Peng Qing, Huang Yining, Sun Wei, Xing Haiying
Department of Neurology, Peking University First Hospital, Beijing 100034, China.
Department of Neurology, Peking University First Hospital, Beijing 100034, China. Email:
Chin Med J (Engl). 2014;127(18):3204-8.
Endothelial dysfunction is not only an early stage of atherosclerosis, but also involved in the pathogenesis of cerebral small-vessel diseases. Patients with cerebral microbleeds (CMBs) may have arteriolosclerosis as well as systemic atherosclerosis. However, little is known about the associations among CMBs, atherosclerosis of cerebral large arteries, and endothelial function. Our study aimed to investigate the relationships among them.
This was a cross-sectional study. Ninety patients hospitalized in Peking University First Hospital with acute ischemic stroke were enrolled consecutively between November 1, 2007 and January 31, 2008. All subjects underwent transcranial Doppler and carotid color duplex ultrasonography to record the intima-media thickness (IMT) of common carotid artery, carotid plaque, and cerebral artery stenosis. Brain magnetic resonance imaging (MRI) routine sequences and gradient recall-echo T2(*)-weighted imaging were performed to count CMBs with clinical data blindness. Endothelial function was evaluated using flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of the brachial artery. FMD and NMD were examined by an experienced vascular sonographer using a high-resolution ultrasound.
Thirty cases (33.3%) had CMBs with counts ranging from 1 to 30. Both FMD ((9.9 ± 4.8)% vs. (15. 2 ± 7.4)%, P = 0.001) and NMD ((13.7 ± 6.1)% vs. (19.0 ± 7.4)%, P = 0.001) were significantly decreased in CMB-positive patients than in CMB-negative patients. No significant relationships were demonstrated between CMBs and intracranial and/or extracranial artery stenosis. The frequencies of CMBs in patients with IMT≥1.0 mm, carotid plaque, and extracranial artery stenosis were 37.5%, 39.4%, and 47.6% respectively, with no significant difference, but much higher than in patients with IMT <1.0 mm (5%, P < 0.05). In Logistic regression analysis, impaired FMD (OR = 5.783, 95% CI 1.652-6.718, P = 0.007) and high pulse pressure (OR = 6.228, 95% CI 1.594-3.891, P = 0.009) were independently associated with the presence of CMBs, as well as previous ischemic stroke. In contrast, NMD was not correlated with CMBs.
CMBs may coexist with cerebral atherosclerosis in ischemic stroke. Endothelial dysfunction may play a role in the pathogenesis of CMBs, but may not simply reflect functional alterations of large arteries.
内皮功能障碍不仅是动脉粥样硬化的早期阶段，还参与脑小血管疾病的发病机制。脑微出血（CMB）患者可能存在小动脉硬化以及全身性动脉粥样硬化。然而，关于CMB、脑大动脉粥样硬化和内皮功能之间的关联知之甚少。我们的研究旨在探讨它们之间的关系。
这是一项横断面研究。2007年11月1日至2008年1月31日期间，连续纳入北京大学第一医院90例急性缺血性卒中住院患者。所有受试者均接受经颅多普勒和颈动脉彩色双功超声检查，以记录颈总动脉内膜中层厚度（IMT）、颈动脉斑块和脑动脉狭窄情况。进行脑磁共振成像（MRI）常规序列和梯度回波T2（*）加权成像，在临床数据盲态下计数CMB。使用肱动脉的血流介导的血管舒张（FMD）和硝酸甘油介导的血管舒张（NMD）评估内皮功能。FMD和NMD由经验丰富的血管超声检查人员使用高分辨率超声进行检查。
30例（33.3%）患者存在CMB，数量范围为1至30个。CMB阳性患者的FMD（（9.9±4.8）%对（15.2±7.4）%，P = 0.001）和NMD（（13.7±6.1）%对（19.0±7.4）%，P = 0.001）均较CMB阴性患者显著降低。CMB与颅内和/或颅外动脉狭窄之间未显示出显著关系。IMT≥1.0 mm、颈动脉斑块和颅外动脉狭窄患者的CMB发生率分别为37.5%、39.4%和47.6%，虽无显著差异，但均显著高于IMT<1.0 mm的患者（5%，P<0.05）。在逻辑回归分析中，FMD受损（OR = 5.783，95%CI 1.652 - 6.718，P = 0.007）和高脉压（OR = 6.228，95%CI 1.594 - 3.891，P = 0.009）与CMB的存在以及既往缺血性卒中独立相关。相比之下，NMD与CMB无关。
CMB可能与缺血性卒中中的脑动脉粥样硬化共存。内皮功能障碍可能在CMB的发病机制中起作用，但可能并非简单反映大动脉的功能改变。
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