J. Philip Kistler Stroke Research Center, Center for Human Genetics Research, Massachusetts General Hospital, 175 Cambridge St, Suite 300, Boston, MA 02114, USA.
Neurology. 2010 Nov 9;75(19):1670-7. doi: 10.1212/WNL.0b013e3181fc279a.
White matter hyperintensity (WMH) may be a marker of an underlying cerebral microangiopathy. Therefore, we hypothesized that WMH would be most severe in patients with lacunar stroke and intracerebral hemorrhage (ICH), 2 types of stroke in which cerebral small vessel (SV) changes are pathophysiologically relevant.
We determined WMH volume (WMHV) in cohorts of prospectively ascertained patients with acute ischemic stroke (AIS) (Massachusetts General Hospital [MGH], n = 628, and the Ischemic Stroke Genetics Study [ISGS], n = 263) and ICH (MGH, n = 122).
Median WMHV was 7.5 cm³ (interquartile range 3.4-14.7 cm³) in the MGH AIS cohort (mean age 65 ± 15 years). MGH patients with larger WMHV were more likely to have lacunar stroke compared with cardioembolic (odds ratio [OR] = 1.87 per SD normally transformed WMHV), large artery (OR = 2.25), undetermined (OR = 1.87), or other (OR = 1.85) stroke subtypes (p < 0.03). These associations were replicated in the ISGS cohort (p = 0.03). In a separate analysis, greater WMHV was seen in ICH compared with lacunar stroke (OR = 1.2, p < 0.02) and in ICH compared with all ischemic stroke subtypes combined (OR = 1.34, p < 0.007).
Greater WMH burden was associated with SV stroke compared with other ischemic stroke subtypes and, even more strongly, with ICH. These data, from 2 independent samples, support the model that increasing WMHV is a marker of more severe cerebral SV disease and provide further evidence for links between the biology of WMH and SV stroke.
脑白质高信号（WMH）可能是潜在脑微血管病的一个标志物。因此，我们假设，在腔隙性脑卒中和脑出血（ICH）患者中，WMH 会最严重，这两种类型的脑卒中在病理生理学上与脑小血管（SV）变化相关。
我们确定了急性缺血性脑卒中（AIS）（麻省总医院 [MGH]，n=628 和缺血性脑卒中遗传学研究 [ISGS]，n=263）和 ICH（MGH，n=122）前瞻性确定的患者队列中的 WMH 体积（WMHV）。
在 MGH AIS 队列中（平均年龄 65±15 岁），WMHV 的中位数为 7.5cm³（四分位距 3.4-14.7cm³）。与心源性栓塞（优势比 [OR]按正常转化 WMHV 每标准差增加 1.87）、大动脉（OR=2.25）、未确定（OR=1.87）或其他（OR=1.85）脑卒中亚型相比，WMHV 较大的 MGH 患者更有可能发生腔隙性脑卒中（p<0.03）。这些关联在 ISGS 队列中得到了复制（p=0.03）。在单独的分析中，与腔隙性脑卒中相比，ICH 中可见更大的 WMHV（OR=1.2，p<0.02），与所有缺血性脑卒中亚型相比，ICH 中可见更大的 WMHV（OR=1.34，p<0.007）。
与其他缺血性脑卒中亚型相比，更大的 WMH 负担与 SV 脑卒中相关，与 ICH 相关性更强。这两项来自两个独立样本的研究数据支持这样一种模式，即 WMHV 的增加是更严重的脑 SV 疾病的标志物，并为 WMH 和 SV 脑卒中的生物学之间的联系提供了进一步的证据。
