Cerebral white matter lesions, retinopathy, and incident clinical stroke
Cerebral white matter lesions, retinopathy, and incident clinical stroke
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DOI：
10.1001/jama.288.1.67
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发表时间：
2002-07-03
影响因子：
120.7
通讯作者：
Mosley, TH
中科院分区：
文献类型：
--
作者：
Wong, TY;Klein, R;Mosley, TH
背景在脑成像扫描中发现的白色病变（WML）被假设为具有微血管病因，并先于临床卒中的发展。然而，很少有临床数据可以支持这些假说。目的研究健康中年男性和女性中WML、视网膜微血管异常和临床卒中事件的关系。设计和设置社区动脉粥样硬化风险研究（ARIC），一项前瞻性研究，1987- 1989年在美国4个社区进行了一项基于人群的队列研究。参与者共有1684名年龄在51至72岁之间的人接受了脑磁共振成像（MRI）检查。第三次检查时进行视网膜摄影（1993-1995）.主要结果测量WML的几率，通过MRI的标准化方法定义，通过存在或不存在特定的视网膜微血管异常（如微动脉瘤、视网膜出血）;在中位随访47年后确定的临床卒中事件，结果有视网膜病变者比无视网膜病变者更易发生WML（22.9% vs 9.9%;比值比，2.5; 95%置信区间[CI]，1.5-4.0，经年龄、性别、种族和血管风险因素校正）。临床卒中的5年累积发生率在有WML的患者中高于无WML的患者（6.8% vs 1.4%;校正的相对风险[RR]，3.4; 95% CI，1.5-7.7），在有视网膜病变的患者中高于无视网膜病变的患者（8.0% vs 1.4%;校正的RR，4.9; 95% CI，2.0-11.9）。同时患有WMLS和视网膜病变的患者的5年累积卒中发病率显著高于无WMLS或视网膜病变的患者（20.0%对1.4%;调整后RR为18.1; 95%CI，5.9-55.4）。中间-在MRI上检测到脑WML的老年人更可能有视网膜微血管异常，比没有WML的人中风。当WML患者同时存在视网膜病变时，中风的风险更高。
Context White matter lesions (WMLs) detected on cerebral imaging scans have been hypothesized to have a microvascular etiology and to precede the development of clinical stroke. However, few clinical data are available to support these hypotheses.Objective To examine the relationship of WMLs, retinal microvascular abnormalities, and incident clinical stroke in healthy, middle-aged men and women.Design and Setting The Atherosclerosis Risk in Communities Study (ARIC), a prospective, population-based cohort study conducted in 4 US communities and initiated in 1987-1989.Participants A total of 1684 persons aged 51 to 72 years who had cerebral magnetic resonance imaging (MRI) and retinal photography at the third examination (1993-1995).Main Outcome Measures Odds of WMLs, defined by standardized methods from MRI, by presence or absence of specific retinal microvascular abnormality (eg, microaneurysm, retinal hemorrhage) on retinal photograph; incident clinical stroke, ascertained after a median follow-up of 47 years, according to presence or absence of WMLs and retinopathy.Results Persons with retinopathy were more likely to have WMLs than those without retinopathy (22.9% vs 9.9%; odds ratio, 2.5; 95% confidence interval [CI], 1.5-4.0, adjusted for age, sex, race, and vascular risk factors). The 5-year cumulative incidence of clinical stroke was higher in persons with vs without WMLs (6,8% vs 1.4%; adjusted relative risk [RR], 3.4; 95% CI, 1.5-7.7) and in persons with vs without retinopathy (8.0% vs 1.4%; adjusted RR, 4.9; 95% CI, 2.0-11.9). Persons with both WMLS and retinopathy had a significantly higher 5-year cumulative incidence of stroke than those without either WMLs or retinopathy (20.0% vs 1.4%; adjusted RR, 18.1; 95% CI, 5.9-55.4).Conclusions In this cohort, middle-aged persons with cerebral WMLs detected on MRI were more likely to have retinal microvascular abnormalities and to have an increased risk of clinical stroke than people without WMLs. The risk of stroke was higher when retinopathy was simultaneously present in persons with WMLs.