颈动脉粥样硬化对脑小血管病进展的影响:基于顺义队列研究  

The effect of carotid atherosclerosis on the progression of cerebral small vessel disease:based on Shunyi Cohort Study

作　　者：潘子昂 张丁丁 刘子悦 舒美钧 翟菲菲[1] 姚明[1] 周立新[1] 倪俊[1] 金征宇[2] 戴晴[3] 张抒扬[5] 崔丽英[1] 韩菲 朱以诚 PAN Zi‑ang;ZHANG Ding‑ding;LIU Zi‑yue;SHU Mei‑jun;ZHAI Fei‑fei;YAO Ming;ZHOU Li‑xin;NI Jun;JIN Zheng‑yu;DAI Qing;ZHANG Shu‑yang;CUI Li‑ying;HAN Fei;ZHU Yi‑cheng(Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Medical Research Center,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Ultrasound,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院神经科,100730 [2]中国医学科学院,北京协和医学院,北京协和医院医学研究中心,疑难重症及罕见病国家重点实验室,100730 [3]中国医学科学院,北京协和医学院,北京协和医院放射科,100730 [4]中国医学科学院,北京协和医学院,北京协和医院超声医学科,100730 [5]中国医学科学院,北京协和医学院,北京协和医院心内科,100730

出　　处：《中国现代神经疾病杂志》2023年第11期986-992,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：北京协和医院中央高水平医院临床科研专项(项目编号:2022-PUMCH-D-007)。

摘　　要：目的分析顺义队列社区人群基线无症状性颈动脉粥样硬化对脑小血管病进展的影响。方法基于顺义队列人群(2013年6月至2016年4月)共选择年龄≥35岁居民658人为研究对象。颈动脉超声测量基线是否存在颈动脉斑块;对比基线和随访期间MRI表现以评估脑小血管病影像学标志物腔隙、脑微出血和脑白质高信号进展情况。单因素和多因素Logistic回归分析颈动脉斑块对新发腔隙和脑微出血的影响,多因素线性逐步回归分析基线颈动脉斑块与脑白质高信号体积进展之间的线性数量关系。结果共658人中250人(37.99%)存在颈动脉斑块;平均随访(5.57±0.49)年,70人(10.64%)新发腔隙、56人(8.51%)新发脑微出血,脑白质高信号体积年进展量为0.28(0.14,0.55)cm^(3)/年。Logistic回归分析显示,存在颈动脉斑块是随访期间新发脑微出血的危险因素(OR=2.411,95%CI:1.240~4.687;P=0.009)。结论基线存在颈动脉斑块可增加5年内脑微出血进展风险,而对腔隙、脑白质高信号等缺血改变的影响可能需要更长时间的累积效应。Objective To analyze the effect of asymptomatic carotid atherosclerosis on the progression of cerebral small vessel disease(CSVD)in Shunyi cohort community population.Methods A total of 658 residents aged≥35 years old from Shunyi cohort population(from June 2013 to April 2016)were selected as study subjects.Carotid ultrasound was used to assess the presence of baseline carotid plaque,and CSVD progression was assessed by baseline and follow‑up MRI,which included lacunes,cerebral microbleeds(CMBs)and white matter hyperintensity(WMH).Univariate and multivariate Logistic regression was used to analyze the effect of carotid plaque on incident lacunes or CMBs,and linear regression was used to analyze the linear correlation between baseline carotid plaque and WMH progression.Results Among 658 people 250 people(37.99%)had carotid plaque at baseline.After(5.57±0.49)years of follow‑up,70 people(10.64%)developed incident lacunes and 56 people(8.51%)had incident CMBs.The annual WMH progression was 0.28(0.14,0.55)cm^(3)/year.Logistic regression analysis showed the presence of baseline carotid plaque significantly predicted incident CMBs(OR=2.411,95%CI:1.240-4.687;P=0.009).Conclusions Prensence of carotid plaque increased CMBs progression during five‑year follow‑up,but the influence on lacunes and WMH progression requires a longer cumulative effect.

关 键 词：大脑小血管疾病 斑块 动脉粥样硬化 颈动脉 纵向研究 居住特征 

分 类 号：R743[医药卫生—神经病学与精神病学] R543.4[医药卫生—临床医学]