Homocysteine is Associated with the Development of Cerebral Small Vessel Disease: Retrospective Analyses from Neuroimaging and Cognitive Outcomes
Homocysteine is Associated with the Development of Cerebral Small Vessel Disease: Retrospective Analyses from Neuroimaging and Cognitive Outcomes
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105393
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发表时间：
2020-12-01
影响因子：
2.5
通讯作者：
Lv, Pei Yuan
中科院分区：
文献类型：
--
作者：
Ji, Yifan;Li, Xiangyu;Lv, Pei Yuan
目的：随着人口老龄化，脑小血管病（cSVD）的负担日益加重，近年来引起广泛关注。同型半胱氨酸（Hcy）作为动脉粥样硬化的传统危险因素，也可能参与cSVD的发生发展。本研究旨在通过综合评估Hcy与cSVD不同MRI标志物以及cSVD同质人群认知结果的相关性，探讨Hcy在cSVD临床治疗中的价值。方法：231 例 MRI 确诊的 cSVD 住院患者被纳入这项回顾性研究（平均年龄 66.4 +/- 10.0 岁，男性占 47.6%）。除了脑部 MRI 和血浆总同型半胱氨酸 (tHcy) 检查外，还进行了简易精神状态检查 (MMSE) 和蒙特利尔认知评估 (MoCA)，以评估他们的整体认知功能。基于脑 MRI 演示，评估了 cSVD 神经影像特征的负担，包括白质高信号 (WMH)、推测血管起源的腔隙、脑微出血 (CMB) 和血管周围空间扩大 (EPVS)。结果：调整可能的混杂因素后，统计分析显示，血浆 tHcy 水平不仅与深部/脑室周围 WMH 负担相关（P < 0.001，趋势 P < 0.001；P < 0.001，趋势 P < 0.001）、腔隙（P < 0.001，趋势 P < 0.001）、肺叶 CMB（P = 0.002）和基底神经节中的 EPVS（P < 0.001，趋势 P = 0.002），但仍然是 cSVD 患者认知障碍的独立预测因子（B=-0.159，95% CI -0.269--0.049，P = 0.005，趋势 P < 0.001）。结论：血浆 tHcy 水平与 cSVD 的发展相关，且与剂量无关，并且可以预测 cSVD 患者的认知结果。这些发现为 cSVD 的病理生理学和未来的疾病管理提供了潜在的线索。
Objective: As the population ages, a growing burden of cerebral small vessel disease (cSVD) has sparked extensive concerns recently. Homocysteine (Hcy), as a traditional risk factor for atherosclerosis, may also participate in the development of cSVD. By comprehensively assessing Hcy's correlation with different MRI markers of cSVD and cognitive outcomes in a homogeneous population with cSVD, this study aims to explore the value of Hcy in the clinical management of cSVD. Methods: 231 inpatients with MRI-confirmed cSVD were enrolled in this retrospective study (mean age 66.4 +/- 10.0 years, male sex 47.6%). Along with brain MRI and plasma total Hcy (tHcy) examination, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were also performed to assess their global cognitive function. Burdens of cSVD neuroimaging features encompassing white matter hyperintensity (WMH), lacunes of presumed vascular origin, cerebral micro-bleeds (CMBs), and enlarged perivascular spaces (EPVS) were evaluated based on brain MRI demonstrations. Results: After adjusting for possible confounders, statistical analyses showed that plasma tHcy levels were not only correlated with burdens of deep/periventricular WMH (P < 0.001, P for trend < 0.001; P < 0.001, P for trend < 0.001), lacunes (P < 0.001, P for trend < 0.001), lobar CMBs (P = 0.002), and EPVS in the basal ganglia (P < 0.001, P for trend = 0.002) but also remained an independent predictor of cognitive impairment (B=-0.159, 95%CI -0.269--0.049, P = 0.005, P for trend < 0.001) in the patients with cSVD. Conclusions: Plasma tHcy levels are associated with the development of cSVD in a dose-independent manner and may predict the cognitive outcomes in cSVD patients. These findings provide a potential clue to cSVD's physiopathology and future disease management.