Wang Juan, Xi Yuan-Xue, Li Jia-Qi, Zhu Wei-Wen
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
School of Public Health, Guangzhou Medical University, Guangzhou, China.
Front Aging Neurosci. 2022 Sep 29;14:998268. doi: 10.3389/fnagi.2022.998268. eCollection 2022.
Subcortical ischemic vascular disease (SIVD) is a leading cause of vascular dementia. The present study tries to explore not only the gender-specific association between H-type hypertension and SIVD but also the indirect effects of H-type hypertension on cognition through the ischemic brain injury caused by SIVD.
A total of 601 SIVD patients were included, comprising 322 males and 279 females. H-type hypertension was defined as hypertension accompanied with elevated serum total homocysteine (tHcy) level. The imaging manifestations of ischemic brain injury caused by SIVD were also evaluated, including white matter lesions (WML), lacunar infarction (LI) and brain atrophy (BA). Gender-specific subgroup analyses in association between H-type hypertension and SIVD were conducted, followed by a structural equation model based evaluation of the gender-specific mediating effects of SIVD on the relationship between H-type hypertension and cognition.
For males, there was no noticeable difference in WML, LI and BA scores among control group, isolated hypertension group, isolated high tHcy group, and H-type hypertension group in most brain regions, but significant difference was found in all brain regions for females. Multiple regression analyses showed that H-type hypertension was significantly associated with WML, LI and BA for females, but not for males. For males, H-type hypertension mainly affected cognition through direct effect, while the H-type hypertension effect was mediated by ischemic brain injury caused by SIVD for females.
H-type hypertension was more closely related to SIVD for females than males, suggesting a gender-specific difference in association patterns between H-type hypertension and cognition.
皮质下缺血性血管疾病（SIVD）是血管性痴呆的主要病因。本研究不仅试图探讨H型高血压与SIVD之间的性别特异性关联，还试图探讨H型高血压通过SIVD引起的缺血性脑损伤对认知的间接影响。
共纳入601例SIVD患者，其中男性322例，女性279例。H型高血压定义为伴有血清总同型半胱氨酸（tHcy）水平升高的高血压。还评估了SIVD引起的缺血性脑损伤的影像学表现，包括白质病变（WML）、腔隙性梗死（LI）和脑萎缩（BA）。对H型高血压与SIVD之间的关联进行了性别特异性亚组分析，随后基于结构方程模型评估了SIVD对H型高血压与认知关系的性别特异性中介作用。
对于男性，在大多数脑区，对照组、单纯高血压组、单纯高tHcy组和H型高血压组之间的WML、LI和BA评分无明显差异，但女性在所有脑区均有显著差异。多元回归分析显示，H型高血压与女性的WML、LI和BA显著相关，但与男性无关。对于男性，H型高血压主要通过直接作用影响认知，而对于女性，H型高血压的作用是由SIVD引起的缺血性脑损伤介导的。
H型高血压与女性SIVD的关系比男性更为密切，提示H型高血压与认知之间的关联模式存在性别特异性差异。
