LONGITUDINAL STUDY ON STROKE RECURRENCE AND DEVELOPMENT OF DEMENTIA

中风复发和痴呆发展的纵向研究

• 批准号: 10670586
• 负责人: KOBAYASHI Shotai
• 金额: $ 1.22万
• 依托单位: SHIMANE MEDICAL UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1998
• 资助国家: 日本
• 起止时间: 1998 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-10670586/
• 关键词: SILENT BRAIN INFARCTION; MRI; STROKE PATIENT; STROKE RECURRENCE; BLOOD PRESSURE; Dementia; 脳卒中家族歴; 高血圧; Lp(a)フェノタイプ; 脳卒中再発; 脳梗塞; 脳ドック; Lp(a)phenotype; Wisconsin card sorting test; 無症候性脳梗塞; 脳血流; 脳ドッグ; CP(a)Phenotype; Stroop検査; 無症侯性脳梗塞

1) To investigate risk factors for cognitive decline in the subjects with silent cerebrovascular diseases, we performed MRI examination and cognitive function test every 3 years during 6years. The subjects were 31 elderly people (mean age were 72 years old) without past history of cerebral diseases including stroke. They were all independent in ADL.They received MRI 3 times at starting of examination, 3 years after and 6 years after. We compared MRI findings among 3 sets, and evaluated whether white matter lesion or silent infarct did increase or not. Sixteen subjects of these showed silent worsening on MRI, and they showed also decline in Okabe memory scale. Blood pressure elevated in this group comparing with non-worsening MRI group. Cerebral blood flow did not change during 6years. Latent decline of cognitive functions in normal elderly related to subclinical worsening of silent infarction or white matter lesions on MRI.And the risk factor for this decline is elevation of blood pres … More sure.2) We studied the relationship between stroke recurrence and controlling of blood pressure in 135 patients with brain infarction. Stroke recurrence mostly occurred as 43.3% within 12 months from initial onset, and as 70% within 24 months. A tendency of J curve phenomenon in blood pressure groups was observed in the patients with lacunar infarction. Nadir of diastolic pressure was 80-85 mmHg, but significant difference was observed only with higher blood pressure group. We conclude incomplete control of hypertension is a risk factor for stroke recurrence.3) To investigate genetic risk factors for stroke, we studied phenotype of Lp (a) and polymorphism of genotype in MTHFR which related to metabolism of homocystein in the 74 patients with symptomatic brain infarction and 214 controls. Multivariate logistic analysis revealed Lp (a) phenotype (OR 3.98) and MTHFR (OR 2.75) were significant risk factors for stroke. We also studied these polymorphism in the 147 subjects who received brain check-up in our SIHS.This results showed that Lp (a) was significant risk factor for silent brain infarction (OR 1.53).4) ConclusionThese results indicate that hypertension is the greatest risk factor for stroke recurrence and decline of cognitive functions related to increase of silent cerebrovascular diseases. Phenotype of Lp (a) is also a risk factor for silent brain infarction. Less

1）为了调查无症状脑血管病受试者认知能力下降的危险因素，我们在6年内每3年进行一次MRI检查和认知功能测试。研究对象为31名老年人（平均年龄72岁），既往无中风等脑部疾病史。他们在ADL方面都是独立的。他们在检查开始时、3年后和6年后接受了3次MRI。我们比较了 3 组的 MRI 结果，并评估白质病变或无症状梗塞是否增加。其中 16 名受试者在 MRI 上表现出无声恶化，并且冈部记忆量表也出现下降。与未恶化的 MRI 组相比，该组的血压升高。 6年内脑血流量没有变化。正常老年人认知功能的潜在下降与 MRI 上无症状梗塞或白质病变的亚临床恶化有关。这种下降的危险因素是血压升高……更确定。2）我们研究了 135 名脑梗塞患者的中风复发与血压控制之间的关系。中风复发大多发生在发病后 12 个月内，占 43.3%，24 个月内复发率为 70%。腔隙性脑梗死患者血压组中观察到J曲线现象的趋势。舒张压最低值为80-85 mmHg，但仅在血压较高的组中观察到显着差异。我们得出结论，高血压控制不完全是中风复发的危险因素。3）为了调查中风的遗传危险因素，我们研究了74名有症状脑梗死患者和214名对照者的Lp（a）表型和与同型半胱氨酸代谢相关的MTHFR基因型多态性。多变量逻辑分析显示，Lp (a) 表型 (OR 3.98) 和 MTHFR (OR 2.75) 是卒中的显着危险因素。我们还在SIHS中接受脑部检查的147名受试者中研究了这些多态性。结果表明，Lp（a）是无症状脑梗死的显着危险因素（OR 1.53）。4）结论这些结果表明，高血压是卒中复发和与无症状脑血管疾病增加相关的认知功能下降的最大危险因素。 Lp(a)的表型也是无症状脑梗塞的危险因素。较少的

项目成果

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K.Yamashita: "Cerebral Blood Flow and Cessation of Clgarette Smoking in Healthy Volunteers"Internal Medicine. 39(11). 891-893 (2000)

K.Yamashita：“健康志愿者的脑血流量和戒烟”内科。

K.Imaoka,S.Kobayashi: "Leukoencephalopathy with cerebral amyloid angiopaty"Journal of Neurologv. 10・1. 95-107 (1999)

K. Imaoka，S. Kobayashi：“白质脑病伴脑淀粉样血管病”《神经病学杂志》10・1（1999）。

小林祥泰: "凝固系異常と脳血管障害"日本内科学会雑誌. 88・5. 80-86 (1999)

小林义康：“凝血系统异常和脑血管疾病”日本内科医学会杂志88・5（1999）。

小林祥泰: "無症候性脳血管障害と血管病変"南山堂. 5 (1999)

Yoshiyasu Kobayashi：“症状性脑血管疾病和血管病变”Nanzando 5 (1999)。