Xu Xin, Gao Yuanyuan, Liu Renyuan, Qian Lai, Chen Yan, Wang Xiaoying, Xu Yun
1Department of Neurology, Affiliated Drum Tower Hospital, and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing 210008, China.
2Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing 210008, China.
Aging Dis. 2018 Jun 1;9(3):444-452. doi: 10.14336/AD.2017.0808. eCollection 2018 Jun.
Both white matter hyperintensities (WMHs) and lacunar infarctions (LIs) are magnetic resonance imaging (MRI) markers of cerebral small vessel disease (SVD). However, the association between WMH and LI remains unclear. In this study, we asked whether WMH progression is related to LI occurrence using retrospective data. Overall, 8475 WMH patients with at least two MRI images were screened, and 187 patients were included in the final study; 76 patients had WMH with LI (WL), and 111 patients had WMH without LI (WOL). The 187 patients were divided into three groups according to WMH progression: Group 1 (no progression), Group 2 (0-53.64% WMH progression) and Group 3 (≥53.64% WMH progression). We found that both WMH volumes and Fazekas scores were higher in WL patients compared with those in WOL patients according to the 1 and 2 MRI images (P<0.001), whereas WMH progression was not significantly different between these two groups (P>0.05). Importantly, we found that the occurrence rates for LI were increased in Groups 2 and 3 compared with those in Group 1. Multiple logistic regression analysis demonstrated that the risk of LI occurrence was significantly increased in Group 2 versus that in Group 1 (odds ratio, 3.36; 95% CI, 1.48 to 7.67; P=0.004) after adjusting for the baseline patient characteristics and the interval between the two MRI scans. Additionally, with a stratification time of less than 24 months, the risk of LI occurrence was higher in Group 2 versus that in Group 1, after adjusting for baseline confounding factors (odds ratio, 3.68; 95% CI, 1.51 to 8.99; P=0.004). In conclusion, we found that WMH progression was significantly associated with LI occurrence, particularly within the first two years, and that this progression could serve as an independent indicator of LI development.
脑白质高信号（WMHs）和腔隙性脑梗死（LIs）都是脑小血管病（SVD）的磁共振成像（MRI）标志物。然而，WMH与LI之间的关联仍不明确。在本研究中，我们利用回顾性数据探究WMH进展是否与LI的发生有关。总体而言，我们筛选了8475例至少有两张MRI图像的WMH患者，最终187例患者纳入研究；76例患者为伴有LI的WMH（WL），111例患者为不伴有LI的WMH（WOL）。根据WMH进展情况，将187例患者分为三组：第1组（无进展）、第2组（WMH进展0 - 53.64%）和第3组（WMH进展≥53.64%）。我们发现，根据首次和第二次MRI图像，WL患者的WMH体积和 Fazekas评分均高于WOL患者（P<0.001），而两组之间的WMH进展无显著差异（P>0.05）。重要的是，我们发现第2组和第3组的LI发生率高于第1组。多因素logistic回归分析表明，在调整患者基线特征和两次MRI扫描间隔后，第2组发生LI的风险显著高于第1组（比值比，3.36；95%CI，1.48至7.67；P = 0.004）。此外，在分层时间小于24个月时，调整基线混杂因素后，第2组发生LI的风险高于第1组（比值比，3.68；95%CI，1.51至8.99；P = 0.004）。总之，我们发现WMH进展与LI发生显著相关，尤其是在头两年内，并且这种进展可作为LI发展的独立指标。
