脑淀粉样血管病和高血压性小血管病中腔隙的分布

Distribution of lacunes in cerebral amyloid angiopathy and hypertensive small vessel disease.

作者信息

Pasi Marco, Boulouis Gregoire, Fotiadis Panagiotis, Auriel Eitan, Charidimou Andreas, Haley Kellen, Ayres Alison, Schwab Kristin M, Goldstein Joshua N, Rosand Jonathan, Viswanathan Anand, Pantoni Leonardo, Greenberg Steven M, Gurol M Edip

机构信息

From the Hemorrhagic Stroke Research Program (M.P., G.B., P.F., E.A., A.C., K.H., A.A., K.M.S., A.V., S.M.G., M.E.G.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; NEUROFARBA Department (M.P., L.P.), Neuroscience Section, University of Florence, Italy; Université Paris-Descartes (G.B.), INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France; and Division of Neurocritical Care and Emergency Neurology (J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston.

出版信息

Neurology. 2017 Jun 6;88(23):2162-2168. doi: 10.1212/WNL.0000000000004007. Epub 2017 May 5.

DOI:10.1212/WNL.0000000000004007

PMID:28476760

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5467956/

Abstract

OBJECTIVE

To evaluate whether the burden of deep and lobar lacunes differs between patients with intracerebral hemorrhage (ICH) with definite/probable cerebral amyloid angiopathy (CAA) per the Boston criteria and hypertensive small vessel disease (HTN-SVD; ICH in basal ganglia, thalami, brainstem).

METHODS

We defined lobar and deep lacunes similar to the topographic distribution used for ICH and cerebral microbleeds (CMBs). We then compared their distribution between patients with CAA-ICH and those with strictly deep CMB and ICH (HTN-ICH). The independent associations of lacune location with the diagnosis of CAA-ICH and HTN-ICH were evaluated with multivariable models. The relationship between lobar lacunes and white matter hyperintensity (WMH) volume was evaluated by means of partial correlation analyses adjusted for age and a validated visual scale.

RESULTS

In our final cohort of 316 patients with ICH, lacunes were frequent (24.7%), with similar rates in 191 patients with CAA and 125 with HTN-ICH (23% vs 27.2%, = 0.4). Lobar lacunes were more commonly present in CAA (20.4% vs 5.7%, < 0.001), while deep lacunes were more frequent in HTN-ICH (15.2% vs 2.1%, < 0.001). After correction for demographics and clinical and neuroimaging markers of SVD, lobar lacunes were associated with CAA ( = 0.003) and deep lacunes with HTN-ICH ( < 0.001). Lobar lacunes in 80% of the cases were at least in contact with WMH, and after adjustment for age, they were highly correlated to WMH volume ( = 0.42, < 0.001).

CONCLUSIONS

Lobar lacunes are associated with CAA, whereas deep lacunes are more frequent in HTN-SVD. Lobar lacunes seem to have a close relationship with WMH, suggesting a possible common origin.

摘要

目的

根据波士顿标准，评估确诊/可能患有脑淀粉样血管病（CAA）的脑出血（ICH）患者与高血压性小血管病（HTN-SVD；基底节、丘脑、脑干的ICH）患者之间深部和脑叶腔隙的负担是否存在差异。

方法

我们按照用于ICH和脑微出血（CMB）的地形分布来定义脑叶和深部腔隙。然后，我们比较了CAA-ICH患者与严格深部CMB和ICH患者（HTN-ICH）之间它们的分布情况。采用多变量模型评估腔隙位置与CAA-ICH和HTN-ICH诊断的独立相关性。通过针对年龄和经过验证的视觉量表进行调整的偏相关分析，评估脑叶腔隙与白质高信号（WMH）体积之间的关系。

结果

在我们最终纳入的316例ICH患者队列中，腔隙很常见（24.7%），191例CAA患者和125例HTN-ICH患者的发生率相似（23%对27.2%，P = 0.4）。脑叶腔隙在CAA中更常见（20.4%对5.7%，P < 0.001），而深部腔隙在HTN-ICH中更常见（15.2%对2.1%，P < 0.001）。在对人口统计学以及SVD的临床和神经影像学标志物进行校正后，脑叶腔隙与CAA相关（P = 0.003），深部腔隙与HTN-ICH相关（P < 0.001）。80%的病例中脑叶腔隙至少与WMH接触，在对年龄进行调整后，它们与WMH体积高度相关（P = 0.42，P < 0.001）。