Low carotid wall shear stress independently accelerates the progression of cognitive impairment and white matter lesions in the elderly.
Low carotid wall shear stress independently accelerates the progression of cognitive impairment and white matter lesions in the elderly.
复制标题
低颈动脉壁剪切应力独立加速老年人认知障碍和白质病变的进展
DOI：
10.18632/oncotarget.23191
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发表时间：
2018-02-16
期刊：
影响因子：
--
通讯作者：
Liu Z
中科院分区：
文献类型：
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作者：
Zhang H;Liu H;Dong Y;Wang J;Zhao Y;Cui Y;Chai Q;Liu Z
近年来，血流动力学与认知障碍和白色白质病变（WML）的关联已成为人们关注的焦点。689例年龄≥60岁的老年受试者合格入组。平均随访5.4年后，简易精神状态检查（MMSE）评分显著下降，总白色高信号（WMH）、脑室周围（P）WMH和深部（D）WMH增加（P < 0.001）。参与者按颈动脉平均壁切应力（WSS）的三分位数分组。MMSE评分的下降和总WMH、PWMH和DWMH的增加从最低组到最高组逐渐减少。各组间比较有显著性差异（均P <0.05）。平均WSS是MMSE评分、总WMH、PWMH和调整混杂因素后DWMH变化的独立和显著因素（P <0.001）。调整混杂因素后，最低（风险比：2.753; 95% CI：1.945 - 3.895; P < 0.001）和中间（风险比：1.531; 95% CI：1.084 - 2.162; P = 0.015）组发生认知功能障碍的风险高于最高组。WSS峰值与MMSE评分、总WMH、PWMH和DWMH的变化之间存在类似的相关性。我们的研究结果表明，颈动脉WSS是老年人认知功能障碍和WML进展的独立因素。低WSS显著恶化认知障碍和WML的进展。
The association of hemodynamics with cognitive impairment and white matter lesions (WMLs) has come to the foreground in recent years. Six hundred eighty-nine elderly participants aged ≥60 years were eligible enrolled. After an average of 5.4 years follow-up, there was a significant decline in Mini-Mental State Examination (MMSE) scores and increases in total white matter hyperintensities (WMH), periventricular (P)WMH, and deep (D)WMH (P < 0.001). The participants were grouped by the tertiles of carotid mean wall shear stress (WSS). The decline in MMSE scores and the increases in total WMH, PWMH, and DWMH decreased from the lowest group to the highest group. There were significant differences between each group comparison (all P <0.05). Mean WSS was an independent and significant factor for the changes in MMSE scores, total WMH, PWMH, and DWMH after adjustment for confounders (P <0.001). The risk of developing cognitive impairment was higher in the lowest (hazard ratio: 2.753; 95% CI: 1.945 to 3.895; P < 0.001) and intermediate (hazard ratio: 1.531; 95% CI: 1.084 to 2.162; P = 0.015) groups than in the highest group after adjustment for confounders. Similar associations were yielded between peak WSS and the changes in MMSE scores, total WMH, PWMH, and DWMH. Our results indicated that carotid WSS is an independent factor for the progression of cognitive impairment and WMLs in the elderly. Low WSS significantly deteriorates the progression of cognitive impairment and WMLs.