Arvanitakis Zoe, Capuano Ana W, Leurgans Sue E, Buchman Aron S, Bennett David A, Schneider Julie A
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL.
Brain Pathol. 2017 Jan;27(1):77-85. doi: 10.1111/bpa.12365. Epub 2016 Apr 14.
The relationship of cerebral vessel pathology to brain microinfarcts is not fully understood. We examined associations of cerebral vessel pathology with microinfarcts among community-dwelling persons who came to autopsy. Brain specimens were derived from 1,066 deceased subjects (mean age-at-death = 88 years, 65% women) participating in a cohort study of aging. Microinfarcts were classified by number, age and location. Severity of vessel pathologies was graded semi-quantitatively. Almost a third of subjects (n = 300; 28%) had at least one chronic microinfarct, including 128 cortical only, 120 subcortical only, and 47 with both. Moderate-to-severe atherosclerosis was present in 430 (41%) subjects, arteriolosclerosis in 382 (36%), and amyloid angiopathy in 374 (35%). The odds of one or multiple microinfarct(s) was increased for more severe atherosclerosis (OR =1.22; 95%CI: 1.03-1.45), arteriolosclerosis (OR =1.18; 95%CI: 1.02-1.37) and amyloid angiopathy (OR =1.13; 95%CI: 1.00-1.28). Separately, the odds of subcortical microinfarct(s) was increased for atherosclerosis (OR =1.49; 95%CI: 1.20-1.84) and arteriolosclerosis (OR =1.39; 95%CI: 1.16-1.67) but not amyloid angiopathy; whereas the odds of cortical microinfarct(s) was increased for amyloid angiopathy (OR =1.26; 95%CI: 1.09-1.46) only. While cerebral vessel pathologies are associated with microinfarct burden, atherosclerosis and arteriolosclerosis are associated with subcortical microinfarcts, and amyloid angiopathy with cortical microinfarcts.
脑血管病理学与脑微梗死之间的关系尚未完全明确。我们研究了在接受尸检的社区居民中脑血管病理学与微梗死之间的关联。脑标本取自1066名参与衰老队列研究的已故受试者（平均死亡年龄=88岁，65%为女性）。微梗死根据数量、年龄和位置进行分类。血管病理学的严重程度采用半定量分级。近三分之一的受试者（n = 300；28%）至少有一处慢性微梗死，其中仅皮质微梗死128例，仅皮质下微梗死120例，两者均有的47例。430名（41%）受试者存在中重度动脉粥样硬化，382名（36%）存在小动脉硬化，374名（35%）存在淀粉样血管病。更严重的动脉粥样硬化（OR = 1.22；95%CI：1.03 - 1.45）、小动脉硬化（OR = 1.18；95%CI：1.02 - 1.37）和淀粉样血管病（OR = 1.13；95%CI：1.00 - 1.28）使发生一处或多处微梗死的几率增加。单独来看，动脉粥样硬化（OR = 1.49；95%CI：1.20 - 1.84）和小动脉硬化（OR = 1.39；95%CI：1.16 - 1.67）使皮质下微梗死的几率增加，但淀粉样血管病未使该几率增加；而仅淀粉样血管病（OR = 1.26；95%CI：1.09 - 1.46）使皮质微梗死的几率增加。虽然脑血管病理学与微梗死负担相关，但动脉粥样硬化和小动脉硬化与皮质下微梗死相关，淀粉样血管病与皮质微梗死相关。
