Pavlović Aleksandra M, Pekmezović Tatjana, Zidverc-Trajković Jasna, Jovanović Zagorka, Mijajlovic Milija, Pavlović Dragan, Tomić Gordana, Sternić Nadežda
Clinic for Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Clin Neurol Neurosurg. 2011 Nov;113(9):762-7. doi: 10.1016/j.clineuro.2011.08.011. Epub 2011 Sep 3.
Although typically linked to aging, small vessel disease (SVD) is also observed in younger adult patients, with common vascular risk factors (RF). We aimed to investigate features of SVD occurrence at an early adult age.
Vascular RF, functional and cognitive status and severity of lesions on MRI expressed as total score on Age-Related White Matter Changes (ARWMC) scale were analyzed in 200 consecutive patients with cerebral SVD admitted to a tertiary neurological hospital. Variables were compared between younger (35-55 years) and older (>56 years) patients.
In this study, 63 (31.5%) of patients were 55 years or younger. Both age groups had comparable RF profiles, but smoking emerged as an independent predictor for SVD at a younger age (OR 2.9; 95% CI 1.5-5.5; p=0.002). Younger patients had better functional (OR 1.8; 95% CI 1.3-2.5; p=0.0001) and cognitive (χ(2) 13.94; p=0.0009) status compared to older patients. However, two thirds of younger patients had some degree of cognitive deficit. Total score on ARWMC scale was lower in younger patients (mean 12.3 in younger versus 15.2 in older, OR 1.11; 95% CI 1.0-1.18; p=0.001). There was a strong correlation in both groups between functional score, cognitive status and ARWMC score (p<0.0001).
In our dataset, younger patients with SVD shared common vascular RF with older patients. In the group aged ≤55, better functional and cognitive status and less severe MRI changes were noted. However, a substantial number of younger SVD patients presenting with TIA or ischemic stroke had various deficits.
虽然小血管疾病（SVD）通常与衰老相关，但在年轻成年患者中也有发现，且伴有常见的血管危险因素（RF）。我们旨在研究成年早期SVD发生的特征。
对一家三级神经科医院收治的200例连续性脑SVD患者进行分析，评估其血管RF、功能和认知状态以及MRI上病变的严重程度，以年龄相关性白质改变（ARWMC）量表的总分表示。比较年轻（35 - 55岁）和年长（>56岁）患者的各项变量。
在本研究中，63例（31.5%）患者年龄在55岁及以下。两个年龄组的RF特征相似，但吸烟是年轻患者SVD的独立预测因素（OR 2.9；95% CI 1.5 - 5.5；p = 0.002）。与年长患者相比，年轻患者的功能（OR 1.8；95% CI 1.3 - 2.5；p = 0.0001）和认知（χ(2) 13.94；p = 0.0009）状态更好。然而，三分之二的年轻患者存在一定程度的认知缺陷。年轻患者的ARWMC量表总分较低（年轻患者平均为12.3，年长患者为15.2，OR 1.11；95% CI 1.0 - 1.18；p = 0.001）。两组的功能评分、认知状态和ARWMC评分之间均存在强相关性（p < 0.0001）。
在我们的数据集中，年轻的SVD患者与年长患者具有共同的血管RF。在年龄≤55岁的组中，观察到更好的功能和认知状态以及较轻的MRI改变。然而，大量表现为短暂性脑缺血发作（TIA）或缺血性卒中的年轻SVD患者存在各种缺陷。
