Zhang Shoulong, Wang Nuo, Chen Lei, Zhang Ping, Shen Lei, Huang Shiren, Zhang Chunyang, Deng Benqiang
Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China; Heping Hospital, Shijiazhuang, China.
Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
J Stroke Cerebrovasc Dis. 2019 Mar;28(3):523-530. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.053. Epub 2018 Dec 8.
Elevated serum aldosterone concentration is known to be linked with elevated risk of cerebrovascular events as a result of vascular senescence. We studied the association between serum aldosterone concentration and cerebral arteriosclerosis status involving cerebral atherosclerosis burden and cerebral vascular calcification.
A total of 207 patients (mean age = 62.40 ± 10.54, 70 female patients) admitted with acute ischemic stroke from a single center-based stroke registry were included in the study. The participants were categorized into 4 groups in accordance to the serum aldosterone concentration. Cerebral atherosclerosis burden was derived as the stenosis degree of main intracranial arteries, and cerebral artery calcification was investigated from the cavernous portions of both internal carotid arteries from brain computed tomography angiography.
The median aldosterone was 146.00 pg/mL; interquartile range was 133.18-172.10 pg/mL. Advanced intracranial atherosclerosis was present in 134 patients (64.7%) and advanced intracranial arterial calcification was present in 77 patients (37.2%). The prevalence of cerebral atherosclerosis burden and cerebral artery calcification showed increasing tendency through the aldosterone quartiles. Multivariable logistic regression analysis including age, sex, vascular risk factors, estimated glomerular filtration rate and aldosterone quartiles disclosed that the highest serum aldosterone quartile was an independent predictor of advanced intracranial atherosclerosis (odds ratio, 5.07; 95% confidence interval, 1.82-14.17; P = .001) and advanced intracranial arterial calcification (odds ratio, 6.24; 95% confidence interval, 2.03-19.22; P = .001).
An increased serum aldosterone concentration was independently associated with intracranial atherosclerosis burden and arterial calcification. Future studies should investigate whether aldosterone antagonists prevent stroke in at risk population.
已知血清醛固酮浓度升高与血管衰老导致的脑血管事件风险增加有关。我们研究了血清醛固酮浓度与脑动脉硬化状态之间的关联，包括脑动脉粥样硬化负担和脑血管钙化。
本研究纳入了来自单中心卒中登记处的207例急性缺血性卒中患者（平均年龄=62.40±10.54岁，女性患者70例）。参与者根据血清醛固酮浓度分为4组。脑动脉粥样硬化负担通过主要颅内动脉的狭窄程度得出，脑动脉钙化通过脑部计算机断层血管造影术对双侧颈内动脉海绵窦段进行研究。
醛固酮中位数为146.00 pg/mL；四分位数间距为133.18 - 172.10 pg/mL。134例患者（64.7%）存在重度颅内动脉粥样硬化，77例患者（37.2%）存在重度颅内动脉钙化。脑动脉粥样硬化负担和脑动脉钙化的患病率在醛固酮四分位数分组中呈上升趋势。多变量逻辑回归分析纳入年龄、性别、血管危险因素、估计肾小球滤过率和醛固酮四分位数，结果显示血清醛固酮最高四分位数是重度颅内动脉粥样硬化（比值比，5.07；95%置信区间，1.82 - 14.17；P = 0.001）和重度颅内动脉钙化（比值比，6.24；95%置信区间，2.03 - 19.22；P = 0.001）的独立预测因素。
血清醛固酮浓度升高与颅内动脉粥样硬化负担和动脉钙化独立相关。未来研究应探讨醛固酮拮抗剂是否能预防高危人群发生卒中。
