Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing, Beijing, 100730, China.
Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
BMC Neurol. 2024 Sep 6;24(1):328. doi: 10.1186/s12883-024-03835-5.
Intracranial artery stenosis (ICAS) and cerebral small vessel disease (CSVD) are associated with a heavy socioeconomic burden; however, their longitudinal changes remain controversial.
We conducted a longitudinal analysis on 756 participants of Shunyi Cohort who underwent both baseline and follow-up brain magnetic resonance imaging (MRI) and MR angiography in order to investigate the risk factors for ICAS and CSVD progression in community population. Incident ICAS was defined as new stenosis occurring in at least one artery or increased severity of the original artery stenosis. CSVD markers included lacunes, cerebral microbleeds (CMB), and white matter hyperintensities (WMH).
After 5.58 ± 0.49 years of follow-up, 8.5% of the 756 participants (53.7 ± 8.0 years old, 65.1% women) had incident ICAS. Body mass index (BMI) (OR = 1.09, 95% CI = 1.01-1.17, p = 0.035) and diabetes mellitus (OR = 2.67, 95% CI = 1.44-4.93, p = 0.002) were independent risk factors for incident ICAS. Hypertension was an independent risk factor for incident lacunes (OR = 2.12, 95% CI = 1.20-3.77, p = 0.010) and CMB (OR = 2.32, 95% CI = 1.22-4.41, p = 0.011), while WMH progression was primarily affected by BMI (β = 0.108, SE = 0.006, p = 0.002). A higher LDL cholesterol level was found to independently protect against WMH progression (β = -0.076, SE = 0.027, p = 0.019).
Modifiable risk factor profiles exhibit different in patients with ICAS and CSVD progression. Controlling BMI and diabetes mellitus may help to prevent incident ICAS, and antihypertensive therapy may conduce to mitigate lacunes and CMB progression. LDL cholesterol may play an inverse role in large arteries and small vessels.
颅内动脉狭窄（ICAS）和脑小血管病（CSVD）与沉重的社会经济负担相关；然而，其纵向变化仍存在争议。
我们对 756 名顺义队列的参与者进行了一项纵向分析，这些参与者均在基线和随访时接受了脑磁共振成像（MRI）和磁共振血管造影（MRA）检查，以研究社区人群中 ICAS 和 CSVD 进展的危险因素。新发 ICAS 定义为至少一条动脉出现新的狭窄或原有动脉狭窄程度加重。CSVD 标志物包括腔隙、脑微出血（CMB）和脑白质高信号（WMH）。
在 5.58±0.49 年的随访后，756 名参与者中有 8.5%（53.7±8.0 岁，65.1%为女性）发生了新发 ICAS。体重指数（BMI）（比值比[OR] = 1.09，95%置信区间[CI] = 1.01-1.17，p = 0.035）和糖尿病（OR = 2.67，95%CI = 1.44-4.93，p = 0.002）是新发 ICAS 的独立危险因素。高血压是新发腔隙性病变（OR = 2.12，95%CI = 1.20-3.77，p = 0.010）和 CMB（OR = 2.32，95%CI = 1.22-4.41，p = 0.011）的独立危险因素，而 WM H 进展主要受 BMI 影响（β = 0.108，SE = 0.006，p = 0.002）。发现 LDL 胆固醇水平升高可独立保护 WM H 进展（β = -0.076，SE = 0.027，p = 0.019）。
可改变的危险因素谱在 ICAS 和 CSVD 进展患者中表现不同。控制 BMI 和糖尿病可能有助于预防新发 ICAS，而降压治疗可能有助于减轻腔隙性病变和 CMB 进展。LDL 胆固醇可能在大动脉和小血管中发挥相反作用。
