Metabolic determinants of white matter hyperintensity burden in patients with ischemic stroke.
Metabolic determinants of white matter hyperintensity burden in patients with ischemic stroke.
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DOI：
10.1016/j.atherosclerosis.2015.02.052
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发表时间：
2015-05
期刊：
影响因子：
5.3
通讯作者：
Rost, Natalia S.
中科院分区：
文献类型：
--
作者：
Cloonan, Lisa;Fitzpatrick, Kaitlin M.;Kanakis, Allison S.;Furie, Karen L.;Rosand, Jonathan;Rost, Natalia S.
关键词：
增加白质高强度(WMH)负荷与卒中风险和卒中后不良结局有关。虽然WMH的生物学仍不明确，但有几条证据表明血管内皮细胞功能障碍。在这项研究中，我们试图评估血管内皮功能障碍的代谢标记物与急性缺血性中风(AIS)患者WMH严重程度之间的关系。在这项回顾性研究中，连续的研究对象，18岁的≥，在我们的ED住院，有人工智能，脑核磁共振，和血液同型半胱氨酸(Hcy)和血红蛋白A1c(HgbA1c)的测量符合该分析的条件。WMH体积(WMHV)使用经过验证的半自动算法进行量化，并进行对数变换以进行线性回归分析。纳入AIS患者809例(平均年龄65.57±14.7岁，WMHV中位数6.25 cm~3(IQR 2.8~13.1))。在单变量分析中，年龄、女性、种族、民族、收缩压、高血压病史、房颤、冠状动脉疾病、既往中风病史、当前饮酒和吸烟(均为p<；0.0001)以及同型半胱氨酸水平(p<；0.0001)和糖化血红蛋白水平(p=0.0005)与WMHV相关。然而，在多变量模型中，只有同型半胱氨酸水平和HgbA1c水平(P=0.008)与年龄(P=0.0001)、种族(P=0.39，P=0.01)、种族(？=−0.11，P=0.03)和当前饮酒量(？=0.26，P=0.002)一起独立预测WMHV。Hcy和HgbA1c水平升高之前曾被认为与氧化应激相关的内皮功能障碍有关。AIS中Hcy和HgbA1c与WMH负荷之间的关联表明，WMHV升高的患者的内皮功能障碍程度可能更严重，这可能部分解释了WMHV与卒中后不良预后的关系。
Increasing white matter hyperintensity (WMH) burden is linked to risk of stroke and poor post-stroke outcomes. While the biology of WMH remains ill-defined, several lines of evidence implicate endothelial dysfunction. In this study, we sought to assess the association between metabolic markers of endothelial dysfunction and WMH severity in patients with acute ischemic stroke (AIS). In this retrospective study, consecutive subjects, ≥18 years of age, admitted to our ED with AIS, brain MRI, and blood homocysteine (Hcy) and hemoglobin A1c (HgbA1c) measurements were eligible for this analysis. WMH volume (WMHV) was quantified using a validated semi-automated algorithm and log-transformed for linear regression analyses. : There were 809 AIS subjects included (mean age 65.57±14.7, median WMHV 6.25cm3 (IQR 2.8-13.1)). In univariate analysis, age, female gender, race, ethnicity, systolic blood pressure, history of hypertension, atrial fibrillation, coronary artery disease, prior stroke, and current alcohol and tobacco use (all p<0.05), as well as Hcy (p<0.0001) and HgbA1c levels (p=0.0005) were associated with WMHV. However, only Hcy (ß=0.11, p=0.003) and HgbA1c levels (ß=0.1, p=0.008) independently predicted WMHV in the multivariate model, along with age (ß=0.03, p<0.0001), race (ß=0.39, p=0.01), ethnicity (ß= −0.11, p=0.03), and current alcohol use (ß=0.26, p=0.002). Elevated levels of Hcy and HgbA1c have been previously linked to endothelial dysfunction related to oxidative stress. The association between Hcy and HgbA1c and WMH burden in AIS suggests that the degree of endothelial dysfunction may be greater in patients with increased WMHV, and may in part explain the relationship between WMHV and poor post-stroke outcomes.
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DOI：
10.1136/bmj.c3666
发表时间：
2010-07-26
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Debette S;Markus HS
通讯作者：
Markus HS
影响因子：
5.6
作者：
Chen S;Li N;Deb-Chatterji M;Dong Q;Kielstein JT;Weissenborn K;Worthmann H
通讯作者：
Worthmann H
DOI：
10.1038/nrneph.2014.102
发表时间：
2014-08
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Chaiworapongsa T;Chaemsaithong P;Yeo L;Romero R
通讯作者：
Romero R
影响因子：
8.3
作者：
Mukamal, KJ;Longstreth, WT;Siscovick, DS
通讯作者：
Siscovick, DS
影响因子：
8.3
作者：
Jeerakathil, T;Wolf, PA;DeCarli, C
通讯作者：
DeCarli, C