Hoshino Atsushi, Nakamura Takashi, Enomoto Satoko, Kawahito Hiroyuki, Kurata Hiroyuki, Nakahara Yoshifumi, Ijichi Toshiharu
Department of Cardiology, Kyoto Prefectural University of Medicine, Kyoto.
Intern Med. 2008;47(20):1775-81. doi: 10.2169/internalmedicine.47.1314. Epub 2008 Oct 15.
We have recently reported the prevalence of subclinical cardiovascular diseases and the association between the presence of subclinical coronary artery disease (CAD) and vascular risk factors in ischemic stroke patients. The relationship between the presence of subclinical CAD and elements of brain ischemia including intracranial artery stenosis, silent brain infarction (SBI), and white matter lesions remains unclear. We determined the usefulness of elements of brain ischemia to predict the presence of subclinical CAD in ischemic stroke patients.
The study group comprised 100 patients with first-ever ischemic stroke who had no history of CAD. Intracranial artery stenosis on magnetic resonance angiography and SBI and white matter lesions on magnetic resonance imaging were investigated in comparison with CAD defined as > or =50% stenosis on coronary computed tomographic angiography.
Thirty-six patients had subclinical CAD. Intracranial artery stenosis (78.1% vs 35.1%, p<0.0001) and SBI (69.4% vs 46.9%, p=0.03) were more prevalent in patients with subclinical CAD. Of the patients with both intracranial artery stenosis and SBI, 61% had subclinical CAD. Multiple regression analyses showed that the presence of subclinical CAD was independently associated with intracranial artery stenosis; <50% stenosis (OR 8.01 95%CI 2.02 to 31.9; p<0.01), > or =50% stenosis (OR 19.5 95%CI 2.77 to 137.4; p<0.01), and multiple SBI (OR 3.85 95%CI 1.23 to 12.0; p<0.05).
The evaluation of intracranial artery stenosis and SBI may be useful to identify ischemic stroke patients at high risk for subclinical CAD.
我们最近报道了缺血性脑卒中患者亚临床心血管疾病的患病率以及亚临床冠状动脉疾病（CAD）的存在与血管危险因素之间的关联。亚临床CAD的存在与脑缺血因素（包括颅内动脉狭窄、无症状脑梗死[SBI]和白质病变）之间的关系仍不清楚。我们确定了脑缺血因素在预测缺血性脑卒中患者亚临床CAD存在方面的实用性。
研究组包括100例首次发生缺血性脑卒中且无CAD病史的患者。将磁共振血管造影显示的颅内动脉狭窄以及磁共振成像显示的SBI和白质病变与冠状动脉计算机断层血管造影定义为狭窄≥50%的CAD进行比较。
36例患者有亚临床CAD。亚临床CAD患者中颅内动脉狭窄（78.1%对35.1%，p<0.0001）和SBI（69.4%对46.9%，p=0.03）更为普遍。在同时患有颅内动脉狭窄和SBI的患者中，61%有亚临床CAD。多元回归分析显示，亚临床CAD的存在与颅内动脉狭窄独立相关；狭窄<50%（比值比8.01，95%置信区间2.02至31.9；p<0.01），狭窄≥50%（比值比19.5，95%置信区间2.77至137.4；p<0.01），以及多发性SBI（比值比3.85，95%置信区间1.23至12.0；p<0.05）。
评估颅内动脉狭窄和SBI可能有助于识别有亚临床CAD高风险的缺血性脑卒中患者。
