Department of Neurology, Boston University School of Medicine, MA (A.A.P., H.L., V.L.B., J.S., A.C.-A., S.G., D.G., H.J.A., J.R.R.).
Department of Neurology, VA Boston Healthcare System, MA (V.L.B.).
Stroke. 2020 Nov;51(11):3348-3351. doi: 10.1161/STROKEAHA.119.028688. Epub 2020 Oct 6.
Enlarged perivascular spaces (EPVS) are considered subclinical markers of small vessel disease, associated with increased risk of stroke and dementia. Increasing evidence links chronic kidney disease (CKD) to small vessel disease. We explored the relationship between CKD and EPVS burden and the influence of racial group in this relation.
Consecutive patients with stroke who underwent brain magnetic resonance imaging were included (n=894). Racial group was categorized as White, Black, or other (other racial groups). CKD was defined by glomerular filtration rate <60 mL/minute per 1.73 m for >3 months. EPVS were rated following a standardized method, dichotomized for analyses (mild [<20] versus severe [≥20]), and stratified by brain region (basal ganglia and centrum semiovale).
In multivariable-adjusted analysis, the association of CKD with severe EPVS varied across racial groups. Comparing patients with and without CKD within racial groups, we found that Whites with CKD had higher odds of severe centrum semiovale EPVS (odds ratio [OR], 2.41 [95% CI, 0.98-5.88]). Among patients with CKD, Black patients had higher odds of severe EPVS in the basal ganglia and centrum semiovale compared with Whites (OR, 1.93 [95% CI, 1.18-3.16] and OR, 1.90 [95% CI, 1.16-3.11], respectively) and other racial groups (OR, 2.03 [95% CI, 1.23-3.36] and OR, 2.02 [95% CI, 1.22-3.34], respectively).
CKD was more prevalent in our sample of patients with stroke with severe EPVS in the centrum semiovale. The relation differed when stratified by racial group and brain topography. Further studies are needed to confirm that CKD may relate differently to subclinical measures of small vessel disease according to race.
扩大的血管周围间隙（EPVS）被认为是小血管疾病的亚临床标志物，与中风和痴呆的风险增加有关。越来越多的证据表明慢性肾脏病（CKD）与小血管疾病有关。我们探讨了 CKD 与 EPVS 负担之间的关系，以及这种关系中种族群体的影响。
连续纳入了接受脑部磁共振成像检查的中风患者（n=894）。种族群体分为白种人、黑种人和其他（其他种族群体）。CKD 的定义为肾小球滤过率<60 mL/min/1.73 m2>3 个月。EPVS 采用标准化方法进行评分，分为轻度（<20）和重度（≥20），并按脑区（基底节和脑半卵圆中心）分层。
在多变量调整分析中，CKD 与重度 EPVS 的关系在不同种族群体中存在差异。在比较各种族群体内有和无 CKD 的患者后，我们发现白种人 CKD 患者发生重度脑半卵圆中心 EPVS 的几率更高（比值比 [OR]，2.41[95%置信区间，0.98-5.88]）。在 CKD 患者中，黑种人发生基底节和脑半卵圆中心重度 EPVS 的几率高于白种人（OR，1.93[95%置信区间，1.18-3.16]和 OR，1.90[95%置信区间，1.16-3.11]）和其他种族群体（OR，2.03[95%置信区间，1.23-3.36]和 OR，2.02[95%置信区间，1.22-3.34]）。
在我们的中风患者样本中，EPVS 严重程度为脑半卵圆中心患者中 CKD 更为常见。当按种族群体和脑区进行分层时，这种关系有所不同。需要进一步的研究来证实 CKD 可能根据种族与小血管疾病的亚临床指标的关系不同。
