From the University of Bordeaux Ségalen (S.S., C.T., C.D., Y.Z., A.A., S.D.), INSERM U897 Neuroepidemiology, Bordeaux, France; Pekin Union Medical College Hospital (Y.Z.), China; Inserm U1061(C.B.), Montpellier; University Montpellier I (C.B.); University Pierre et Marie Curie-Paris 6 (A.A.); CNRS-CEA UMR5296 (F.C., B.M.), Université Bordeaux Segalen, Bordeaux; University of Versailles Saint-Quentin-en-Yvelines (S.D.); Department of Neurology (S.D.), Lariboisière Hospital, Paris; INSERM UMR S-1161 (S.D.), Paris 7 University, France; Department of Neurology (S.D.), Bordeaux University Hospital, Bordeaux; and Department of Neurology (S.D.), Boston University School of Medicine, Framingham Heart Study, Boston, MA.
Neurology. 2014 Nov 11;83(20):1844-52. doi: 10.1212/WNL.0000000000000980. Epub 2014 Oct 15.
We examined the cross-sectional association between lipid fractions and 2 MRI markers of cerebral small vessel disease, white matter hyperintensity volume (WMHV) and lacunes, representing powerful predictors of stroke and dementia.
The study sample comprised 2,608 participants from the 3C-Dijon Study (n = 1,842) and the Epidemiology of Vascular Aging Study (EVA) (n = 766), 2 large French population-based cohorts (72.8 ± 4.1 and 68.9 ± 3.0 years; 60.1% and 58.4% women, respectively). Analyses were performed separately in each study and combined using inverse variance meta-analysis. Lipid fractions (triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol) were studied as continuous variables. WMHV was studied both in a continuous and dichotomous manner, the latter reflecting the age-specific top quartile of WMHV (EXT-WMHV). Analyses were adjusted for age and sex.
Increasing triglycerides were associated with larger WMHV in the 3C-Dijon Study (β ± SE = 0.0882 ± 0.0302, p = 0.0035), in the EVA Study (β ± SE = 0.1062 ± 0.0461, p = 0.021), and in the combined analysis (β ± SE = 0.0936 ± 0.0252, p = 0.0002) and with higher frequency of lacunes in the 3C-Dijon Study (odds ratio [OR] = 1.65 [95% confidence interval 1.10-2.48], p = 0.015), in the EVA Study (OR = 1.58 [95% confidence interval 0.93-2.70], p = 0.09), and in the combined analysis (OR = 1.63 [95% confidence interval 1.18-2.25], p = 0.003). Associations were attenuated but maintained after adjusting for other vascular risk factors or for inflammatory markers. Associations were present and in the same direction both in participants taking and those not taking lipid-lowering drugs but tended to be stronger in the former for EXT-WMHV. Increasing low-density lipoprotein cholesterol tended to be associated with a decreased frequency and severity of all MRI markers of cerebral small vessel disease in both studies.
Increasing triglycerides but not other lipid fractions were associated with MRI markers of cerebral small vessel disease in older community persons.
我们研究了血脂成分与脑小血管疾病 2 种 MRI 标志物（脑白质高信号体积[WMHV]和腔隙）之间的横断面关联，这 2 种标志物是中风和痴呆的有力预测因子。
本研究样本包括来自 3C-第戎研究（n=1842）和血管老化流行病学研究（EVA）（n=766）的 2608 名参与者，这是 2 个大型法国人群为基础的队列（分别为 72.8±4.1 和 68.9±3.0 岁；分别为 60.1%和 58.4%的女性）。分别在每个研究中进行分析，并使用逆方差荟萃分析进行合并。血脂成分（甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇）作为连续变量进行研究。WMHV 既以连续方式也以二分方式进行研究，后者反映了 WMHV 的特定年龄最高四分位数（EXT-WMHV）。分析调整了年龄和性别。
在 3C-第戎研究中，甘油三酯升高与更大的 WMHV 相关（β±SE=0.0882±0.0302，p=0.0035），在 EVA 研究中（β±SE=0.1062±0.0461，p=0.021），在合并分析中（β±SE=0.0936±0.0252，p=0.0002），在 3C-第戎研究中，甘油三酯升高与腔隙的发生率更高相关（比值比[OR]=1.65[95%置信区间 1.10-2.48]，p=0.015），在 EVA 研究中（OR=1.58[95%置信区间 0.93-2.70]，p=0.09），在合并分析中（OR=1.63[95%置信区间 1.18-2.25]，p=0.003）。调整其他血管危险因素或炎症标志物后，相关性减弱但仍存在。在服用和未服用降脂药物的参与者中均存在这些关联，且方向相同，但在前者中，EXT-WMHV 的关联更强。在这两项研究中，低密度脂蛋白胆固醇升高的趋势与脑小血管疾病所有 MRI 标志物的发生率和严重程度降低相关。
在年龄较大的社区人群中，甘油三酯升高而不是其他血脂成分与脑小血管疾病的 MRI 标志物相关。
