Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel (S.K.).
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland (S.K., A.L.C.S., R.F.G., J.C.).
Stroke. 2020 Nov;51(11):3264-3270. doi: 10.1161/STROKEAHA.120.030063. Epub 2020 Oct 1.
Data on the significance of combined white matter hyperintensities (WMH)/lacunar brain infarcts, and their progression over time for the prediction of stroke are scarce. We studied associations between the progression in combined measures of microvascular brain disease and risk of stroke in the ARIC study (Atherosclerosis Risk in Communities).
Prospective analysis of 907 stroke-free ARIC participants who underwent a brain magnetic resonance imaging (MRI) in 1993 to 1995, a second brain MRI in 2004 to 2006, and were subsequently followed for stroke incidence through December 31, 2017 (median [25%-75%] follow-up 12.6 [8.9-13.4] years). A combined measure of microvascular brain disease was defined at each visit and categorized by progression from first to second brain MRI as no progression; mild progression (increase of ≥1 unit in WMH grade or new lacune), and moderate progression (increase of ≥1 unit in WMH grade and new lacune). All definite/probable ischemic or hemorrhagic incident strokes occurring after this second MRI, and through 2017, were included. Associations between microvascular brain disease, progression in the combined measures, and stroke incidence were studied with Cox proportional hazard models, adjusting for age, sex, race, education level, time from first to second MRI, body mass index, smoking, hypertension, diabetes mellitus, and coronary heart disease.
At the second brain MRI (mean age 72), the distribution of the combined measure was 37% WMH grade <2 and no lacune; 57% WMH grade ≥2 or lacune; and 6% WMH grade ≥2 and lacune. No progression in the combined measures was observed in 38% of participants, 57% showed mild progression and 5% showed moderate progression. Sixty-four incident strokes occurred during the follow-up period. Compared with no change in the combined measure, moderate progression of microvascular brain disease was significantly associated with higher risk of stroke (adjusted hazard ratio, 3.00 [95% CI, 1.30-6.94]).
Progression of microvascular brain disease, manifesting as both new lacunes and increase in WMHs grade, is related to substantial increase in long-term risk of stroke.
关于脑白质病变（WMH）/腔隙性脑梗死联合病变的意义及其随时间进展对卒中预测的价值的数据较少。我们在 ARIC 研究（社区动脉粥样硬化风险研究）中研究了微血管脑疾病进展与卒中风险之间的关联。
对 907 例无卒中的 ARIC 参与者进行前瞻性分析，这些参与者于 1993 年至 1995 年接受了脑部磁共振成像（MRI）检查，于 2004 年至 2006 年接受了第二次脑部 MRI 检查，并通过 2017 年 12 月 31 日（中位[25%-75%]随访时间 12.6[8.9-13.4]年）进行卒中发病情况随访。在每次检查时定义微血管脑疾病的综合指标，并根据从第一次 MRI 到第二次 MRI 的进展情况进行分类：无进展；轻度进展（WMH 分级增加≥1 级或出现新的腔隙）；中度进展（WMH 分级增加≥1 级和出现新的腔隙）。所有在第二次 MRI 检查后且至 2017 年发生的明确/可能的缺血性或出血性卒中事件均纳入研究。使用 Cox 比例风险模型研究微血管脑疾病、综合指标的进展与卒中发病之间的关联，调整因素包括年龄、性别、种族、教育程度、从第一次 MRI 到第二次 MRI 的时间、体重指数、吸烟、高血压、糖尿病和冠心病。
在第二次脑部 MRI 检查时（平均年龄 72 岁），综合指标的分布情况为：37%的患者 WMH 分级<2 且无腔隙；57%的患者 WMH 分级≥2 或有腔隙；6%的患者 WMH 分级≥2 且有腔隙。38%的患者无综合指标的进展，57%的患者有轻度进展，5%的患者有中度进展。在随访期间发生了 64 例卒中事件。与综合指标无变化相比，微血管脑疾病的中度进展与卒中风险显著升高相关（校正后的危险比为 3.00[95%置信区间，1.30-6.94]）。
新腔隙和 WMH 分级增加的微血管脑疾病进展与长期卒中风险的显著增加相关。
