van Dijk E J, Prins N D, Vermeer S E, Vrooman H A, Hofman A, Koudstaal P J, Breteler M M B
Department of Epidemiology and Biostatistics, Erasmus Medical Center, PO Box 1738, 3000DR Rotterdam, The Netherlands.
Circulation. 2005 Aug 9;112(6):900-5. doi: 10.1161/CIRCULATIONAHA.104.506337. Epub 2005 Aug 1.
Inflammatory processes are involved in the development and consequences of atherosclerosis. Whether these processes are also involved in cerebral small-vessel disease is unknown. Cerebral white matter lesions and lacunar brain infarcts are caused by small-vessel disease and are commonly observed on MRI scans in elderly people. These lesions are associated with an increased risk of stroke and dementia. We assessed whether higher C-reactive protein (CRP) levels were related to white matter lesion and lacunar infarcts.
We based our study on 1033 participants of the population-based Rotterdam Scan Study for whom complete data on CRP levels were available and who underwent brain MRI scanning. Subjects were 60 to 90 years of age and free of dementia at baseline. Six hundred thirty-six subjects had a second MRI scan on average 3.3 years later. We used multivariate regression models to assess the associations between CRP levels and markers of small-vessel disease. Higher CRP levels were associated with presence and progression of white matter lesions, particularly with marked lesion progression (ORs for highest versus lowest quartile of CRP 3.1 [95% CI 1.3 to 7.2] and 2.5 [95% CI 1.1 to 5.6] for periventricular and subcortical white matter lesion progression, respectively). These associations persisted after adjustment for cardiovascular risk factors and carotid atherosclerosis. Persons with higher CRP levels tended to have more prevalent and incident lacunar infarcts.
Inflammatory processes may be involved in the pathogenesis of cerebral small-vessel disease, in particular, the development of white matter lesions.
炎症过程参与动脉粥样硬化的发生发展及后果。这些过程是否也参与脑小血管病尚不清楚。脑白质病变和腔隙性脑梗死由小血管病引起，在老年人的磁共振成像（MRI）扫描中很常见。这些病变与中风和痴呆风险增加相关。我们评估了较高的C反应蛋白（CRP）水平是否与白质病变和腔隙性梗死有关。
我们的研究基于鹿特丹扫描研究中的1033名参与者，这些参与者有完整的CRP水平数据且接受了脑部MRI扫描。受试者年龄在60至90岁之间，基线时无痴呆。636名受试者平均在3.3年后进行了第二次MRI扫描。我们使用多变量回归模型评估CRP水平与小血管病标志物之间的关联。较高的CRP水平与白质病变的存在和进展相关，特别是与明显的病变进展相关（CRP最高四分位数与最低四分位数相比，脑室周围和皮质下白质病变进展的比值比分别为3.1 [95%可信区间1.3至7.2]和2.5 [95%可信区间1.1至5.6]）。在调整心血管危险因素和颈动脉粥样硬化后，这些关联仍然存在。CRP水平较高的人往往有更普遍和新发的腔隙性梗死。
炎症过程可能参与脑小血管病的发病机制，特别是白质病变的发展。
