Accelerated development of cerebral small vessel disease in young stroke patients
Accelerated development of cerebral small vessel disease in young stroke patients
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DOI：
10.1212/wnl.0000000000003123
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发表时间：
2016-09-20
期刊：
影响因子：
9.9
通讯作者：
de Leeuw, Frank-Erik
中科院分区：
文献类型：
--
作者：
Arntz, Renate M.;van den Broek, Steffen M. A.;de Leeuw, Frank-Erik
目的：研究年轻中风后小血管疾病的长期患病率，并将其与健康对照进行比较。方法：这项前瞻性队列研究包括 337 名患有缺血性中风或 TIA 的患者，年龄 18-50 岁，无 TIA 或中风病史。此外，还包括 90 名年龄和性别匹配的对照。随访时，使用 MRI 评估腔隙、微出血和白质高信号 (WMH) 体积。为了研究危险因素与小血管疾病之间的关系，使用了逻辑回归和线性回归。结果：平均随访 9.9 (SD 8.1) 年后，纳入了 337 名患者（227 名患有缺血性中风，110 名患有 TIA）。患者平均年龄为 49.8 岁（SD 10.3），其中 45.4% 为男性；对照组的平均年龄为 49.4 岁 (SD 11.9)，其中 45.6% 为男性。与对照组相比，患者更常见至少 1 个腔隙（24.0% vs 4.5%，p < 0.0001）。 In addition, they had a higher WMH volume (median 1.5 mL [interquartile range (IQR) 0.5-3.7] vs 0.4 mL [IQR 0.0-1.0], p < 0.001).与对照组相比，患者的 WMH 量平均早 10-20 年。在患者组中，基线时中风年龄（= 0.03，95%置信区间[CI] 0.02-0.04）、高血压（= 0.22，95% CI 0.04-0.39）和吸烟（= 0.18，95% CI 0.01-0.34）与WMH体积相关。结论：年轻中风患者的小血管疾病负担高于中风患者。 controls adjusted for confounders.这些患者的大脑衰老速度似乎加快了 10-20 年，这可能表明他们更容易受到血管危险因素的影响。
Objective:To study the long-term prevalence of small vessel disease after young stroke and to compare this to healthy controls.Methods:This prospective cohort study comprises 337 patients with an ischemic stroke or TIA, aged 18-50 years, without a history of TIA or stroke. In addition, 90 age- and sex-matched controls were included. At follow-up, lacunes, microbleeds, and white matter hyperintensity (WMH) volume were assessed using MRI. To investigate the relation between risk factors and small vessel disease, logistic and linear regression were used.Results:After mean follow-up of 9.9 (SD 8.1) years, 337 patients were included (227 with an ischemic stroke and 110 with a TIA). Mean age of patients was 49.8 years (SD 10.3) and 45.4% were men; for controls, mean age was 49.4 years (SD 11.9) and 45.6% were men. Compared with controls, patients more often had at least 1 lacune (24.0% vs 4.5%, p < 0.0001). In addition, they had a higher WMH volume (median 1.5 mL [interquartile range (IQR) 0.5-3.7] vs 0.4 mL [IQR 0.0-1.0], p < 0.001). Compared with controls, patients had the same volume WMHs on average 10-20 years earlier. In the patient group, age at stroke ( = 0.03, 95% confidence interval [CI] 0.02-0.04) hypertension ( = 0.22, 95% CI 0.04-0.39), and smoking ( = 0.18, 95% CI 0.01-0.34) at baseline were associated with WMH volume.Conclusions:Patients with a young stroke have a higher burden of small vessel disease than controls adjusted for confounders. Cerebral aging seems accelerated by 10-20 years in these patients, which may suggest an increased vulnerability to vascular risk factors.