无症状大脑中动脉狭窄患者脑白质改变进展的危险因素

Risk factors for progression of white matter changes among asymptomatic patients with middle cerebral artery stenosis

目的对一项随机研究进行分析,探讨无症状大脑中动脉狭窄患者脑白质改变(white matter changes,WMC)发生和进展的危险因素。方法对无中风症状,但存在动脉硬化危险因素的患者进行磁共振检查,入选大脑中动脉(middle cerebral artery,MCA)狭窄的患者。记录临床特点和基础血生化指标,随访2年,随访结束时再次行磁共振检查。WMC采用定量分析,体积增加超过所有患者WMC体积增加的平均值被定义为有进展。Logistic回归分析确定WMC发生和进展的独立危险因素。结果 220例无症状MCA狭窄者患中,69例存在WMC,Logistic回归分析显示年龄(OR=1.096,P<0.001)和高血压(OR=2.370,P=0.024)是WMC发生的独立危险因素。在进入研究时,69例的WMC平均体积为4.23cm3,经过两年时间增加至5.49cm3,有6例未能完成随访。随访结束时发现63例中24例(38.1%)WMC有进展。Logistic回归分析发现仅有基础WMC体积是预测WMC进展的独立危险因素(OR=1.329,P=0.003)。结论年龄和高血压是WMC发生的独立预测因素,而对于WMC的进展则是基础WMC体积更有预测意义,也就是说发现时WMC越严重,进展的机会越多,尽早发现WMC可能对于预防进展更有意义。

Objective We did a post-hoe analysis of the MRIs of a randomized study among stroke-free individu- als aiming to find the risk factors for the development and progression of WMC. Methods We examined 220 MRI of stroke-free individuals with traditional risk factors for atherosclerosis and middle cerebral artery stenosis. Clinical character- istics and basic blood biochemistry were recorded. All subjects were followed for 2 years. Serial MRI examinations were per- formed at the baseline and the end of 2 years. Progression of WMC was defined as the increase of volume more than the mean increase of the whole group during the 2 years follow-up. Logistic regression analysis was used to decide the predictors of the development and progression of WMC using SPSS 10. 0 for windows. Results Sixty-nine individuals had WMC at the baseline and 63 underwent serial MRI examinations. Age （ OR = 1. 096, P 〈 0. 001 ） and hypertension （ OR = 2. 370, P = 0. 024） were the only significant risk factors for WMC at baseline among the 220 individuals. Among the 63 cases with seri- al MRI, twenty-four individuals had WMC progression. After multivariate logistic regression analysis, the baseline volume of WMC （ OR = 1. 329, P = 0. 003） was the only independent risk factor for the progression of WMC. Conclusions Age and hypertension are the two dependent risk factors for the development of WMC. Volume of WMC at the baseline may play roles in predicting progression of WMC. Early detection of WMC will be important for preventing the progression of WMC.