High Prevalence of Cerebral Small Vessel Disease on 7T Magnetic Resonance Imaging in Familial Hypercholesterolemia
High Prevalence of Cerebral Small Vessel Disease on 7T Magnetic Resonance Imaging in Familial Hypercholesterolemia
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DOI：
10.5551/jat.48553
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发表时间：
2019-01-01
影响因子：
4.4
通讯作者：
Ishigaki, Yasushi
中科院分区：
文献类型：
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作者：
Todate, Yusuke;Uwano, Ikuko;Ishigaki, Yasushi
目的：目前尚不清楚低密度脂蛋白胆固醇（LDL-C）升高是否是脑血管疾病的危险因素。家族性高胆固醇血症（FH）是了解过量LDL-C影响的最合适模型，因为受影响的个体具有固有的高水平循环LDL-C。为了阐明高胆固醇血症对脑小血管疾病（SVD）的影响，我们研究了脑血管损伤的详细情况下，由于高密度脂蛋白胆固醇升高使用高分辨率脑磁共振成像（MRI）在FH患者。方法：28例FH和35例健康对照组进行了7 T脑MRI。结果：室周高信号（PVH）的患病率明显高于对照组（对照组，0% vs. FH，14.2%，p= 0.021），并且FH患者的深层白色物质强度往往比对照组更频繁。在FH患者中，患有各种形式脑损伤的患者，如腔隙性梗死、PVH、深部白色高信号（DWMH）、微出血和脑萎缩的SVD患病率显著较高（对照组，n=2，5.7% vs. FH，n=7，25.0%，p< 0.001，卡方检验）。两组颅内主要动脉的迂曲程度和脑纹动脉的信号强度相似。在FH患者中，随着PVH分级的进展，一些动脉粥样硬化危险因素，如体重指数、血压和甘油三酯水平，显示出不断恶化的value.Conclusion：这些结果从FH患者中获得的结果表明，持续升高的LDL-C导致脑PVH。在FH的治疗中，不仅要注意冠心病的发展，而且要注意脑SVD的存在。
Aim: It remains unclear whether elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for cerebral vascular disease. Familial hypercholesterolemia (FH) is the most appropriate model for understanding the effects of excess LDL-C because affected individuals have 'inherently high levels of circulating LDL-C. To clarify the effects of hypercholesterolemia on cerebral small vessel disease (SVD), we investigated cerebrovascular damage in detail due to elevated LDL-C using high resolution brain magnetic resonance imaging (MRI) in patients with FH.Methods: Twenty-eight patients with FH and 35 healthy controls underwent 7T brain MRI. The prevalence of SVD and arterial structural changes were determined in each group.Results: The prevalence of periventricular hyperintensity (PVH) was significantly higher (control, 0% vs. FH, 14.2%, p= 0.021) and deep white matter intensity tended to be more frequent in FH patients than in controls. The prevalence of SVD in patients with forms of cerebral damage, such as lacunar infarction, PVH, deep white matter hyperintensities (DWMH), microbleeding, and brain atrophy, was significantly higher among FH patients (control, n=2, 5.7% vs. FH, n=7, 25.0%, p< 0.001, chi-square test). The tortuosity of major intracranial arteries and the signal intensity of lenticulostriate arteries were similar in the two groups. In FH patients, as the grade of PVH progressed, several atherosclerosis risk factors, such as body mass index, blood pressure, and 'glyceride level, showed ever worsening values.Conclusion: These results obtained from FH patients revealed that persistently elevated LDL-C leads to cerebral PVH. It is necessary in the management of FH to pay attention not only to the development of coronary heart disease but also to the presence of cerebral SVD.