From the Departments of Epidemiology (S.S., L.G.M.C., M.d.G., A.H., O.H.F., A.D., M.A.I., M.W.V.), Radiology (L.G.M.C., M.d.G., A.v.d.L., W.J.N., M.A.I., M.W.V.), Medical Informatics (M.d.G., W.J.N.), and Neurology (M.A.I.), Erasmus University Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
Neurology. 2016 Aug 30;87(9):927-34. doi: 10.1212/WNL.0000000000003032. Epub 2016 Aug 3.
To investigate the association of cerebral white matter microstructural integrity with mortality.
We included 4,294 individuals, free from stroke and dementia (mean age 63.6 years, 44% male) from the population-based Rotterdam Study (2006-2011). Diffusion-MRI was used to assess the microstructural integrity of the white matter, both globally and for specific white matter tracts. Fractional anisotropy and mean diffusivity were the measures used to quantify white matter integrity. All-cause mortality and cause-specific mortality was recorded with a median follow-up time of 5.4 and 4.6 years, respectively. Cox regression models, adjusted for age, sex, APOE ε4 allele carriership, cardiovascular risk factors, and macrostructural MRI changes, were used to estimate hazard ratios.
During the follow-up time, 216 participants (5.0%) died of all causes, 31 (0.7%) of cardiovascular causes, and 102 individuals (2.4%) died of noncardiovascular causes. Each SD decrease in fractional anisotropy and each SD increase in mean diffusivity was associated with a 1.37-fold (95% confidence interval: 1.20-1.57) and a 1.49-fold (95% confidence interval: 1.28-1.75) higher hazard of all-cause mortality, respectively. The associations were more prominent with cardiovascular mortality than with noncardiovascular mortality. In tract-specific analyses, we observed that association tracts were more prominently related to mortality.
Our findings suggest that impairments in cerebral white matter, even at early stages, are not limited to adverse brain outcomes and they are related to mortality, especially from cardiovascular causes.
探讨脑白质微观结构完整性与死亡率的关系。
我们纳入了 4294 名无卒中及痴呆的个体（平均年龄 63.6 岁，44%为男性），这些个体来自人群为基础的鹿特丹研究（2006-2011 年）。弥散磁共振成像（diffusion-MRI）用于评估白质的微观结构完整性，包括整体和特定白质束。各向异性分数和平均弥散度是用于量化白质完整性的指标。全因死亡率和特定原因死亡率的记录中位随访时间分别为 5.4 年和 4.6 年。使用 Cox 回归模型，调整年龄、性别、APOE ε4 等位基因携带情况、心血管危险因素和宏观结构 MRI 改变，以估计风险比。
在随访期间，216 名参与者（5.0%）死于各种原因，31 名（0.7%）死于心血管原因，102 名（2.4%）死于非心血管原因。各向异性分数每降低 1 个标准差和平均弥散度增加 1 个标准差，全因死亡率的危险比分别为 1.37 倍（95%置信区间：1.20-1.57）和 1.49 倍（95%置信区间：1.28-1.75）。与非心血管死亡率相比，这些关联在心血管死亡率中更为显著。在束特异性分析中，我们观察到关联束与死亡率的关系更为显著。
我们的研究结果表明，脑白质的损伤，即使在早期阶段，也不仅与不良的脑结局有关，而且与死亡率有关，尤其是与心血管原因有关。
