Longstreth W T, Manolio T A, Arnold A, Burke G L, Bryan N, Jungreis C A, Enright P L, O'Leary D, Fried L
Department of Neurology, University of Washington, Seattle, USA.
Stroke. 1996 Aug;27(8):1274-82. doi: 10.1161/01.str.27.8.1274.
Our aim was to identify potential risk factors for and clinical manifestations of white matter findings on cranial MRI in elderly people.
Medicare eligibility lists were used to obtain a representative sample of 5888 community-dwelling people aged 65 years or older. Correlates of white matter findings were sought among 3301 participants who underwent MRI scanning and denied a history of stroke or transient ischemic attack. Participants underwent extensive standardized evaluations at baseline and on follow-up, including standard questionnaires, physical examination, multiple blood tests, electrocardiogram, pulmonary function tests, carotid sonography, and M-mode echocardiography. Neuroradiologists graded white matter findings from 0 (none) to 9 (maximal) without clinical information.
Many potential risk factors were related to the white matter grade, but in the multivariate model the factors significantly (all P < .01) and independently associated with increased grade were greater age, clinically silent stroke on MRI, higher systolic blood pressure, lower forced expiratory volume in 1 second (FEV1), and income less than $50,000 per year. If excluded, FEV1 was replaced in the model by female sex, history of smoking, and history of physician-diagnosed hypertension at the baseline examination. Many clinical features were correlated with the white matter grade, especially those indicating impaired cognitive and lower extremity function.
White matter findings were significantly associated with age, silent stroke, hypertension, FEV1, and income. The white matter findings may not be considered benign because they are associated with impaired cognitive and lower extremity function.
我们的目的是确定老年人头颅磁共振成像（MRI）上白质病变的潜在危险因素及临床表现。
利用医疗保险资格名单获取了5888名年龄在65岁及以上社区居民的代表性样本。在3301名接受MRI扫描且否认有中风或短暂性脑缺血发作病史的参与者中寻找白质病变的相关因素。参与者在基线和随访时接受了广泛的标准化评估，包括标准问卷、体格检查、多项血液检查、心电图、肺功能测试、颈动脉超声检查和M型超声心动图检查。神经放射科医生在不了解临床信息的情况下将白质病变从0（无）分级到9（最大）。
许多潜在危险因素与白质分级有关，但在多变量模型中，与分级增加显著（所有P <.01）且独立相关的因素是年龄较大、MRI上的临床无症状性中风、收缩压较高、第一秒用力呼气量（FEV1）较低以及年收入低于50,000美元。如果排除FEV1，则在模型中用女性性别、吸烟史和基线检查时医生诊断的高血压史代替。许多临床特征与白质分级相关，尤其是那些表明认知和下肢功能受损的特征。
白质病变与年龄、无症状性中风、高血压、FEV1和收入显著相关。白质病变可能不能被视为良性，因为它们与认知和下肢功能受损有关。
