van der Veen Pieternella H, Muller Majon, Vincken Koen L, Witkamp Theo D, Mali Willem P T M, van der Graaf Yolanda, Geerlings Mirjam I
Department of Radiology, University Medical Center Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands; Department of Internal Medicine, VU University Medical Center Amsterdam, The Netherlands.
J Neurol Sci. 2014 Feb 15;337(1-2):112-8. doi: 10.1016/j.jns.2013.11.029. Epub 2013 Nov 27.
We estimated the progression of brain atrophy and cerebrovascular lesions on MRI in a prospective cohort of patients with various manifestations of arterial disease. Within the SMART-MR study, using brain MRI data from baseline and after on average 3.9 years of follow-up, intracranial volume (ICV), total brain, cortical gray matter, ventricular, white matter lesion volumes and visually rated infarcts were obtained from 663 patients (mean age 57 ± 9 years, 81% men). Global and cortical atrophy increased quadratically with age. Men showed more progression of global and cortical atrophy than women (mean difference in change (95% CI): -0.25 (-0.44; -0.06) and -0.94 (-1.35; -0.52)% ICV) and had an increased risk of new brain infarcts (OR = 2.7, 95% CI 1.2-6.1). Compared with coronary artery disease patients, cerebrovascular disease patients showed more progression of cortical and subcortical atrophy and an increased risk of new brain infarcts, and peripheral arterial disease patients showed more progression of cortical atrophy. These results were independent of cerebrovascular lesions and cardiovascular risk factors. In patients with manifest arterial disease, brain atrophy tended to accelerate with older age and men had more progression of brain atrophy and cerebrovascular lesions than women. Additionally, patients with cerebrovascular and peripheral arterial disease showed the most prominent progression of atrophy and lesions.
我们在一个患有各种动脉疾病表现的前瞻性队列患者中，评估了MRI上脑萎缩和脑血管病变的进展情况。在SMART-MR研究中，利用基线和平均3.9年随访后的脑MRI数据，从663例患者（平均年龄57±9岁，81%为男性）中获取了颅内体积（ICV）、全脑、皮质灰质、脑室、白质病变体积以及视觉评定的梗死灶。整体和皮质萎缩随年龄呈二次方增加。男性的整体和皮质萎缩进展比女性更多（变化的平均差异（95%CI）：-0.25（-0.44；-0.06）和-0.94（-1.35；-0.52）%ICV），并且新发脑梗死的风险增加（OR = 2.7，95%CI 1.2 - 6.1）。与冠状动脉疾病患者相比，脑血管疾病患者的皮质和皮质下萎缩进展更多，新发脑梗死的风险增加，而外周动脉疾病患者的皮质萎缩进展更多。这些结果独立于脑血管病变和心血管危险因素。在患有明显动脉疾病的患者中，脑萎缩往往随年龄增长而加速，男性的脑萎缩和脑血管病变进展比女性更多。此外，脑血管疾病和外周动脉疾病患者的萎缩和病变进展最为显著。
