JAHA:外周微血管内皮功能障碍对白质高信号的影响

2021-10-10 MedSci原创 MedSci原创

外周内皮功能障碍与50岁以上患者皮质旁WMH体积增加有关,这是预测未来IS风险的潜在标志。

白质高信号(WMH)以T2加权液体衰减反转恢复脑磁共振成像高信号为特征,与缺血性卒中(IS)风险增加有关。内皮功能障碍是血管功能障碍的指标,可预测IS风险。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究旨在调查内皮功能障碍与区域WMH之间的关联,及其对未来IS风险的影响。

研究人员招募了219名患者(平均年龄为53.1±14.1岁;34.7%为男性),他们使用反应性充血外周动脉眼压计和脑磁共振成像进行了外周内皮功能评估,没有任何IS病史。

总体和皮质附近WMH体积/颅内体积(%)随着年龄的增长而增加,并且在50岁以上的患者(n=131)中比50岁以下的患者(n=88)更为突出(总WMH:≤50岁,Pearsonr=0.24,P=0.03;>50岁,Pearsonr=0.62,P<0.0001;近皮质WMH:≤50岁,Pearsonr=0.09,P=0.40;>50岁,Pearsonr=0.55,P<0.0001)。在调整其他协变量后,反应性充血外周动脉张力测量指数与总体和皮质旁WMH体积/颅内体积(%)呈负相关(反应性充血外周动脉张力测量指数,标准化β系数为-0.17,P=0.04)。在中位随访6.5年期间,皮质旁WMH体积/颅内体积(%)与IS风险增加相关(风险比为1.47;95%CI为1.05-1.92;P=0.03)。

由此可见,外周内皮功能障碍与50岁以上患者皮质旁WMH体积增加有关,这是预测未来IS风险的潜在标志。

原始出处:

Takumi Toya.et al.Impact of Peripheral Microvascular Endothelial Dysfunction on White Matter Hyperintensity.JAHA.2021.https://www.ahajournals.org/doi/10.1161/JAHA.121.021066

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createdBy=0a27288, createdName=smallant2002, createdTime=Thu Aug 25 04:48:04 CST 2022, time=2022-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950839, encodeId=2475195083996, content=<a href='/topic/show?id=20101021e97e' target=_blank style='color:#2F92EE;'>#高信号#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102179, encryptionId=20101021e97e, topicName=高信号)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e4137, createdName=meichuangyi, createdTime=Thu Feb 03 03:48:04 CST 2022, time=2022-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663604, encodeId=6205166360411, content=<a href='/topic/show?id=699a89540b9' target=_blank style='color:#2F92EE;'>#血管内皮功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, 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objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1365425, encodeId=a7461365425f1, content=<a href='/topic/show?id=2a2150e76fd' target=_blank style='color:#2F92EE;'>#微血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50776, encryptionId=2a2150e76fd, topicName=微血管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, createdName=mgqwxj, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417585, encodeId=5c15141e585b4, content=<a 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time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1450064, encodeId=56111450064af, content=<a href='/topic/show?id=85eb304409c' target=_blank style='color:#2F92EE;'>#内皮功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30440, encryptionId=85eb304409c, topicName=内皮功能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d41d5536295, createdName=zhangxingru, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2060774, encodeId=6d262060e74ff, content=<a href='/topic/show?id=54ee3044405' target=_blank style='color:#2F92EE;'>#内皮功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30444, encryptionId=54ee3044405, topicName=内皮功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Fri Oct 22 11:48:04 CST 2021, time=2021-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059060, encodeId=276a205906092, content=<a href='/topic/show?id=0fd2895423a' target=_blank style='color:#2F92EE;'>#血管内皮功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89542, encryptionId=0fd2895423a, topicName=血管内皮功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a27288, createdName=smallant2002, createdTime=Thu Aug 25 04:48:04 CST 2022, time=2022-08-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950839, encodeId=2475195083996, content=<a href='/topic/show?id=20101021e97e' target=_blank style='color:#2F92EE;'>#高信号#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102179, encryptionId=20101021e97e, topicName=高信号)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e4137, createdName=meichuangyi, createdTime=Thu Feb 03 03:48:04 CST 2022, time=2022-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663604, encodeId=6205166360411, content=<a href='/topic/show?id=699a89540b9' target=_blank style='color:#2F92EE;'>#血管内皮功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, 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objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1365425, encodeId=a7461365425f1, content=<a href='/topic/show?id=2a2150e76fd' target=_blank style='color:#2F92EE;'>#微血管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50776, encryptionId=2a2150e76fd, topicName=微血管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=669d219, createdName=mgqwxj, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1417585, encodeId=5c15141e585b4, content=<a 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time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1450064, encodeId=56111450064af, content=<a href='/topic/show?id=85eb304409c' target=_blank style='color:#2F92EE;'>#内皮功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30440, encryptionId=85eb304409c, topicName=内皮功能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d41d5536295, createdName=zhangxingru, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2060774, encodeId=6d262060e74ff, content=<a href='/topic/show?id=54ee3044405' target=_blank style='color:#2F92EE;'>#内皮功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30444, encryptionId=54ee3044405, topicName=内皮功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b70c362, createdName=jiadan198782, createdTime=Fri Oct 22 11:48:04 CST 2021, time=2021-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2059060, encodeId=276a205906092, content=<a href='/topic/show?id=0fd2895423a' target=_blank style='color:#2F92EE;'>#血管内皮功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89542, encryptionId=0fd2895423a, topicName=血管内皮功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=, 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href='/topic/show?id=c667e181616' target=_blank style='color:#2F92EE;'>#白质高信号#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71816, encryptionId=c667e181616, topicName=白质高信号)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44693296090, createdName=zhangph, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1421397, encodeId=89c0142139ea9, content=<a href='/topic/show?id=09d33294eb8' target=_blank style='color:#2F92EE;'>#功能障碍#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32947, encryptionId=09d33294eb8, topicName=功能障碍)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b3493649807, createdName=naiwu78, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1450064, encodeId=56111450064af, content=<a href='/topic/show?id=85eb304409c' target=_blank style='color:#2F92EE;'>#内皮功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30440, encryptionId=85eb304409c, topicName=内皮功能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d41d5536295, createdName=zhangxingru, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=)]
    2021-10-12 zhaohui6731
  7. 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time=2021-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1450064, encodeId=56111450064af, content=<a href='/topic/show?id=85eb304409c' target=_blank style='color:#2F92EE;'>#内皮功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30440, encryptionId=85eb304409c, topicName=内皮功能)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d41d5536295, createdName=zhangxingru, createdTime=Tue Oct 12 06:48:04 CST 2021, time=2021-10-12, status=1, ipAttribution=)]
    2021-10-12 mgqwxj
  8. 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由此可见,该研究提供的证据表明在LVO导致的高WMH负担的AIS患者中,MT的安全性和有效性与WMH负荷较低的患者相似,并证实其具有较高的不良预后风险。因为超过四分之一的WMH处于最高四分位数的患者3个月结局较好,所以WMH负担可能不是拒绝MT的理由。

Ann Neurol:内脏肥胖通过炎症引起的深部白质高信号

由此可见,该研究的结果表明,在高内脏脂肪堆积的肥胖受试者深部白质中,选择性地增加了WMH负担,而不依赖于高血压等常见肥胖合并症。中介变量分析提出了内脏肥胖通过增加促炎细胞因子促进深部白质病变,表明它们之间存在病理学机制的联系。需要纵向研究进一步证实这一假设。

JAMA Neurol:可逆性脑血管收缩综合征白质高信号的动态变化

研究发现可逆性脑血管收缩综合征患者的白质高信号病变存在与疾病严重程度平行的动态时间变化,这类患者白质高强度的部分归因于局部灌注不足和中央搏动流阻尼能力受损

Neurology:缺血性脑卒中患者取栓术后白质高信号负荷变化

目的:为了验证白质高信号(WMH)负荷对经机械取栓术(MR)治疗的急性缺血性脑卒中(AIS)患者神经功能预后、症状性颅内出血率(sICH)和手术成功率的影响。