321/321L kuhiliʻole kila capillary tube Hui o nā mea keʻokeʻo hyperintensity me ka coronary artery calcification i loko o nā kānaka olakino: he cross-sectional study

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He mea maʻamau ka ʻike maʻamau o ke ʻano keʻokeʻo keʻokeʻo (WWH) ma ke kiʻi hoʻohālikelike magnetic (MRI) o ka lolo a ua ʻike ʻia e hōʻike i ka maʻi moku liʻiliʻi i ka lolo.ʻO ka pahuhopu o kā mākou noiʻi ʻana ʻo ia ka noiʻi ʻana i ka hui ʻana o ke kalapona coronary artery (CCA) me WMH a e wehewehe i ka pilina ma waena o WMH a me nā kumu pilikia no ka atherosclerosis i loko o kahi heluna olakino nui.ʻO kēia haʻawina hope loa he 1337 poʻe i loaʻa i ka MRI lolo a me ka helu helu ʻana me ka loiloi CAC ma kahi kikowaena lapaʻau o ka haukapila.Ua wehewehe ʻia ka GVM o ka lolo e like me ka helu Fazekas ma mua o 2 mau helu ma MRI o ka lolo.Ua loiloi ʻia a hoʻopaʻa ʻia ka intracranial arterial stenosis (ICAS) i ka wā i hōʻike ʻia ai ka angiography ma mua o 50% stenosis.Ua loiloi ʻia nā hui o nā mea pilikia, nā helu CAC a me ICAS me ka lolo HBG me ka hoʻohana ʻana i ka loiloi regression multivariate.I loko o ka loiloi multivariate, ua hōʻike nā ʻāpana me nā helu CAC kiʻekiʻe i ka hui pū ʻana me ka periventricular a me ka hypertension hohonu ma kahi ʻano hilinaʻi.ʻO ka hele ʻana o ICAS i pili pū me ka HBH lolo, a ma waena o nā ʻano hoʻololi lāʻau, ʻo ka makahiki a me ke kiʻekiʻe he mau mea pilikia kūʻokoʻa.I ka hopena, i ka heluna kanaka olakino, pili nui ka CAC me ka WMH lolo, hiki ke hāʻawi i nā hōʻike e ʻike ai i nā poʻe i pilikia no ka lolo WMH me ka pili ʻana i ka helu CAC.

Kūleʻa kila 321 Coil Tube Chemical Composition

ʻO ka hui kemika o 321 stainless steel coil tubing penei:
- Kalapona: 0.08% ka nui
- Manganese: 2.00% ka nui
- Nikela: 9.00% min

321/321L kila kuhiliʻole 8*0.2 paipu capillary

Kuhili 'ole 321 Coil Tube Mechanical Pono

321/321L kila kuhiliʻole 8*0.2 paipu capillary

Wahi a ka Mea Hana Kūleʻa Kūleʻa Kūleʻa 321, ua helu ʻia nā mea mechanical o ke kila kila 321 coil tubing ma lalo nei: Tensile Strength (psi) Yield Strength (psi) Elongation (%)

321/321L kila kuhiliʻole 8*0.2 paipu capillary

ʻO ka hyperintensity mea keʻokeʻo (WWH) kahi ʻike maʻamau i ka T2-weighted a me ka wai-attenuated magnetic resonance imaging (MRI) inversion recovery (FLAIR) sequences o ka brain1,2.ʻOiai ʻaʻole ʻike ʻia ke ʻano pathophysiological pololei o ka HHH, ua hōʻike ʻia e pili ana i nā mea pilikia no ka atherosclerosis e like me ka ʻelemakule, hypertension, diabetes, ulaula, a me ka momona, e hōʻike ana i ka hāʻawi ʻana o nā mīkini vascular i ka hoʻomohala ʻana o HHH3,4,5. ,6.,7,8,9,10.Ua hōʻike pū ʻia nā noiʻi pathological ʻo ka HHH ma muli o ka hoʻohaʻahaʻa ʻana i ka vascular integrity, no laila e hōʻoia ana he hōʻike ʻo HHH i ka maʻi moku liʻiliʻi ma ka lolo11.Eia kekahi, he koʻikoʻi koʻikoʻi ka SHG e like me ka mea i hōʻike ʻia e pili ana i ka hopena a me ka prognosis o nā maʻi neurological like ʻole, me ka emi ʻana o ka cognitive, dementia, depression, gait disturbance, and stroke12,13,14,15,16,17,18, 19 , 20, 21, 22, 23.
Manaʻo ʻia ʻo Coronary calcium assessment (CAC) he mea maʻalahi a hilinaʻi hoʻi o ka maʻi maʻi o ke kanaka i ka atherosclerosis a ua hōʻike ʻia e pili pū me ka ischemic stroke a me ka cranial artery stenosis, a me ka coronary heart disease24,25.ʻO ka maʻi moku liʻiliʻi liʻiliʻi e noho pū me ke atherosclerosis o nā aʻaʻaʻa intracranial nui no ka mea ʻo nā moku perforating liʻiliʻi e hāʻawi ana i ka mea keʻokeʻo mai ke aʻa basilar nui.Nui nā haʻawina i ʻike i kahi hui ma waena o SHH a me nā kumu pilikia no ka atherosclerosis a i ʻole carotid atherosclerosis, akā naʻe, he mau haʻawina wale nō i kālele i ka pilina ma waena o ka ukana SAS a me SHH, a ua mālama ʻia kēia mau haʻawina i nā poʻe ʻelemakule a i ʻole nā ​​kāne 29, 30, 31 .32.
Me ka nui o ka loaʻa ʻana o ka neuroimaging i nā makahiki i hala iho nei, ua ʻike nui ʻia ka prevalence kiʻekiʻe a me ke koʻikoʻi koʻikoʻi o ka HHH ma ke ʻano he wānana no ka emi ʻana o ka cognitive a me ka hopena stroke19,20,21,22,23.ʻO ke kumu o kēia noiʻi ʻana inā hiki ke hoʻohana ʻia ka helu CAC i ka hoʻomaʻamaʻa lapaʻau e wānana i ka pilikia o SHH, kahi wānana o nā maʻi neurological like ʻole, hiki ke lilo i mea hana kūpono a pono e hoʻoholo ai i ka pōmaikaʻi o nā haʻawina kanaka ʻē aʻe. e like me MRI o ka lolo19,20,21,22,23.Ua kuhi mākou he pili pili loa ʻo HHH i ka ukana CCA, kahi hōʻailona o ke atherosclerosis, i ka nui o nā kānaka olakino i ka lehulehu.Eia hou, ua ʻimi mākou e kōkua i ka hoʻomaopopo ʻana i nā hana i hoʻokumu ʻia i ka hoʻomohala ʻana o HHH ma o ka ʻike ʻana i nā kumu pilikia pili i ke kino.No laila, ʻo ka pahuhopu nui o kēia haʻawina ʻo ia ka noiʻi ʻana i ka hui ʻana o CAC me WMH i kahi heluna olakino.ʻO ka lua, ʻo ke kumu o kēia haʻawina ʻo ia ka wehewehe ʻana i ka pilina ma waena o SHG a me nā kumu pilikia no ka atherosclerosis.
ʻO kēia haʻawina he haʻawina cross-sectional retrospective e pili ana i ka heluna lehulehu.Ua ʻimi mākou i nā ʻikepili uila o nā poʻe i komo i nā hoʻokolohua olakino, me ka MRI lolo a me ka magnetic resonance angiography (MRA), ma Gangbuk Samsung Hospital General Medical Centers ma Seoul a me Suwon ma waena o Ianuali 2016 a me Dekemaba 2019. ʻO ka heluna kanaka i komo i nā kumuhana i komo i ka CAC computed tomography ( CT) a me ka lolo kiʻi ma ke ʻano he ʻāpana o nā hoʻokolohua kino holoʻokoʻa, ʻo ia nā ʻano hana nānā olakino maʻamau ma Korea.No ka hōʻike ʻana, koi ke kānāwai Korea i nā limahana a pau e hoʻopaʻa i ka lāʻau lapaʻau maʻamau i kēlā me kēia makahiki a i ʻole ʻelua makahiki, no laila he poʻe limahana a i ʻole ʻohana o nā limahana o nā hui like ʻole a i ʻole nā ​​hui aupuni kūloko.
ʻO ka poʻe 3983, ua kāpae ʻia ʻo 2646 no kēia mau kumu: a) kūʻē i ka hoʻohana ʻana i ka ʻike olakino no nā kumu noiʻi i loko o kahi nīnau nīnau ponoʻī ma mua o ka hoʻokolokolo ʻana (n = 376);inā hana ʻia nā hoʻokolohua hou i ka wā (n = 43), ua kāpae ʻia nā poʻe me nā hoʻokolohua hou, a ua koho ʻia ʻo CT a me ka lolo me ka loiloi CAC i hana ʻia ma ka lā hoʻokahi a i ʻole i ka manawa manawa hope loa i koho ʻia no ke aʻo ʻana;(c) ʻike ʻia ka dementia, ka maʻi o Parkinson.mōʻaukala, hydrocephalus, ʻoki lolo ma mua, ʻaʻa lolo, maʻi moyamoya, hahau a hemorrhage (n = 47);(d) ka poʻe me nā ʻeha lolo koʻikoʻi i ʻike ʻia e ka nānā ʻana i nā kiʻi, no ka laʻana, ma muli o ka encephalomalacia mua ma muli o ka hahau (ʻoi aku ka nui o ke anawaena ma mua o 15 mm) a i ʻole ka hemorrhage traumatic kahiko, arteriovenous malformation, a i ʻole neoplastic lesion (n = 46);(e) nā kānaka me MRI a i ʻole MRA ʻaʻole lawa ka maikaʻi no ka nānā ʻana i nā kiʻi (n = 2);(f) nā kānaka i loaʻa ʻole i ka CT ma ka pālākiō CAC (n = 1796);(g) ka poʻe i nele i ka ʻikepili helu i koi ʻia no ka nānā ʻana, me ka helu kino kino (BMI) a me nā pae homocysteine ​​​​(n = 336).Hōʻike ʻia ka papa kuhikuhi no ka hoʻopaʻa ʻana i nā haumāna haʻawina ma ke Kiʻi 1.
E hoʻokomo i kahi papa kuhikuhi o nā mea komo.ʻO ke kiʻi ʻoniʻoni ʻoniʻoni MRI, MRA magnetic resonance angiography, periventricular white matter hyperintensity PVWMH, deep white thing hyperintensity DWMH.
No laila, 1337 mau kumuhana (mean makahiki 51.63 ± 9.20 makahiki, makahiki 20-89 makahiki, 1157 [86.54%] mau maʻi kāne) i komo i loko o kēia haʻawina.Ua loiloi ʻia nā mea komo a pau no nā ʻike lapaʻau a me radiographic.Ua hana ʻia kēia haʻawina e like me nā loina o ka Hōʻike o Helsinki a ua ʻae ʻia e ka Institutional Review Board (IRB) o Gangbuk Samsung Hospital (IRB No. 2020-12-036-006).Ua haʻalele ka IRB ma Kangbuk Samsung Hospital i ka ʻae ʻana ma muli o ka hoʻohana ʻana i ka ʻikepili de-identified a me ka hoʻolālā noiʻi retrospective.Ua hana ʻia nā ʻano noiʻi āpau e like me nā alakaʻi a me nā lula pili.
Ua hōʻiliʻili mākou i nā ʻikepili pilikino pilikino e pili ana i ke kāne, ka makahiki, BMI, systolic a me ke koko diastolic, ka mōʻaukala puhi, ka hana kino, a me ka ʻike a me ka mālama ʻana i ka hypertension, diabetes, hyperlipidemia, a me ka maʻi naʻau coronary.Mai nā nīnau nīnau paʻa ponoʻī, ua hōʻiliʻili mākou i ka ʻikepili i ka mōʻaukala olakino o kēlā me kēia kanaka a me ka mōʻaukala o ka puhi ʻana, a inā paha lākou i hana mau i ka hoʻoikaika kino kino no nā minuke 10 ma ka liʻiliʻi 3 manawa o ka pule.
No ka mea ua hoʻonohonoho ʻia nā mea komo a pau e nānā ʻia ma Ganbuk Samsung Hospital General Medical Center, ua hana ʻia nā hoʻokolohua ʻoihana ma ka lā hoʻokahi me MRI o ka lolo a me MRA ma hope o ka hoʻokē ʻai ʻana o 12-hola, a ua komo pū ka ʻikepili i ka glucose, glycated hemoglobin (HbA1c), nā pae. o ka nui o ka cholesterol, LDL cholesterol, HDL cholesterol, triglycerides a me ka homocysteine.
Ua wehewehe ʻia ka hypertension arterial e like me ka lawe ʻana i nā lāʻau antihypertensive i kēia manawa, ke koko systolic ≥ 140 mmHg.a i ʻole ke koko diastolic ≥ 90 mmHg33.Ua wehewehe ʻia ka maʻi maʻi ma ke ʻano he hoʻohana lāʻau antidiabetic i kēia manawa, ka hoʻokē ʻai koko glucose ≥ 126 mg/dL, a i ʻole HbA1c ≥ 6.5%.Ua wehewehe ʻia ka dyslipidemia ma ke ʻano o ka hoʻohana ʻana i nā lāʻau hoʻohaʻahaʻa lipid i kēia manawa, ka kolamu holoʻokoʻa ≥240 mg/dl, lipoprotein cholesterol haʻahaʻa ≥160 mg/dl, kolamu lipoprotein kiʻekiʻe <40 mg/dl, a i ʻole triglycerides ≥200 mg/dl35.
ʻO nā mea komo a pau i loaʻa i ka MRI o ka lolo a me ka MRA me kahi poʻo poʻoʻewalu-channel e hoʻohana ana i ka 1.5 T MRI scanner (Optima MR360, GE Healthcare, Milwaukee, Wisconsin a iʻole Signa HDxt, GE Healthcare, Milwaukee, Wisconsin).Aia ka protocol imaging i nā kiʻi kaumaha T1 axial (manawa hana hou [TR]/manawa echo [TE] = 417–450/9 ms a i ʻole 400–450/10 ms), nā kiʻi kaumaha T2 (TR/TE = 4343–4694 )./100-110 ms a i ʻole 4084-4494/95-104 ms), nā kiʻi FLAIR (TR/TE = 11000/127-138 ms a i ʻole 8800/128-130 ms) a me nā kiʻi 3D time-of-flight (TOF) (TR /TE = 28/7 ms a i ʻole 27/3 ms, mānoanoa ʻāpana = 1.2 mm).ʻO 5 mm ka mānoanoa o ka ʻāpana no nā ʻōkuhi kiʻi āpau koe wale nō TOF MRA.
Hoʻokaʻawale ʻia ke kiʻekiʻe o ka periventricular a me ka hohonu WMH e like me kēlā me kēia kumuhana Fazekas scale1, e like me ka mea i hōʻike ʻia ma ke Kiʻi Hoʻohui 1 ma ka pūnaewele.Ua helu ʻia ka PVWMH penei: 0 = ʻaʻohe, 1 = ka pāpale a i ʻole ka lining lahilahi, 2 = ka halo maʻemaʻe, 3 = ka hyperintensity periventricular irregular e hoʻonui ana i kahi mea keʻokeʻo hohonu.Hoʻokaʻawale ʻia ʻo DWMH penei: 0 = ʻaʻohe, 1 = punctate, 2 = hoʻomaka ka hui ʻana o nā ʻeha, 3 = nā wahi nui o ka hui.No ka mea, ʻike ʻia ka lolo HBH grade 2 a i ʻole ke kiʻekiʻe i ke koʻikoʻi o ka maʻi maʻi no ka mea maʻalahi ia i nā hōʻailona a me ka holomua, ua hoʻokaʻawale mākou i nā maʻi me nā helu Fazekas o 2 a me 3 i PVBVH a me DGBV36,37.
ʻO ka loiloi TOF MRA, e pili ana i ka warfarin-aspirin symptomatic intracranial maʻi (WASID), wehewehe i ka intracranial artery stenosis (ICAS) he intracranial artery stenosis ʻoi aku ma mua o 50%38.ʻO nā moku i hoʻokomoʻia i loko o ka nānāʻana,ʻo ia ka'āpana carotid i loko mai ka'āpana cavernous a hiki i ka māhele M2 o ke aʻaʻa cerebral waena, ka māhele A2 o ke aʻaʻa cerebral mua, ka māhele P2 o ke aʻaʻa cerebral posterior, ke aʻa basilar, a me ka intracranial. aʻaʻa.ʻāpana o ke aʻa vertebral.
Ua hana ʻia nā loiloi radiological āpau e kahi neuroradiologist (JYK), ʻaʻole i ʻike i nā ʻikepili āpau a me nā ʻikepili.ʻO ka hilinaʻi o ka pālākiō ʻike ma waena o nā mea nānā i loiloi ʻia e kahi radiographer hoʻomaʻamaʻa lua (JYC) ma 700 mau kumuhana i koho ʻole ʻia a i loko o kahi 2 mau mahina ma hope o ka heluhelu mua ʻana.E loiloi i ka hilinaʻi i loko o ka mea nānā.Hōʻike nā loiloi hiʻohiʻona o PVWMH, DWMH, a me ICAS i ke akamai inter-expert maikaʻi (Cohen-weighted kappa: 0.7, 0.81, a me 0.67, kēlā me kēia; n = 700) a i loko o ka loea (Cohen-weighted kappa: 0.92, 0.88, a me 0. 65, kēlā me kēia; n = 1339) protocol.
Ua helu ʻia ka helu CAC i nā poʻe i loaʻa iā CT e loiloi i ka CAC i loko o 5 mau makahiki o ka lolo MRI a me MRA39.ʻO ka poʻe 1,337, 686 ka lolo i ka lā hoʻokahi a me 651 i kekahi lā i loko o 5 mau makahiki.
Ua hoʻohana nā kikowaena Seoul a me Suwon i ka mAc (310 mA × 0.4 s) paipu i kēia manawa ma 2.5 mm mānoanoa, 400 ms rotation manawa, 120 kV tube voltage, a me 124 ECG-dependent dose modulation.Wahi a Agatston et al.40, ua helu ʻia ka CAC mai ka 4 nui epicardial coronary arteries (hema main, left anterior descending, left circumflex, and right coronary arteries).Ua makapō ʻia ka ʻenehana CT e kekahi ʻike e pili ana i ke kumuhana a ua hoʻoholo ʻia ka helu CAC me ka hoʻohana ʻana i ka polokalamu HEARTBEAT-CS (Philips, Cleveland, OH, USA).Ua māhele ʻia nā helu CAC i ʻekolu pūʻulu: 0, 1-100, a me >100.
Hoʻohālikelike ʻia nā hiʻohiʻona kumu ma waena o nā kumuhana me ka WMH cerebral ʻole me ka hoʻohana ʻana i ka ho'āʻo χ2 no nā hoʻololi categorical a me ka ho'āʻo t-t-test a i ʻole Mann-Whitney no nā mea hoʻololi mau, inā kūpono.Hōʻike ʻia nā mea hoʻololi maʻamau ma ke ʻano he mean ± ka hoʻokaʻawale maʻamau, aʻo nā mea hoʻololi maʻamau ʻole e hōʻike ʻia ma ke ʻano he median a me ka laulā interquartile.Ua hoʻokomo ʻia nā ʻano hoʻololi Dummy no ka nalowale ʻana o nā waiwai o nā ʻano hoʻololi categorical.
Ua hana ʻia ka loiloi loiloi logistic multivariate e helu i nā ratio odds (ORs) a me 95% confidence intervals (CIs) e loiloi i ka pilina ma waena o ka lolo WMH a me nā helu CAC a me nā kumu pilikia no ka atherosclerosis.Ma muli o ka piʻi ʻana o ka nui o ka HHH me ka makahiki a ua ʻokoʻa ʻia e ka wahine, ua hana ʻia nā loiloi multivariate āpau e loiloi i nā hui ma waena o nā mea hoʻololi ʻē aʻe a me HHH18 i hoʻoponopono ʻia no ka makahiki a me ke kāne.Ua hoʻohana ʻia kekahi ʻano hoʻohālikelike logistic multivariate e loiloi inā he hui kūʻokoʻa ka helu CAC me ka lolo SHG, ʻoiai ma hope o ka hoʻoponopono ʻana no nā kumu pilikia atherosclerosis a me ICAS ma ke ʻano he mea hoʻohilahila i hōʻike ʻia e pili ana me SHH i nā hōʻike mua10, 26, 27, 41 Ua hoʻololi ʻia ke kumu hoʻohālike 1 no ka makahiki a me ke kāne, ua hoʻoponopono ʻia ke ʻano 2 no ka makahiki, ke kāne, a me nā kumu pilikia no ka atherosclerosis (BMI, hypertension, diabetes, dyslipidemia, mea puhi puhi i kēia manawa a i mua paha, hoʻomaʻamaʻa maʻamau, ka mōʻaukala maʻi coronary o ka maʻi puʻuwai a me nā pae cystine. ).hoʻoponopono ʻia;Ua hoʻoponopono ʻia ke kumu hoʻohālike 3 no ka makahiki, ke kāne, nā mea pilikia no ka atherosclerosis, a me ka hele ʻana o ICAS.Ua loiloi ʻia ka hele ʻana o ka lolo WMH e like me nā helu helu CAC me ka hoʻohana ʻana i ka helu CAC 0 ma ke ʻano he benchmark.
Ua hana ʻia ka ʻikepili helu me ka mana o Stata 16.1 (StataCorp, College Station, Texas, USA) a me R studio version 3.6.3 (RStudio, Boston, Massachusetts, USA).ʻElua mau huelo p-values ​​<0.05 i manaʻo ʻia he koʻikoʻi koʻikoʻi.
Hōʻike ʻia nā hiʻohiʻona kumu o nā kānaka 1337 ma ka Papa 1. ʻO ka makahiki mean o ka poʻe i komo, i manaʻo ʻia mai ka manawa o MRI o ka lolo, ʻo 51.63 ± 9.20 mau makahiki, a ʻo 86.54% o ka heluna kanaka noiʻi he kāne.ʻO nā kumu koʻikoʻi nui no ka atherosclerosis i loko o kēia pūʻulu ʻo ia ka puhi ʻana a i ʻole i hala (57.82%), a ukali ʻia e ka dyslipidemia (51.76%) a me ka hypertension (28.65%).Ma ke ʻano o ka radiological variables, 158 mau maʻi (11.82%) i loaʻa iā PVWMH, 148 (11.07%) i DWMH, a me 21 (1.57%) i loaʻa iā ICAS.Ma ke ʻano o ka helu CAC, 849 mau kumuhana (63.5%) i loaʻa ka helu CAC o 0, 332 (24.83%) i loaʻa ka helu ma waena o 0 a me 100, a ʻo 156 (11.67%) i ʻoi aku ka helu ma mua o 100.
I loko o kahi loiloi univariate, ʻo ka makahiki, ke kāne, a me ka hapa nui o nā mea pilikia no ka atherosclerosis, koe wale no ka BMI, dyslipidemia, a me ka puhi ʻana i kēia manawa a i hala paha, ua pili nui ʻia me ka loaʻa ʻana o ka lolo HHH (p <0.05) (Table 2).ʻO nā poʻe me PVWMH a me DWMH ua ʻoi aku ka nui o ke kaumaha o ke kiʻekiʻe kiʻekiʻe, ka maʻi diabetes, ka mōʻaukala o ka maʻi coronary artery, CAC, a me ICAS ma mua o nā poʻe me ka PVWMH a me DWMH.Ma kahi loiloi univariate, ʻoi aku ka nui o nā wahine a me nā kumuhana i ka hui WMH i hōʻike i kā lākou hoʻomaʻamaʻa mau.ʻO ka median (interquartile range; IQR) CAC he 62 (IQR 0-269.5) i ka hui PVWMH a me 46.5 (IQR 0-192) i ka hui DWMH.Hōʻike ʻia ka puʻunaue o nā ʻāpana CAC ma ke alo o PVWMH a me DWMH i ka fig.2. Ua hoʻonui ʻia ka māhele o nā ʻāpana me nā helu CAC kiʻekiʻe me ke kiʻekiʻe o ka WMH comorbid.
Ka pākēneka o nā wae helu CAC ma muli o ka loaʻa ʻana o PVMWH (a), DWMH (b), a me PVWMH a i ʻole DWMH (c).Ka helu ʻana o nā ʻaʻa kalapona o ka SAS, hyperintensity mea keʻokeʻo SHG, hyperintensity mea keʻokeʻo periventricular HVBV, hyperintensity mea keʻokeʻo hohonu SHVH.
Hoʻoponopono ʻia ka loiloi regression multivariate no ka makahiki (OR 1.13; 95% CI 1.10-1.16; OR 1.11; 95% CI 1.08-1.14) a me ke kiʻekiʻe (OR 2.29; 95% CI 1.50-3.50, OR 1.98, 1.25%). .ʻO ia ka PVWMH ma hope o ka hoʻoponopono ʻana no ka makahiki, ka wahine, nā kumu pilikia o ka atherosclerosis (BMI, hypertension, diabetes, dyslipidemia, i kēia manawa a i ʻole ka mea puhi puhi mua, hoʻomaʻamaʻa, ka mōʻaukala o ka maʻi coronary artery, a me nā pae homocysteine ​​​​) a me nā mea wānana koʻikoʻi kūʻokoʻa o DWMH a ICAS (p <0.05 a pau) (Papa 3).ʻAʻohe pilina koʻikoʻi ma waena o ka WMH i hoʻoponopono ʻia a me ka wahine, BMI, ka maʻi diabetes a i ʻole dyslipidemia, ka mōʻaukala o ka puhi ʻana, a i ʻole ka hoʻomaʻamaʻa maʻamau.
ʻOiai ma hope o ka hoʻoponopono ʻana i nā kumu hoʻohālikelike, ua hōʻike nā ʻāpana me nā helu CAC kiʻekiʻe i ka hui pū ʻana me ka lolo GMI ma ke ʻano i hilinaʻi ʻia i ka hoʻohālikelike ʻana i nā ʻano kuhikuhi me ka helu CAC o 0. No PVWMH a me DWMH, nā ʻāpana me ka helu CAC ʻoi aku ka nui ma mua o 100 ( OR 5.45; 95 % CI 3.11–9.54 a i ʻole 3.66; 95% CI 2.10–6.38) i hōʻike i ka hui ʻoi aku ma mua o nā ʻāpana me nā helu CAC o 0 a 100 (OR 2.22; 95% CI).1.36–3.61, A I OLE 1.59;95% CI 0.98–2.58).I ka hoʻohālikelike ʻana i ka hui ʻana me CAC ma waena o nā hui PVWMH a me DWMH, ua hōʻike ʻia nā hiʻohiʻona loiloi multivariate ʻekolu i nā hui kiʻekiʻe me PVWMH ma nā kāʻei helu CAC ʻelua.Ua hōʻike pū ka hele ʻana o ICAS i kahi hui nui me PVWMH (OR 3.97, 95% CI 1.31-12.06) a me DWMH (OR 7.11, 95% CI 2.33-21.77).
Ua helu ʻia nā helu hoʻonui ʻokoʻa no nā hiʻohiʻona regression a pau e loiloi i ka multicollinearity hiki ke loaʻa, a ʻaʻohe pilikia multicollinearity i loaʻa (Supplementary Table 1 online).
I loko o kēia haʻawina, ua hoʻonui ʻia ka pilikia o ka cerebral SHH me ka hoʻonui ʻana i ka helu CAC ma ke ʻano i hilinaʻi ʻia, a ʻoi aku ka nui o nā hopena ma hope o ka hoʻoponopono ʻana i nā kumu pilikia pili no ka atherosclerosis.Kūlike kā mākou mau hopena me nā haʻawina mua e hōʻike ana i kahi hui ma waena o ka CAC a me ka lolo MRI abnormalities, kākoʻo hou i ka hui ʻana o CAC me ka cerebral small vessel atherosclerosis a me ka moku nui atherosclerosis29,30,31,32.
ʻO ka mea e mahalo ai, i loko o nā hiʻohiʻona loiloi multivariate ʻekolu, ʻoi aku ka kiʻekiʻe o nā OR no nā helu CAC ma ka hui PVWMH ma mua o ka hui DWMH.ʻO kēiaʻokoʻa paha ma muli o ka manaʻo o nāʻokoʻa i nā kaʻina hana pathophysiological a me nā mea pilikia i manaʻoʻia ma waena o PVWMH a me DWMH11,42,43.Loaʻa pinepine nā PVWMH ma nā ʻāpana cerebral ʻelua, e hōʻike ana i kahi maʻi diffuse perfusion, ʻoiai ʻo DWMHs pinepine ka puʻupuʻu asymmetric, e hōʻike ana ua kumu lākou i kahi maʻi focal perfusion.Ma muli o ka hoʻolako ʻia ʻana o ka ʻāina periventricular e nā aʻa hope o ka medulla lōʻihi a me nā lālā perforating [45], ʻoi aku ka maʻalahi i ka wā e hoʻopilikia ʻia ai nā ʻano autoregulatory no ka mālama ʻana i ka cerebral perfusion mau e ka arteriosclerosis a i ʻole lipoid hyalinosis [46, 47, 48, 49].Hoʻomaka ka hypoperfusion a me ka ischemia.Ma keʻano nui, ua hōʻike ʻia kekahi mau haʻawina e pili ana i ka PVWMH50,51,52,53 nā hōʻike o ka atherosclerosis systemic, e like me ke hypertension, diabetes mellitus, a me ka hele ʻana o ka atherosclerosis aortic, e kākoʻo ana i kā mākou ʻike i ka helu CAC, ka makahiki, a me ka arterial. ʻoi aku ka kiʻekiʻe o ka hypertension no ka PVWMH ma mua o ka DWMH ma nā ʻano hoʻohālike āpau.
I loko o kēia noiʻi ʻana, pili loa ka noho ʻana o ICAS me ka lolo HHH, kahi hopena e hiki ke wehewehe ʻia e ka stenosis koʻikoʻi o nā aʻa intracranial nui e hōʻemi ana i ka cerebral perfusion kūloko a kūloko paha, a ʻo kēia hypoperfusion maʻi e kōkua i ka momona hyalinosis, ʻo ia ka nā mīkini kumu.ka hoʻomohala ʻana o WMH 26.54.
Kūlike me nā haʻawina mua 3, 27, 28, 55 i alakaʻi ʻia ma nā ʻano lāhui like ʻole, ua hōʻike pū kā mākou noiʻi ʻana i ka makahiki a me ke kiʻekiʻe kiʻekiʻe ke kūʻokoʻa a pili nui i ka lolo HBG i kahi loiloi multivariate.Eia naʻe, ua hōʻike ka hui ma waena o HHH a me nā mea pilikia ʻē aʻe no ka atherosclerosis i nā hopena like ʻole i nā hōʻike mua27,28,37,56.ʻO nā kumu o kēia mau hopena ʻokoʻa ma muli paha o nā ʻokoʻa o ka heluna kanaka aʻo, nā pae hoʻoholo no ka hoʻoholo ʻana i nā kumu pilikia, a i ʻole nā ​​ala i hoʻohana ʻia no ka nānā ʻana i ka WMH, kahi e pono ai ke aʻo hou.
Pono e ʻike ʻia kekahi mau palena o kēia haʻawina.ʻO ka mea mua, he haʻawina retrospective kēia o ka heluna kanaka ʻĀsia ma kahi kikowaena olakino monobrand.Loaʻa paha ka pilikia o ke koho ʻana ma muli o ka nui o ka poʻe i komo i ke aʻo ʻana he mau makahiki hana, a ʻoi aku ma mua o ka hapalua o lākou he kāne, ma muli o nā hiʻohiʻona kūʻokoʻa o South Korea, e koi ana i nā hui e nānā mau i kā lākou limahana.No ka hoʻohaʻahaʻa ʻana i nā haʻawina cohort, pono e mālama ʻia nā haʻawina lōʻihi, longitudinal, a me nā haʻawina e like me ka Rotterdam Study57 a i ʻole ka Framingham Study58.Ma mua, ua nui nā hōʻike e hoʻohana ana i ka Rotterdam Study e kālele ana i ka pilina ma waena o ka lolo SHG a me nā kumu pilikia like ʻole no ka atherosclerosis Association ma waena o nā cohorts a me nā haʻawina Framingham 4, 59, 60, 61, 62, 63. ua kālele nā ​​haʻawina i ka hui ma waena o GIBD a me CCA i nā heluna maʻamau, ʻo kā mākou mau hopena he pili pili kino.ʻO ka lua, ʻoiai ʻo ka nānā ʻana o MRI i hana ʻia e nā radiologists, ʻaʻole lawa ka objectivity.Eia naʻe, ua hoʻāʻo mākou e lanakila i kēia palena ma o ka hoʻokomo ʻana i kahi helu nui o nā mea komo a wehewehe i nā kumuhana me ka liʻiliʻi a i ʻole ka WMH kiʻekiʻe ma ke ʻano he hui maikaʻi.Eia kekahi, ua hana mākou i nā ho'āʻo hilinaʻi inter-observer a me intra-observer, a ua hōʻike nā hopena i ka ʻaelike maikaʻi.Ua hōʻike mua ʻia hoʻi aia kahi pilina kiʻekiʻe ma waena o nā ʻano loiloi ʻike e hoʻohana ana i ka pālākiō Fazekas a me ka nānā ʻana volumetric i hoʻohana ʻia e loiloi i ka pae o WMH64,65.ʻO ke kolu, ua hoʻokaʻawale ʻia nā poʻe me nā ʻeha lolo me ka hoʻohana ʻana i kahi nīnau nīnau pilikino i hoʻopili ʻia i ka mōʻaukala olakino mua a me ka nānā ʻana i nā kiʻi o nā poʻe me ka maʻi ākea a ʻaʻole hiki ke kānana i nā poʻe me ka maʻi subclinical.Eia kekahi,ʻo ka polokalamu MRI lolo no ka nānāʻana i ke olakino i loko o kā mākou halemaiʻaʻole i hoʻokomo i nā kiʻi i hoʻonuiʻia, no laila, aia ka hiki ke nele i ka hōʻailona o ka hoʻonuiʻana i ka lolo pathological,ʻaʻole i maopopo ma T1-kaumaha, T2-kaumaha a me FLAIR kiʻi, a ʻaʻole kiʻekiʻe ka pololei.Ke hoʻohālikelike ʻia me ka hoʻonui ʻana o MRA, ua helu ʻia ka hele ʻana o ICAS ma ke ʻano haʻahaʻa.ʻO ka hā, no ka mea ʻo ka hapa nui o ka poʻe i komo i kēia noiʻi mai ka heluna olakino a ʻaʻohe maʻi o ka hapa nui, ʻo ka hapa o nā mea i loaʻa i ka ICAS he liʻiliʻi.
Eia naʻe, ua komo kēia haʻawina i nā poʻe olakino ma mua o nā haʻawina mua e nānā ana i ka hui ma waena o SHG a me SAS, a i ko mākou ʻike, ʻo ia ka haʻawina mua e hoʻokomo i nā poʻe olakino olakino me ka ʻole o ka wehewehe ʻana i ke kāne a i ʻole ka makahiki.Nā palena o ka haʻawina 31,32.
ʻO ke koʻikoʻi o ka lolo WMH a me nā maʻi neurological like ʻole e like me ka dementia a me ka hahau i hōʻike ʻia ma muli o ka piʻi nui o ka loaʻa ʻana o ka lolo a me ka manaʻolana o ke ola, akā mau kēia mau maʻi ʻaʻole i lanakila.ʻO ka loaʻa ʻana o nā ʻeha HHH i loko o ka lolo e pili ana i ka emi ʻana o ka naʻau, dementia, puʻuwai, a me ka hahau ʻana, a ke ulu nei nā hōʻike e hiki ke pale i ka HHH12, 13, 14, 15, 16, 17, 18. , 19, 20, 21, 22, 23, 66, 67, 68, 69. No laila, hiki i kā mākou mau hopena ke hāʻawi i nā hōʻike no ka nānā ʻana i nā poʻe i pilikia no ka lolo HHH, kahi mea koʻikoʻi koʻikoʻi a me ka wānana no nā maʻi neurological like ʻole, e pili ana i ka ka helu CAC, no laila e ʻike ai i nā maʻi e hiki ke pōmaikaʻi mai nā hana diagnostic a me nā hana lapaʻau.inā paha he kuleana koʻikoʻi a kūʻokoʻa ʻo CAC i ka hoʻomohala ʻana o WMH i nā haʻawina longitudinal a me nā haʻawina e hiki mai ana mai nā wahi like ʻole, nā makahiki a me nā lāhui, a me nā mea hōʻailona MRI ʻē aʻe o ka maʻi moku liʻiliʻi cerebral pono e hoʻokomo ʻia no ka ʻike piha.
I ka hopena, ua pili nui ka helu CAC a me ka makahiki a me ke kiʻekiʻe me ka lolo WMH i kahi heluna kanaka olakino.ʻO ka helu CAC he hōʻailona ia o ke kaumaha atherosclerotic a he kuleana ko ka wānana i ka pilikia o ka HHH cerebral i ka hana lapaʻau.
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