Shu Junlong, Fei Wen, Zhang Jing, Li Fan, Hao Yu, Ding Zhijie, Ji Shiyong, Zhao Weiwei, Hu Yaxiong, Sun Wei, Huang Yining, Zhao Yuhua, Zhang Wei
Department of Neurology, Peking University First Hospital, Beijing, China.
Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China.
Front Neurol. 2023 Mar 9;14:1086476. doi: 10.3389/fneur.2023.1086476. eCollection 2023.
Cerebral small-vessel disease (CSVD) is prevalent worldwide and one of the major causes of stroke and dementia. For patients with CSVD at high altitude, a special environmental status, limited information is known about their clinical phenotype and specific neuroimaging change. We investigated the clinical and neuroimaging features of patients residing at high altitude by comparing with those in the plain, trying to explore the impact of high altitude environment on CSVD.
Two cohorts of CSVD patients from the Tibet Autonomous Region and Beijing were recruited retrospectively. In addition to the collection of clinical diagnoses, demographic information and traditional vascular risk factors, the presence, location, and severity of lacunes and white matter hyperintensities were assessed by manual counting and using age-related white matter changes (ARWMC) rating scale. Differences between the two groups and influence of long-term residing in the plateau were analyzed.
A total of 169 patients in Tibet (high altitude) and 310 patients in Beijing (low altitude) were enrolled. Fewer patients in high altitude group were found with acute cerebrovascular events and concomitant traditional vascular risk factors. The median (quartiles) ARWMC score was 10 (4, 15) in high altitude group and 6 (3, 12) in low altitude group. Less lacunes were detected in high altitude group [0 (0, 4)] than in low altitude group [2 (0, 5)]. In both groups, most lesions located in the subcortical (especially frontal) and basal ganglia regions. Logistic regressions showed that age, hypertension, family history of stroke, and plateau resident were independently associated with severe white matter hyperintensities, while plateau resident was negatively correlated with lacunes.
Patients of CSVD residing at high altitude showed more severe WMH but less acute cerebrovascular events and lacunes in neuroimaging, comparing to patients residing at low altitude. Our findings suggest potential biphasic effect of high altitude on the occurrence and progression of CSVD.
脑小血管病（CSVD）在全球范围内普遍存在，是中风和痴呆的主要原因之一。对于处于特殊环境状态——高海拔地区的CSVD患者，其临床表型和特定神经影像学变化的相关信息有限。我们通过与平原地区患者进行比较，调查了居住在高海拔地区患者的临床和神经影像学特征，试图探索高海拔环境对CSVD的影响。
回顾性招募了来自西藏自治区和北京的两组CSVD患者。除收集临床诊断、人口统计学信息和传统血管危险因素外，还通过手动计数和使用年龄相关白质改变（ARWMC）评分量表评估腔隙性梗死和白质高信号的存在、位置及严重程度。分析了两组之间的差异以及长期居住在高原地区的影响。
共纳入169名西藏（高海拔）患者和310名北京（低海拔）患者。高海拔组发生急性脑血管事件和伴有传统血管危险因素的患者较少。高海拔组ARWMC评分中位数（四分位数）为10（4，15），低海拔组为6（3，12）。高海拔组检测到的腔隙性梗死[0（0，4）]比低海拔组[2（0，5）]少。在两组中，大多数病变位于皮质下（尤其是额叶）和基底节区。逻辑回归显示，年龄、高血压、中风家族史和高原居住与严重白质高信号独立相关，而高原居住与腔隙性梗死呈负相关。
与居住在低海拔地区的患者相比，居住在高海拔地区的CSVD患者在神经影像学上显示出更严重的白质高信号，但急性脑血管事件和腔隙性梗死较少。我们的研究结果表明高海拔对CSVD的发生和发展可能具有双相效应。
