Vermeer Sarah E, Hollander Monika, van Dijk Ewoud J, Hofman Albert, Koudstaal Peter J, Breteler Monique M B
Dept of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands.
Stroke. 2003 May;34(5):1126-9. doi: 10.1161/01.STR.0000068408.82115.D2. Epub 2003 Apr 10.
Silent brain infarcts and white matter lesions are associated with an increased risk of subsequent stroke in minor stroke patients. In healthy elderly people, silent brain infarcts and white matter lesions are common, but little is known about their relevance. We examined the risk of stroke associated with these lesions in the general population.
The Rotterdam Scan Study is a population-based prospective cohort study among 1077 elderly people. The presence of silent brain infarcts and white matter lesions was scored on cerebral MRI scans obtained from 1995 to 1996. Participants were followed for stroke for on average 4.2 years. We estimated the risk of stroke in relation to presence of brain lesions with Cox proportional hazards regression analysis.
Fifty-seven participants (6%) experienced a stroke during follow-up. Participants with silent brain infarcts had a 5 times higher stroke incidence than those without. The presence of silent brain infarcts increased the risk of stroke >3-fold, independently of other stroke risk factors (adjusted hazard ratio 3.9, 95% CI 2.3 to 6.8). People in the upper tertile of the white matter lesion distribution had an increased stroke risk compared with those in the lowest tertile (adjusted hazard ratio for periventricular lesions 4.7, 95% CI 2.0 to 11.2 and for subcortical lesions 3.6, 95% CI 1.4 to 9.2). Silent brain infarcts and severe white matter lesions increased the stroke risk independently of each other.
Elderly people with silent brain infarcts and white matter lesions are at a strongly increased risk of stroke, which could not be explained by the major stroke risk factors.
无症状脑梗死和白质病变与轻度卒中患者随后发生卒中的风险增加相关。在健康老年人中，无症状脑梗死和白质病变很常见，但对其相关性了解甚少。我们研究了这些病变在普通人群中与卒中相关的风险。
鹿特丹扫描研究是一项针对1077名老年人的基于人群的前瞻性队列研究。1995年至1996年获得的脑部MRI扫描对无症状脑梗死和白质病变的存在情况进行评分。参与者平均随访卒中4.2年。我们通过Cox比例风险回归分析估计与脑病变存在相关的卒中风险。
57名参与者（6%）在随访期间发生了卒中。有无症状脑梗死的参与者卒中发生率比没有的高5倍。无症状脑梗死的存在使卒中风险增加3倍以上，独立于其他卒中风险因素（调整后的风险比为3.9，95%可信区间为2.3至6.8）。与处于最低三分位数的人相比，处于白质病变分布最高三分位数的人卒中风险增加（脑室周围病变的调整后风险比为4.7，95%可信区间为2.0至11.2；皮质下病变的调整后风险比为3.6，95%可信区间为1.4至9.2）。无症状脑梗死和严重白质病变相互独立地增加了卒中风险。
有无症状脑梗死和白质病变的老年人卒中风险大幅增加，这无法用主要的卒中风险因素来解释。
