Graff-Radford Jonathan, Simino Jeannette, Kantarci Kejal, Mosley Thomas H, Griswold Michael E, Windham B Gwen, Sharrett A Richey, Albert Marilyn S, Gottesman Rebecca F, Jack Clifford R, Vemuri Prashanthi, Knopman David S
From the Departments of Neurology (J.G.R., D.S.K.) and Radiology (K.K., C.R.J., P.V.), Mayo Clinic, Rochester, MN; Department of Data Science, Gertrude Ford MIND Center (J.S., M.E.G.) and Department of Medicine (T.H.M., B.G.W.), University of Mississippi Medical Center, Jackson; Department of Neurology (M.S.A., R.F.G.), Johns Hopkins University, Baltimore, MD; and Department of Epidemiology (A.R.S., R.F.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Stroke. 2017 Nov;48(11):2964-2972. doi: 10.1161/STROKEAHA.117.018336. Epub 2017 Oct 10.
Cerebral microbleed (CMB) location (deep versus strictly lobar) may elucidate underlying pathology with deep CMBs being more associated with hypertensive vascular disease and lobar CMBs being more associated with cerebral amyloid angiopathy. The objective of this study was to determine whether neuroimaging signs of vascular disease and Alzheimer pathology are associated with different types of CMBs.
Among 1677 nondemented ARIC (Atherosclerosis Risk in Communities) participants (mean age=76±5 years; 40% men; 26% black) with 3-Tesla MRI scans at the fifth examination (2011-2013), we fit multinomial logistic regression models to quantify relationships of brain volumes (Alzheimer disease signature regions, total gray matter, frontal gray matter, and white matter hyperintensity volumes), infarct frequencies (lacunar, nonlacunar, and total), and apolipoprotein E (number of ε4 alleles) with CMB location (none, deep/mixed, or strictly lobar CMBs). Models were weighted for the sample selection scheme and adjusted for age, sex, education, hypertension, ever smoking status, diabetes mellitus, race site membership, and estimated intracranial volume (brain volume models only).
Deep/mixed and strictly lobar CMBs had prevalences of 8% and 16%, respectively. Larger white matter hyperintensity burden, greater total infarct frequency, smaller frontal volumes (in women only), and smaller total gray matter volume were associated with greater risk of both deep and lobar CMBs relative to no CMBs. Greater white matter hyperintensity volume was also associated with greater risk of deep relative to lobar CMBs. Higher lacunar and nonlacunar infarct frequencies were associated with higher risk of deep CMBs, whereas smaller Alzheimer disease signature region volume and apolipoprotein E ε4 homozygosity were associated with greater risk of lobar CMBs.
CMBs are a common vascular pathology in the elderly. Markers of hypertensive small-vessel disease may contribute to deep CMBs while cerebral amyloid angiopathy may drive development of lobar CMBs.
脑微出血（CMB）的位置（深部与严格局限于脑叶）可能有助于阐明潜在病理情况，深部CMB与高血压性血管疾病的关联更强，而脑叶CMB与脑淀粉样血管病的关联更强。本研究的目的是确定血管疾病和阿尔茨海默病病理的神经影像学征象是否与不同类型的CMB相关。
在1677名参加社区动脉粥样硬化风险研究（ARIC）的非痴呆参与者（平均年龄=76±5岁；40%为男性；26%为黑人）中，他们在第五次检查（2011 - 2013年）时进行了3特斯拉磁共振成像扫描，我们拟合多项逻辑回归模型，以量化脑容量（阿尔茨海默病特征区域、总灰质、额叶灰质和白质高信号体积）、梗死频率（腔隙性、非腔隙性和总梗死频率）以及载脂蛋白E（ε4等位基因数量）与CMB位置（无、深部/混合性或严格脑叶性CMB）之间的关系。模型根据样本选择方案进行加权，并针对年龄、性别、教育程度、高血压、吸烟史、糖尿病、种族站点成员身份以及估计的颅内体积（仅脑容量模型）进行了调整。
深部/混合性和严格脑叶性CMB的患病率分别为8%和16%。相对于无CMB，更大的白质高信号负荷、更高的总梗死频率、更小的额叶体积（仅在女性中）以及更小的总灰质体积与深部和脑叶性CMB的风险增加相关。相对于脑叶性CMB，更大的白质高信号体积也与深部CMB的风险增加相关。更高的腔隙性和非腔隙性梗死频率与深部CMB的风险增加相关，而更小的阿尔茨海默病特征区域体积和载脂蛋白E ε4纯合性与脑叶性CMB的风险增加相关。
CMB是老年人常见的血管病理情况。高血压性小血管疾病的标志物可能导致深部CMB，而脑淀粉样血管病可能促使脑叶性CMB的发生。
