Risk factors for silent cerebral infarcts in subcortical white matter and basal ganglia.
Risk factors for silent cerebral infarcts in subcortical white matter and basal ganglia.
复制标题
皮质下白质和基底节无症状脑梗塞的危险因素。
作者：
Toshiyuki Uehara;M. Tabuchi;E. Mori
背景和目的
本研究的目的是阐明皮质下白质（WM）中的无症状性脑梗死（SCI）的相关危险因素是否与基底节（BG）中的不同。
方法
本研究的对象为219名成人，无中风或短暂性脑缺血发作史，神经系统检查无任何异常，于1994年1月至1997年11月期间连续到我院神经内科就诊，要求对可能的脑血管疾病进行医学评估。受试者包括 141 名男性和 78 名女性，年龄从 33 岁到 83 岁不等（平均值+/-标准差，63.2+/-9.5 岁）。我们对所有受试者进行了脑部 MRI 和颈/颅 MR 血管造影。在本研究中，SCI 被定义为直径 >5 毫米的局灶性病变，且在 T2 加权图像和质子密度图像上均延长。
结果
219 名受试者中有 88 名 (40.2%) 检测到 WM 和/或 BG 中的 SCI。在该系列中未观察到 SCI >15 mm。 50 名受试者仅在 WM 中出现 SCI，32 名受试者在 WM 和 BG 中均出现 SCI，6 名受试者仅在 BG 中出现 SCI。因此，88 名 SCI 受试者中有 82 名 (93.2%) 的 WM 存在病变。大多数 BG 中存在 SCI 的受试者在 WM 中也存在 SCI。多重逻辑回归分析显示，年龄、女性和高血压是 WM 中 SCI 的显着且独立的预测因素，而年龄、缺血性心脏病史和颈动脉狭窄是 BG 中 SCI 的显着且独立的预测因素。
结论
本研究表明，WM 中 SCI 的相关危险因素和 BG 中 SCI 的相关危险因素是不同的。我们的结果表明，SCI 很容易首先出现在与衰老和高血压相关的 WM 中，并且 BG 中另外出现的 SCI 预示着颈动脉和冠状动脉中表现的全身动脉粥样硬化的进展。
BACKGROUND AND PURPOSE
The purpose of this study was to clarify whether the relevant risk factors for silent cerebral infarcts (SCIs) in subcortical white matter (WM) are different from those in the basal ganglia (BG).
METHODS
Subjects of this study were 219 adults without a history of stroke or transient ischemic attack and without any abnormality on a neurological examination who consecutively visited the neurology service in our hospital between January 1994 and November 1997 requesting medical evaluation for possible cerebrovascular diseases. Subjects included 141 men and 78 women ranging in age from 33 to 83 years (mean+/-SD, 63.2+/-9.5 years). We performed brain MRIs and cervical/cranial MR angiographies on all subjects. In this study, SCI was defined as a focal lesion >5 mm in diameter that was prolonged on both T2-weighted and proton density images.
RESULTS
SCIs in the WM and/or BG were detected in 88 (40.2%) of the 219 subjects. No SCI >15 mm was observed in this series. Fifty of the subjects had SCIs only in the WM, 32 subjects had SCIs in both the WM and BG, and 6 subjects had SCIs only in the BG. Thus, 82 (93.2%) of 88 subjects with SCIs had lesions in the WM. Most subjects with SCIs in the BG also had SCIs in the WM. Multiple logistic regression analyses revealed that age, female sex, and hypertension were significant and independent predictors of SCIs in the WM, and that age, a history of ischemic heart disease, and carotid artery stenosis were significant and independent predictors of SCIs in the BG.
CONCLUSIONS
The present study indicated that the relevant risk factors for SCIs in the WM and those for SCI in the BG were different. Our results suggest that SCIs are prone to first appear in the WM in association with aging and hypertension, and the additional appearance of SCIs in the BG predicts a progression of generalized atherosclerosis that is manifested in the carotid and coronary arteries.
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