( r=0.309, P=0.029) and significantly negatively correlated with step length variability ( r=-0.344, P=0.014). Conclusion:GD in patients with CSVD is associated with decreased CBF in the left occipital lobe and bilateral cerebellum, and decreased CBF in the left cerebellum significantly increased the risk of GD in patients with CSVD.