Arntz Renate M, van den Broek Steffen M A, van Uden Inge W M, Ghafoorian Mohsen, Platel Bram, Rutten-Jacobs Loes C A, Maaijwee Noortje A M, Schaapsmeerders Pauline, Schoonderwaldt Hennie C, van Dijk Ewoud J, de Leeuw Frank-Erik
From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
Neurology. 2016 Sep 20;87(12):1212-9. doi: 10.1212/WNL.0000000000003123. Epub 2016 Aug 12.
To study the long-term prevalence of small vessel disease after young stroke and to compare this to healthy controls.
This prospective cohort study comprises 337 patients with an ischemic stroke or TIA, aged 18-50 years, without a history of TIA or stroke. In addition, 90 age- and sex-matched controls were included. At follow-up, lacunes, microbleeds, and white matter hyperintensity (WMH) volume were assessed using MRI. To investigate the relation between risk factors and small vessel disease, logistic and linear regression were used.
After mean follow-up of 9.9 (SD 8.1) years, 337 patients were included (227 with an ischemic stroke and 110 with a TIA). Mean age of patients was 49.8 years (SD 10.3) and 45.4% were men; for controls, mean age was 49.4 years (SD 11.9) and 45.6% were men. Compared with controls, patients more often had at least 1 lacune (24.0% vs 4.5%, p < 0.0001). In addition, they had a higher WMH volume (median 1.5 mL [interquartile range (IQR) 0.5-3.7] vs 0.4 mL [IQR 0.0-1.0], p < 0.001). Compared with controls, patients had the same volume WMHs on average 10-20 years earlier. In the patient group, age at stroke (β = 0.03, 95% confidence interval [CI] 0.02-0.04) hypertension (β = 0.22, 95% CI 0.04-0.39), and smoking (β = 0.18, 95% CI 0.01-0.34) at baseline were associated with WMH volume.
Patients with a young stroke have a higher burden of small vessel disease than controls adjusted for confounders. Cerebral aging seems accelerated by 10-20 years in these patients, which may suggest an increased vulnerability to vascular risk factors.
研究青年卒中后小血管疾病的长期患病率，并与健康对照进行比较。
这项前瞻性队列研究纳入了337例年龄在18 - 50岁、无短暂性脑缺血发作（TIA）或卒中病史的缺血性卒中和TIA患者。此外，还纳入了90名年龄和性别匹配的对照。在随访时，使用磁共振成像（MRI）评估腔隙性梗死、微出血和白质高信号（WMH）体积。为研究危险因素与小血管疾病之间的关系，采用了逻辑回归和线性回归。
平均随访9.9（标准差8.1）年后，纳入337例患者（227例缺血性卒中，110例TIA）。患者的平均年龄为49.8岁（标准差10.3），男性占45.4%；对照的平均年龄为49.4岁（标准差11.9），男性占45.6%。与对照相比，患者更常至少有1个腔隙性梗死（24.0%对4.5%，p < 0.0001）。此外，他们的WMH体积更高（中位数1.5 mL[四分位间距（IQR）0.5 - 3.7]对0.4 mL[IQR 0.0 - 1.0]，p < 0.001）。与对照相比，患者平均在早10 - 20年时就有相同体积的WMH。在患者组中，卒中时的年龄（β = 0.03，95%置信区间[CI]0.02 - 0.04）、基线时的高血压（β = 0.22，95%CI 0.04 - 0.39）和吸烟（β = 0.18，95%CI 0.01 - 0.34）与WMH体积相关。
校正混杂因素后，青年卒中患者的小血管疾病负担高于对照。这些患者的脑老化似乎加速了10 - 20年，这可能表明他们对血管危险因素的易感性增加。
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