Gerdes Victor E A, Kwa Vincent I H, ten Cate Hugo, Brandjes Dees P M, Büller Harry R, Stam Jan
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Atherosclerosis. 2006 May;186(1):166-72. doi: 10.1016/j.atherosclerosis.2005.07.008. Epub 2005 Aug 11.
Cerebral white matter lesions (WML) are regarded as manifestations of small vessel disease, but have also been associated with large vessel atherosclerosis. We investigated whether WML have a predictive value for future ischemic events.
Two-hundred-thirty patients with proven atherosclerotic disease, recent ischemic stroke (IS, n=70), recent myocardial infarction (MI, n=71), or peripheral arterial disease (PAD, n=89) were included. The presence of periventricular lesions (PVL) and deep white matter lesions (DWML) on MRI at entry and ischemic events during follow-up were registered. During follow-up with a mean duration of 3.5+/-1.4 years 22 patients had a MI, 21 patients suffered an IS and 2 patients died suddenly. The frequency of ischemic events during follow-up was higher among patients with PVL than in those without PVL (IS: 18% versus 5%, p=0.001; MI: 15% versus 7%, p=0.03; any ischemic event: 36% versus 11%, p<0.001). DWML was associated only with the combined outcome any ischemic event (p=0.04). In multivariate regression analysis the presence of PVL was independently associated with IS (HR 3.2 (95%CI 1.3-8.4) and MI (HR 3.4 (95%CI 1.4-8.0)).
We observed an association between WML, especially PVL, and future ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease.
脑白质病变（WML）被视为小血管疾病的表现，但也与大血管动脉粥样硬化有关。我们研究了WML对未来缺血性事件是否具有预测价值。
纳入230例确诊为动脉粥样硬化疾病的患者，包括近期缺血性卒中（IS，n = 70）、近期心肌梗死（MI，n = 71）或外周动脉疾病（PAD，n = 89）。记录入组时MRI上脑室周围病变（PVL）和深部白质病变（DWML）的存在情况以及随访期间的缺血性事件。在平均随访3.5±1.4年期间，22例患者发生MI，21例患者发生IS，2例患者突然死亡。有PVL的患者随访期间缺血性事件的发生率高于无PVL的患者（IS：18%对5%，p = 0.001；MI：15%对7%，p = 0.03；任何缺血性事件：36%对11%，p<0.001）。DWML仅与任何缺血性事件的综合结局相关（p = 0.04）。在多变量回归分析中，PVL的存在与IS（HR 3.2（95%CI 1.3 - 8.4））和MI（HR 3.4（95%CI 1.4 - 8.0））独立相关。
我们观察到在已确诊动脉粥样硬化疾病的患者中，WML，尤其是PVL，与未来缺血性卒中和心肌梗死之间存在关联。
