Abstract：Objective To investigate the relationship between intracranial artery stenosis and white matter lesions(WML) in patients with lacunar infarcts.Methods From January 2015 to March 2016, clinical data of 279 patients who had the lacunar infarcts in the Neurology Department of Daping Hospital of Third Military Medical University were retrospectively analyzed, including 122 males and 157 females with an average of (66.2±7.9) years. Using MRI to determine the diagnosis of WML and divide into two groups: WML group (164 patients) and without WML group (115 patients). The application of 64 slice spiral CT to assess intracranial vascular. The assessment of intracranial artery stenosis refer to the research methods of symptoms of intracranial artery disease warfarin aspirin(the diagnosis was established if the stenosis rate was more than or equal to 50%). Multivariate logistic regression analyses were performed to examine the association between different intracranial artery stenosis and white matter lesions in patients with lacunar infarcts.Results Among 279 patients with lacunar infarcts in the study. The prevalence of intracranial arterial stenosis 68(24.3%) patients including 51 patients of WML group and 17 patients without WML group. The patients in lacunar infarcts with WML group had a higher average age, and the mobidity of hypertension, diabetes, coronary heart disease, prior stroke, intracranial arterial stenosis was significantly higher compared with those in lacunar cerebral infarction without WML group(all P values<0.05). The incidence of middle cerebral artery stenosis in group WML (16.5% vs 7.0%) was higher (χ2=5.568, P<0.05). After adjustment of age, hypertension, diabetes, coronary heart disease, previous stroke history of these risk factors, logistic regression analysis showed that cerebral artery stenosis with WML risk related in patients with lacunar infarcts(OR=2.13, 95%CI 1.18-3.25, P<0.05 ).Conclusions The middle cerebral artery stenosis may contribute to the risk factors of WML in patients with lacunar infarcts.
陶永,霍颖超,符晓艳,王羚入,朱洁,周华东. 腔隙性脑梗死患者颅内动脉狭窄与脑白质病变发生的关系[J]. 中华解剖与临床杂志, 2016, 21(5): 391-396.
Tao Yong, Huo Yingchao, Fu Xiaoyan, Wang Lingru, Zhu Jie, Zhou Huadong. The relationship between intracranial artery stenosis and white matter lesions in patients with lacunar infarcts. Chinese Journal of Anatomy and Clinics, 2016, 21(5): 391-396.
Simoni M, Li L, Paul NL, et al. Age- and sex-specific rates of leukoaraiosis in TIA and stroke patients: population-based study[J]. Neurology, 2012, 79(12): 1215-1222. DOI:10.1212/WNL.0b013e31826b951e
[2]
Kirton JW, Resnick SM, Davatzikos C, et al. Depressive symptoms, symptom dimensions, and white matter lesion volume in older adults: a longitudinal study[J]. Am J Geriatr Psychiatry, 2014, 22(12): 1469-1477. DOI:10.1016/j.jagp.2013.10.005
[3]
Scott JA, Braskie MN, Tosun D, et al. Cerebral amyloid and hypertension are independently associated with white matter lesions in elderly[J]. Front Aging Neurosci, 2015, 7: 221. DOI:10.3389/fnagi.2015.00221
[4]
Abraham HM, Wolfson L, Moscufo N, et al. Cardiovascular risk factors and small vessel disease of the brain: blood pressure, white matter lesions, and functional decline in older persons[J]. J Cereb Blood Flow Metab, 2016, 36(1): 132-142. DOI:10.1038/jcbfm.2015.121
[5]
Lv P, Jin H, Liu Y, et al. Comparison of risk factor between lacunar stroke and large artery atherosclerosis stroke: a cross-sectional study in China[J]. PLoS ONE, 2016, 11(3): e0149605. DOI:10.1371/journal.pone.0149605
[6]
Yamashita Y, Wada I, Horiba M, et al. Influence of cerebral white matter lesions on the activities of daily living of older patients with mild stroke[J]. Geriatr Gerontol Int, 2016, 16(8)942-947. DOI:10.1111/ggi.12580
[7]
Cai Z, Wang C, He W, et al. Cerebral small vessel disease and Alzheimer′s disease[J]. Clin Interv Aging, 2015, 10: 1695-1704. DOI:10.2147/CIA.S90871
Smith EE. Leukoaraiosis and stroke[J]. Stroke, 2010, 41(10 Suppl): S139-S143. DOI:10.1161/STROKEAHA.110.596056
[10]
Samuels OB, Joseph GJ, Lynn MJ, et al. A standardized method for measuring intracranial arterial stenosis[J]. AJNR Am J Neuroradiol, 2000, 21(4): 643-646
[11]
Mok V, Kim JS. Prevention and management of cerebral small vessel disease[J]. J Stroke, 2015, 17(2): 111-122. DOI:10.5853/jos.2015.17.2.111
[12]
Giwa MO, Williams J, Elderfield K, et al. Neuropathologic evidence of endothelial changes in cerebral small vessel disease[J]. Neurology, 2012, 78(3): 167-174. DOI:10.1212/WNL.0b013e3182407968
[13]
Assareh AA, Mather KA, Crawford JD, et al. Renin-angiotensin system genetic polymorphisms and brain white matter lesions in older Australians[J]. Am J Hypertens, 2014, 27(9): 1191-1198. DOI:10.1093/ajh/hpu035
[14]
Nyquist PA, Bilgel M, Gottesman R, et al. Age differences in periventricular and deep white matter lesions[J]. Neurobiol Aging, 2015, 36(4): 1653-1658. DOI:10.1016/j.neurobiolaging.2015.01.005
[15]
Zhang CR, Cloonan L, Fitzpatrick KM, et al. Determinants of white matter hyperintensity burden differ at the extremes of ages of ischemic stroke onset[J]. J Stroke Cerebrovasc Dis, 2015, 24(3): 649-654. DOI:10.1016/j.jstrokecerebrovasdis.2014.10.016
[16]
Park JH, Kwon HM, Lee J, et al. Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities[J]. Eur J Neurol, 2015, 22(1): 44-52, e2-3. DOI: 10.1111/ene.12431
[17]
Lee SJ, Kim JS, Chung SW, et al. White matter hyperintensities (WMH) are associated with intracranial atherosclerosis rather than extracranial atherosclerosis[J]. Arch Gerontol Geriatr, 2011, 53(2): e129-e132. DOI:10.1016/j.archger.2010.07.008
[18]
Chutinet A, Biffi A, Kanakis A, et al. Severity of leukoaraiosis in large vessel atherosclerotic disease[J]. AJNR Am J Neuroradiol, 2012, 33(8): 1591-1595. DOI:10.3174/ajnr.a3015
[19]
Li H, Xu G, Xiong Y, et al. Relationship between cerebral atherosclerosis and leukoaraiosis in aged patients: results from DSA[J]. J Neuroimaging, 2014, 24(4): 338-342. DOI:10.1111/jon.12047
[20]
Li H, Xiong Y, Xu G, et al. The circle of Willis and white matter lesions in patients with carotid atherosclerosis[J]. J Stroke Cerebrovasc Dis, 2015, 24(8): 1749-1754. DOI:10.1016/j.jstrokecerebrovasdis.2015.03.048
[21]
Sahin N, Solak A, Genc B, et al. Dilatation of the Virchow-Robin spaces as an indicator of unilateral carotid artery stenosis: correlation with white matter lesions[J]. Acta Radiol, 2015, 56(7): 852-859. DOI:10.1177/0284185114544243
[22]
Patankar T, Widjaja E, Chant H, et al. Relationship of deep white matter hyperintensities and cerebral blood flow in severe carotid artery stenosis[J]. Eur J Neurol, 2006, 13(1): 10-16. DOI:10.1111/j.1468-1331.2006.01115.x
[23]
Purkayastha S, Fadar O, Mehregan A, et al. Impaired cerebrovascular hemodynamics are associated with cerebral white matter damage[J]. J Cereb Blood Flow Metab, 2014, 34(2): 228-234. DOI:10.1038/jcbfm.2013.180.
2016, Vol. 21 
