Risk of vascular events in different manifestations of cerebral small vessel disease: A 2-year follow-up study with a control group.
Risk of vascular events in different manifestations of cerebral small vessel disease: A 2-year follow-up study with a control group.
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DOI：
10.1016/j.heliyon.2017.e00455
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发表时间：
2017-11
期刊：
影响因子：
4
通讯作者：
Stępień A
中科院分区：
文献类型：
--
作者：
Staszewski J;Piusińska-Macoch R;Brodacki B;Skrobowska E;Macek K;Stępień A
脑小血管病（CSVD）的自然病程尚未得到深入研究。单中心研究的目的是确定不同CSVD表现的血管事件或死亡风险。150例具有CSVD明显MRI特征和近期腔隙性卒中的连续、功能独立患者（n = 52，LS），深度出血性卒中（n = 20，HS），血管性帕金森综合征（n = 28，VaP），血管性痴呆（n = 50，VaD）和55名无脑血管事件的高动脉粥样硬化血栓形成风险的对照组（CG）前瞻性招募并随访24个月。CSVD和CG的平均年龄和性别分布相似，但CSVD患者患CAD的可能性较低（19% vs 40%，p = 0.02），糖尿病的患病率往往较高（54% vs 37%，p = 0.11）。在基线MRI时有中度至重度白色病变的任何患者中，血管事件或死亡的风险增加（HR 2.0; 95% CI 0.85-7.2），CSVD（4.56; 95% CI 1.3-14.9）与CG相比，无论其临床表现如何：LS或HS（HR 4.70; 95% CI 1.3-16.2）和VaD或VaP（HR 4.59; 95% CI 1.3-15.7）。调整混杂因素并没有实质性改变结果。在24个月的观察期内，无论临床表现（急性或慢性）如何，有症状的CSVD患者发生血管事件或死亡的风险是无脑血管事件的高动脉粥样硬化血栓形成风险对照组的4倍以上。
Natural course of cerebral small vessel disease (CSVD) has not yet been thoroughly studied. The aim of the single center study was to establish risk of vascular events or death in different manifestations of CSVD. 150 consecutive, functionally independent patients with marked MRI features of CSVD and with recent lacunar stroke (n = 52, LS), deep hemorrhagic stroke (n = 20, HS), vascular parkinsonism (n = 28, VaP), vascular dementia (n = 50, VaD) and 55 controls (CG) with high atherothrombotic risk free of cerebrovascular events were prospectively recruited and followed for 24 months. Mean age and sex distribution were similar in CSVD and CG but patients with CSVD were less likely to have CAD (19% vs 40%, p = 0.02) and tended to have higher prevalence of diabetes (54% vs 37%, p = 0.11). The risk of vascular events or death was increased in any patients with moderate to severe white matter lesions at baseline MRI (HR 2.0; 95% CI 0.85–7.2), in CSVD (4.56; 95% CI 1.3–14.9) vs CG, regardless of its clinical manifestation: LS or HS (HR 4.70; 95% CI 1.3–16.2) and VaD or VaP (HR 4.59; 95% CI 1.3–15.7). Adjustment for confounders did not change the results substantially. Patients with symptomatic CSVD regardless of the clinical (acute or chronic) manifestation had more than fourfold the risk of vascular events or death in 24 months of observation compared with controls with high atherothrombotic risk free of cerebrovascular events.