Chou P-S, Chen C-H, Wu M-N, Lin Y-H, Lai C-L, Lin R-T, Yang Y-H
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Intern Med J. 2015 Apr;45(4):390-5. doi: 10.1111/imj.12704.
BACKGROUND/AIM: Cerebral white matter changes (WMC) are commonly observed in magnetic resonance imaging (MRI) scans of elderly people. Information about the prevalence of WMC is limited, and little is known about site-specific risk factors for the subcortical and periventricular regions in patients with ischaemic stroke. The study aims to analyse the prevalence and severity of WMC and investigate the risk factors of periventricular WMC (PVWMC) and deep WMC (DWMC) separately in patients with ischaemic stroke.
The data were collected between January and December 2013 from a medical centre in southern Taiwan. Every patient underwent a cerebral MRI scan, and WMC was separately rated as PVWMC and DWMC by using the modified Fazekas scale.
In total, 527 patients who had experienced ischaemic stroke were included. The mean age of the patients was 67.0 ± 12.5 years (range: 31-94) and 62% of them were men. The mean age was significantly different among the four grades of severity in both the PVWMC (P < 0.001) and DWMC (P < 0.001) groups after adjustments for sex and vascular risk factors. Hypertension was independently correlated with severity of DWMC (P = 0.032) but not with PVWMC (P = 0.222). In multiple logistic regressions model, hypertension was a significant independent indicator of DWMC (odds ratio = 4.30; 95% confidence interval = 1.70-10.89).
Our results suggest a region-specific pathogenesis of cerebral white matter in Asian patients with ischaemic stroke that may differ from those in the general population.
背景/目的：脑白质改变（WMC）在老年人的磁共振成像（MRI）扫描中较为常见。关于WMC患病率的信息有限，对于缺血性中风患者皮质下和脑室周围区域的部位特异性危险因素知之甚少。本研究旨在分析缺血性中风患者中WMC的患病率和严重程度，并分别调查脑室周围WMC（PVWMC）和深部WMC（DWMC）的危险因素。
数据于2013年1月至12月从台湾南部的一个医疗中心收集。每位患者均接受脑部MRI扫描，并使用改良的Fazekas量表将WMC分别评定为PVWMC和DWMC。
共纳入527例缺血性中风患者。患者的平均年龄为67.0±12.5岁（范围：31 - 94岁），其中62%为男性。在对性别和血管危险因素进行调整后，PVWMC组（P < 0.001）和DWMC组（P < 0.001）中，四个严重程度等级之间的平均年龄存在显著差异。高血压与DWMC的严重程度独立相关（P = 0.032），但与PVWMC无关（P = 0.222）。在多因素逻辑回归模型中，高血压是DWMC的显著独立指标（比值比 = 4.30；95%置信区间 = 1.70 - 10.89）。
我们的结果表明，亚洲缺血性中风患者脑白质存在区域特异性发病机制，这可能与一般人群不同。
