Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden.
Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden.
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DOI：
10.1212/wnl.0000000000000837
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发表时间：
2014-09-30
期刊：
影响因子：
9.9
通讯作者：
Wardlaw JM
中科院分区：
文献类型：
--
作者：
Staals J;Makin SD;Doubal FN;Dennis MS;Wardlaw JM
在这项横断面研究中，我们通过测试与血管危险因素和中风亚型的相关性来测试“总SVD评分”的结构有效性，该评分将小血管疾病（SVD）的个体MRI特征结合在一起。我们分析了2项前瞻性卒中研究中腔隙性或非致残性皮质卒中患者的数据。对脑MRI是否存在腔隙、白色高信号、脑微出血和血管周围间隙进行独立评定。每个SVD特征的存在以顺序“SVD评分”（范围0-4）求和。我们用有序回归分析检验了血管危险因素、卒中亚型和脑萎缩的相关性。在461例患者中，多变量分析发现，年龄（比值比[OR] 1.10，95%置信区间[CI] 1.08-1.12），男性（OR 1.58，95% CI 1.10-2.29），高血压（OR 1.50，95% CI 1.02-2.20）、吸烟（OR 2.81，95% CI 1.59-3.63）和腔隙性卒中亚型（OR 2.45，95% CI 1.70-3.54）与总SVD评分显著且独立相关。该评分与脑萎缩无关。总SVD评分可以以简单和实用的方式提供SVD对大脑的全部影响的更完整的估计。它可能在预防SVD进展的干预措施的临床试验中用于患者或风险分层或早期疗效评估，并可能（在进一步测试后）在临床实践中发挥有用的作用。
In this cross-sectional study, we tested the construct validity of a “total SVD score,” which combines individual MRI features of small-vessel disease (SVD) in one measure, by testing associations with vascular risk factors and stroke subtype. We analyzed data from patients with lacunar or nondisabling cortical stroke from 2 prospective stroke studies. Brain MRI was rated for the presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces independently. The presence of each SVD feature was summed in an ordinal “SVD score” (range 0–4). We tested associations with vascular risk factors, stroke subtype, and cerebral atrophy using ordinal regression analysis. In 461 patients, multivariable analysis found that age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08–1.12), male sex (OR 1.58, 95% CI 1.10–2.29), hypertension (OR 1.50, 95% CI 1.02–2.20), smoking (OR 2.81, 95% CI 1.59–3.63), and lacunar stroke subtype (OR 2.45, 95% CI 1.70–3.54) were significantly and independently associated with the total SVD score. The score was not associated with cerebral atrophy. The total SVD score may provide a more complete estimate of the full impact of SVD on the brain, in a simple and pragmatic way. It could have potential for patient or risk stratification or early efficacy assessment in clinical trials of interventions to prevent SVD progression and may (after further testing) have a useful role in clinical practice.