Chung Pil-Wook, Park Kwang-Yeol, Kim Jeong-Min, Shin Dong-Woo, Park Moo-Seok, Chung Yun Jae, Ha Sam-Yeol, Ahn Suk-Won, Shin Hae-Won, Kim Yong Bum, Moon Heui-Soo
From the Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C., Y.B.K., H.-S.M.); Department of Neurology (K.-Y.P., J.-M.K., D.-W.S., M.-S.P., S.-W.A., H.-W.S.) and Division of Endocrinology, Department of Internal Medicine (Y.J.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea; and Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea (S.-Y.H.).
Stroke. 2015 Jan;46(1):248-51. doi: 10.1161/STROKEAHA.114.007706. Epub 2014 Nov 25.
The aim of this study was to determine the association between 25-hydroxyvitamin D (25(OH)D) and neuroimaging correlates of cerebral small vessel disease.
We identified 759 consecutive patients with acute ischemic stroke or transient ischemic attack. Lacunes, white matter hyperintensity, and cerebral microbleed (CMB) were assessed using MR images. Deep CMB was defined as the presence of CMB in basal ganglia, thalamus, or brain stem. The association between 25(OH)D and small vessel disease was tested using linear and logistic regression analyses.
Mean age was 68 (±13) years. Mean level of 25(OH)D was 34.1±17.8 nmol/L. On bivariate analysis, a 25-nmol/L decrease in 25(OH)D was associated with lacunes (regression coefficient, 0.23; 95% confidence interval [CI], 0.02-0.45), severe white matter hyperintensity (odds ratio, 2.05; 95% CI, 1.41-3.08), and deep CMB (odds ratio, 1.28; 95% CI, 1.01-1.63). Also, 25(OH)D deficiency (≤25 nmol/L) was associated with lacunes (regression coefficient, 0.5; 95% CI, 0.04-0.95), severe white matter hyperintensity (odds ratio, 2.74; 95% CI, 1.31-6.45), and deep CMB (odds ratio, 1.68; 95% CI, 1.03-2.78). The association remained significant even after multivariable adjustment and in the subgroup of previously healthy patients.
25(OH)D is inversely associated with lacunes, white matter hyperintensity, and deep CMB. Our findings suggest that 25(OH)D is linked to small vessel disease, and in future trials it should be tested whether 25(OH)D supplementation can prevent small vessel disease.
本研究旨在确定25-羟维生素D（25(OH)D）与脑小血管病神经影像学相关因素之间的关联。
我们纳入了759例连续的急性缺血性卒中或短暂性脑缺血发作患者。使用磁共振成像评估腔隙性梗死、白质高信号和脑微出血（CMB）。深部CMB定义为基底节、丘脑或脑干存在CMB。使用线性和逻辑回归分析检验25(OH)D与小血管病之间的关联。
平均年龄为68（±13）岁。25(OH)D的平均水平为34.1±17.8 nmol/L。在双变量分析中，25(OH)D每降低25 nmol/L与腔隙性梗死（回归系数，0.23；95%置信区间[CI]，0.02 - 0.45）、重度白质高信号（比值比，2.05；95% CI，1.41 - 3.08）和深部CMB（比值比，1.28；95% CI，1.01 - 1.63）相关。此外，25(OH)D缺乏（≤25 nmol/L）与腔隙性梗死（回归系数，0.5；95% CI，0.04 - 0.95）、重度白质高信号（比值比，2.74；95% CI，1.31 - 6.45）和深部CMB（比值比，1.68；95% CI，1.03 - 2.78）相关。即使在多变量调整后以及在既往健康患者亚组中，这种关联仍然显著。
25(OH)D与腔隙性梗死、白质高信号和深部CMB呈负相关。我们的研究结果表明25(OH)D与小血管病有关，在未来的试验中应测试补充25(OH)D是否可以预防小血管病。
