上海社区队列脑小血管病影像标志物发现率及其危险因素的研究

Prevalence and risk factors of cerebral small vessel disease neuroimaging markers:a Shanghai community cohort study

目的探究上海社区老年人群中脑小血管病主要影像标志物的发现率、年龄分布及其危险因素。方法自2016年8月-2019年10月招募上海静安、青浦、闵行区内年龄≥50岁且符合入组标准的受试者。通过统一设计的临床研究登记表、神经心理评估、实验室检查及多模式磁共振对受试者进行信息采集,评估腔隙、白质高信号、脑微出血及血管周围间隙的发现率、严重程度及分布情况,使用多因素Logistic回归模型分析各影像标志物与血管病危险因素的相关性。结果共纳入870名受试者,中位年龄68岁,男性占40.2%。腔隙、白质高信号(Fazekas≥2)、脑微出血及血管周围间隙的发现率分别为17.6%、29.4%、27.8%、96.5%。年龄每增加10岁,腔隙的发生率就增加35%、白质高信号增加126%、脑微出血增加51%。高血压患者相对于非高血压患者腔隙、白质高信号、脑微出血及血管周围间隙的风险分别是1.98、1.64、1.91和1.45倍。结论社区老年人群中脑小血管病的最主要危险因素是年龄与高血压,不同年龄层中的单个影像标志物发现率和脑小血管病总体评分对于脑小血管病的诊断可能有临床意义。

Objective To investigate the prevalence,age distribution and risk factors of cerebral small vessel disease(CSVD)neuroimaging markers in Shanghai elderly community population.Methods From August 2016 to October 2019,subjects aged above 50 years and qualified for the study were enrolled from Jingan,Qingpu and Minghang districts in Shanghai.Uniformly designed clinical research forms,neuropsychological assessment,laboratory tests and MRI were performed to gather information and to analyze the prevalence,severity and distribution of lacune,white matter hyperintensity(WMH),cerebral microbleed(CMB)and perivascular space(PVS).Associations between risk factors and neuroimaging markers were analyzed by multivariate logistic regression models.Results Among 870 enrolled subjects who had undergone MRI,median age was 68 years and 40.2%male.Lacune,WMH(Fazekas≥2),CMB and PVS were detected in 17.6%,29.4%,27.8%,96.5%of subjects respectively.With every 10 years’increase in age,there was a 35%increase in lacune,126%increase in WMH and 51%increase in CMB.Compared with non-hypertensive subjects,hypertensive subjects had a 1.98-fold of risk detecting lacune on MRI,while a 1.64,1.91,1.45 fold of risk for WMH,CMB and PVS.Conclusions Age and hypertension are the major risk factors for CSVD in elderly community population.Age-stratified prevalence of single imaging marker and total CSVD score may have a clinical significance in diagnosing CSVD.