Fu Jianhui, Tang Jie, Han Jinghao, Hong Zhen
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; Department of Neurology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
PLoS One. 2014 Nov 17;9(11):e112832. doi: 10.1371/journal.pone.0112832. eCollection 2014.
White matter lesions (WMLs) in normal elderly are related to chronic ischemia, and progression of WML occurs mostly in moderate to severe disease. However, the mechanism is uncertain. Thus, we enrolled fifty-six normal elderly patients without large artery disease. The severity of WML on MRI was graded as grade 0, I, II and III using the modified Fazekas scale. Cerebral blood flow (CBF) was measured by Xenon-CT. We found that CBF (mL/100 g/min) within periventricular lesions and in the right and left centrum semiovales were 20.33, 21.27 and 21.03, respectively, in group I; 16.33, 15.55 and 15.91, respectively, in group II; and 14.05, 14.46 and 14.23, respectively, in group III. CBF of normal-appearing white matter (NAWM) around periventricular areas and in the right and left centrum semiovales were 20.79, 22.26 and 22.15, respectively, in group 0; 21.12, 22.17 and 22.25, respectively, in group I; 18.02, 19.45 and 19.62, respectively, in group II; and 16.38, 18.18 and 16.74, respectively, in group III. Significant reductions in CBF were observed not only within lesions but also in NAWM surrounding the lesions. In addition, CBF was reduced significantly within lesions compared to NAWM of the same grade. Furthermore, CBF was reduced significantly in NAWM in grades II and III when compared to grades 0 and I. Our finding indicates that ischemia may play a role in the pathogenesis of WML. Additionally, our finding provides an alternative explanation for finding that the progression of WML occurred more commonly in patients with moderate to severe WML.
正常老年人的白质病变（WMLs）与慢性缺血有关，且WML的进展大多发生在中重度疾病中。然而，其机制尚不确定。因此，我们纳入了56例无大动脉疾病的正常老年患者。使用改良的Fazekas量表将MRI上WML的严重程度分为0级、I级、II级和III级。通过氙CT测量脑血流量（CBF）。我们发现，在I组中，脑室周围病变内以及左右半卵圆中心的CBF（mL/100 g/min）分别为20.33、21.27和21.03；在II组中分别为16.33、15.55和15.91；在III组中分别为14.05、14.46和14.23。在0组中，脑室周围区域以及左右半卵圆中心正常白质（NAWM）的CBF分别为20.79、22.26和22.15；在I组中分别为21.12、22.17和22.25；在II组中分别为18.02、19.45和19.62；在III组中分别为16.38、18.18和16.74。不仅在病变内，而且在病变周围的NAWM中均观察到CBF显著降低。此外，与相同级别的NAWM相比，病变内的CBF显著降低。此外，与0级和I级相比，II级和III级的NAWM中的CBF也显著降低。我们的研究结果表明，缺血可能在WML的发病机制中起作用。此外，我们的研究结果为WML进展更常见于中重度WML患者这一发现提供了另一种解释。
