Uehara T, Tabuchi M, Mori E
Neurology Service, Hyogo Brain and Heart Center at Himeji, and Department of Clinical Neurosciences, Hyogo Institute for Aging Brain and Cognitive Disorders, Himeji, Japan.
Stroke. 1999 Feb;30(2):378-82. doi: 10.1161/01.str.30.2.378.
The purpose of this study was to clarify whether the relevant risk factors for silent cerebral infarcts (SCIs) in subcortical white matter (WM) are different from those in the basal ganglia (BG).
Subjects of this study were 219 adults without a history of stroke or transient ischemic attack and without any abnormality on a neurological examination who consecutively visited the neurology service in our hospital between January 1994 and November 1997 requesting medical evaluation for possible cerebrovascular diseases. Subjects included 141 men and 78 women ranging in age from 33 to 83 years (mean+/-SD, 63.2+/-9.5 years). We performed brain MRIs and cervical/cranial MR angiographies on all subjects. In this study, SCI was defined as a focal lesion >5 mm in diameter that was prolonged on both T2-weighted and proton density images.
SCIs in the WM and/or BG were detected in 88 (40.2%) of the 219 subjects. No SCI >15 mm was observed in this series. Fifty of the subjects had SCIs only in the WM, 32 subjects had SCIs in both the WM and BG, and 6 subjects had SCIs only in the BG. Thus, 82 (93.2%) of 88 subjects with SCIs had lesions in the WM. Most subjects with SCIs in the BG also had SCIs in the WM. Multiple logistic regression analyses revealed that age, female sex, and hypertension were significant and independent predictors of SCIs in the WM, and that age, a history of ischemic heart disease, and carotid artery stenosis were significant and independent predictors of SCIs in the BG.
The present study indicated that the relevant risk factors for SCIs in the WM and those for SCI in the BG were different. Our results suggest that SCIs are prone to first appear in the WM in association with aging and hypertension, and the additional appearance of SCIs in the BG predicts a progression of generalized atherosclerosis that is manifested in the carotid and coronary arteries.
本研究旨在明确皮质下白质（WM）中无症状性脑梗死（SCI）的相关危险因素是否与基底节（BG）中的不同。
本研究的受试者为219名无卒中或短暂性脑缺血发作病史且神经系统检查无任何异常的成年人，他们在1994年1月至1997年11月期间连续到我院神经科就诊，要求对可能的脑血管疾病进行医学评估。受试者包括141名男性和78名女性，年龄在33至83岁之间（平均±标准差，63.2±9.5岁）。我们对所有受试者进行了脑部MRI和颈部/头部MR血管造影。在本研究中，SCI被定义为在T2加权像和质子密度像上均呈延长的直径>5mm的局灶性病变。
219名受试者中有88名（40.2%）在WM和/或BG中检测到SCI。本系列中未观察到直径>15mm的SCI。50名受试者仅在WM中有SCI，32名受试者在WM和BG中均有SCI，6名受试者仅在BG中有SCI。因此，88名有SCI的受试者中有82名（93.2%）在WM中有病变。大多数BG中有SCI的受试者在WM中也有SCI。多因素logistic回归分析显示，年龄、女性性别和高血压是WM中SCI的显著且独立的预测因素，年龄、缺血性心脏病史和颈动脉狭窄是BG中SCI的显著且独立的预测因素。
本研究表明，WM中SCI的相关危险因素与BG中SCI的相关危险因素不同。我们的结果表明，SCI易于随着衰老和高血压首先出现在WM中，而BG中SCI的额外出现预示着在颈动脉和冠状动脉中表现出的全身性动脉粥样硬化的进展。
