Hosoki Satoshi, Saito Satoshi, Tonomura Shuichi, Ishiyama Hiroyuki, Yoshimoto Takeshi, Ikeda Shuhei, Ikenouchi Hajime, Yamamoto Yumi, Hattori Yorito, Miwa Kaori, Friedland Robert P, Carare Roxana O, Nakahara Jin, Suzuki Norihiro, Koga Masatoshi, Toyoda Kazunori, Nomura Ryota, Nakano Kazuhiko, Takegami Misa, Ihara Masafumi
Department of Neurology (S.H., S.S., S.T., H. Ishiyama, T.Y., S.I., H. Ikenouchi, Y.H., M.I.), National Cerebral and Cardiovascular Center, Suita, Japan.
Department of Neurology, Keio University School of Medicine, Tokyo, Japan (S.H., J.N., N.S., K.T.).
Stroke. 2020 Dec;51(12):3632-3639. doi: 10.1161/STROKEAHA.120.029607. Epub 2020 Nov 5.
Cerebral microbleeds (CMB) are associated with stroke and cognitive impairment. We previously reported a high prevalence of CMB in people with expressing Cnm, a collagen-binding protein in the oral cavity. is a major pathogen responsible for dental caries. Repeated challenge with harboring the gene encoding Cnm induced cerebral bleeding in stroke-prone spontaneously hypertensive rats. The purpose of this longitudinal study is to examine the relationship of -positive to the development of CMB.
We retrospectively investigated patients with stroke receiving oral microbiological examination and head 3T magnetic resonance imaging evaluations twice in the period 2014 to 2019, allowing >180-day interval. Patients with -positive were compared with those without. Quasi-Poisson regression models were used to explore associations between -positive and the increase in number of CMB between the 2 magnetic resonance imaging scans.
A total of 111 patients were identified; 21 (19%) with -positive and 90 (81%) without. Clinical history, including blood pressure and the use of antithrombotic agents, were comparable between the 2 groups. New CMB were more commonly observed in patients with -positive (52% versus 23%; =0.008). The incidence of CMB was significantly higher in the group with -positive , especially in deep areas, (incidence rate ratios [95% CI], 5.1 [1.9-13.6] for CMB in any brain region; 15.0 [5.4-42.0] for deep CMB), which persisted after adjusting for age, sex, hypertension, and renal impairment (4.7 [1.8-11.9] for CMB in any brain region; 13.9 [4.3-44.5] for deep CMB).
This study demonstrates that -positive is associated with an increased incidence of CMB. Treatment for -positive infection may be a novel microbiota-based therapeutic approach for stroke and cognitive impairment.
脑微出血（CMB）与中风及认知障碍相关。我们之前报道，在表达口腔中一种胶原结合蛋白Cnm的人群中，CMB的患病率很高。变形链球菌是导致龋齿的主要病原体。用携带编码Cnm基因的变形链球菌反复攻击易中风自发性高血压大鼠会诱发脑出血。这项纵向研究的目的是检验变形链球菌阳性与CMB发生之间的关系。
我们回顾性调查了2014年至2019年期间接受口腔微生物学检查和头部3T磁共振成像评估两次（间隔时间>180天）的中风患者。将变形链球菌阳性患者与阴性患者进行比较。使用准泊松回归模型探讨变形链球菌阳性与两次磁共振成像扫描之间CMB数量增加之间的关联。
共确定了111例患者；21例（19%）变形链球菌阳性，90例（81%）阴性。两组之间的临床病史，包括血压和抗血栓药物的使用情况具有可比性。在变形链球菌阳性患者中更常观察到新的CMB（52%对23%；P=0.008）。变形链球菌阳性组中CMB的发生率显著更高，尤其是在深部区域，（任何脑区CMB的发病率比[95%CI]，5.1[1.9 - 13.6]；深部CMB为15.0[5.4 - 42.0]），在调整年龄、性别、高血压和肾功能损害后仍然存在（任何脑区CMB为4.7[1.8 - 11.9]；深部CMB为13.9[4.3 - 44.5]）。
本研究表明变形链球菌阳性与CMB发生率增加有关。治疗变形链球菌阳性感染可能是一种基于微生物群的中风和认知障碍新治疗方法。
