I-321 / 321L yensimbi engenasici ye-capillary tube Umbutho we-white matter hyperintensity kunye ne-coronary artery calcification kubantu abaphilileyo: isifundo esinqamlezayo

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I-White matter hyperintensity (WWH) yinto eqhelekileyo yokufunyaniswa kwi-imaging resonance magnetic (MRI) yobuchopho kwaye iyaziwa ngokubonisa isifo senqanawa encinci kwingqondo.Injongo yophando lwethu yayikukuphanda umbutho we-coronary artery calcium (CCA) kunye ne-WMH kunye nokucacisa ubudlelwane phakathi kwe-WMH kunye nemingcipheko yengozi ye-atherosclerosis kubantu abaninzi abanempilo.Olu phononongo lubandakanya abantu be-1337 abaye bafumana i-MRI yobuchopho kunye ne-computed tomography kunye novavanyo lwe-CAC kwiziko lezonyango esibhedlele senqanaba eliphezulu.IGVM yobuchopho yachazwa njengamanqaku eFazekas angaphezulu kwamanqaku amabini kwiMRI yobuchopho.I-Intracranial arterial stenosis (ICAS) nayo yavavanywa kwaye yaqinisekiswa xa i-angiography ibonisa ngaphezu kwe-50% stenosis.Imibutho yezinto ezinobungozi, amanqaku e-CAC kunye ne-ICAS kunye ne-HBG yobuchopho ahlolwe ngokusebenzisa uhlalutyo lwe-multivariate regression.Kuhlalutyo lwe-multivariate, iindidi ezinamanqaku aphezulu e-CAC abonise ukuxhamla okwandisiweyo kunye ne-periventricular kunye ne-hypertension enzulu ngendlela exhomekeke kwi-dose.Ubukho be-ICAS buye banxulunyaniswa kakhulu ne-HBH yengqondo, kwaye phakathi kwezinto eziguquguqukayo zeklinikhi, ubudala kunye noxinzelelo lwegazi zizinto ezizimeleyo ezinobungozi.Ukuqukumbela, kubantu abasempilweni, i-CAC yayinxulunyaniswa kakhulu ne-WMH yobuchopho, enokubonelela ngobungqina bokuchonga abantu abasengozini yobuchopho be-WMH ngokubhekiselele kumanqaku e-CAC.

Insimbi engenaStainless 321 Coil Tube Chemical Ukubunjwa

Ukwakhiwa kweekhemikhali ze-321 zentsimbi ye-coil tyhubhu yentsimbi ilandelayo:
- Ikhabhoni: 0.08% max
- Manganese: 2.00% max
-Nickel: 9.00% min

I-321 / 321L insimbi engenasici 8 * 0.2 ityhubhu ye-capillary

Steel 321 Coil Tube Mechanical Properties Properties

I-321 / 321L insimbi engenasici 8 * 0.2 ityhubhu ye-capillary

NgokoMvelisi weTube yeCoil eStainless Steel 321, iipropathi zoomatshini zentsimbi engatyiwa 321 ityhubhu yekhoyili zidweliswe ngezantsi: Amandla okuqina (psi) Amandla eSivuno (psi) Ukwandiswa (%)

I-321 / 321L insimbi engenasici 8 * 0.2 ityhubhu ye-capillary

I-White matter hyperintensity (WWH) yinto eqhelekileyo efunyenweyo kwi-T2-weighted kunye ne-fluid-attenuated imaging resonance imaging (MRI) inversion recovery (FLAIR) ukulandelana kwengqondo1,2.Nangona indlela echanekileyo ye-HHH ye-pathophysiological ingaziwa, ibonakaliswe ukuba inxulunyaniswa nemingcipheko ye-atherosclerosis efana nokuguga, uxinzelelo lwegazi, isifo sikashukela, ukutshaya, kunye nokukhuluphala, ebonisa igalelo leendlela ze-vascular kuphuhliso lwe-HHH3,4,5 ,6.,7,8,9,10.Izifundo ze-Pathological ziye zabonisa ukuba i-HHH ibangelwa ukukhubazeka kwe-vascular integrity, ngaloo ndlela iqinisekisa ukuba i-HHH iyimbonakaliso yesifo senqanawa encinci kwingqondo11.Ukongezelela, i-SHG ibaluleke kakhulu kwikliniki njengoko ibonakaliswe ukuba ichaphazela iziganeko kunye nokuxilongwa kweengxaki ezahlukeneyo ze-neurological, kubandakanywa ukuhla kwengqondo, ukudandatheka, ukudandatheka, ukuphazamiseka kwe-gait, kunye ne-stroke12,13,14,15,16,17,18, 19, 20, 21, 22, 23.
Uvavanyo lwe-Coronary calcium assessment (CAC) ithathwa njengomlinganiselo ofanelekileyo kunye nothembekileyo wokuba umntu unokuchaphazeleka kwi-atherosclerosis kwaye ibonakaliswe ukuba idibene ne-ischemic stroke kunye ne-cranial artery stenosis, kunye nesifo senhliziyo24,25.Isifo esincinci se-cerebral cerebral sihlala kunye ne-atherosclerosis yemithambo emikhulu ye-intracranial ngenxa yokuba imikhumbi emincinci egqobhozayo enikezela ngento emhlophe isuka kwi-basilar artery enkulu.Uphononongo oluninzi luchonge unxibelelwano phakathi kwe-SHH kunye nezinto ezinobungozi kwi-atherosclerosis okanye i-carotid atherosclerosis, nangona kunjalo, zizifundo ezimbalwa kuphela ezijolise kubudlelwane phakathi komthwalo we-SAS kunye ne-SHH, kwaye ezi zifundo zenziwe kuphela kubantu abadala okanye amadoda angama-29, 30, 31 .32.
Ngokunyuka kokufumaneka kwe-neuroimaging kwiminyaka yamuva, ukuxhaphaka okuphezulu kunye nokubaluleka kweklinikhi ye-HHH kuya kuqondwa ngakumbi njenge-predictor yokuncipha kwengqondo kunye nesiphumo se-stroke19,20,21,22,23.Isizathu solu phononongo yayikukuba ukuba inqaku le-CAC linokusetyenziswa kwimisebenzi yeklinikhi ukuqikelela umngcipheko we-SHH, i-predictor yeengxaki ezahlukeneyo ze-neurological, inokuba sisixhobo esiluncedo nesiluncedo ukumisela inzuzo enokubakho kwezinye izifundo zabantu, ezinje. njenge-MRI yengqondo19,20,21,22,23.Sicinge ukuba i-HHH inxulumene ngokusondeleyo nomthwalo weCCA, isalathisi se-atherosclerosis, kwinani elikhulu labantu abanempilo kubantu bonke.Ukongezelela, siye safuna ukunceda ukuqonda iindlela eziphantsi kophuhliso lwe-HHH ngokuchonga imiba echaphazelekayo yengozi yeklinikhi.Ngaloo ndlela, injongo ephambili yolu phononongo yayikukuphanda umbutho we-CAC kunye ne-WMH kubantu abasempilweni.Okwesibini, injongo yolu phononongo yayikukucacisa ubudlelwane phakathi kwe-SHG kunye nezinto ezinobungozi kwi-atherosclerosis.
Olu phononongo luphononongo lwe-cross-section retrospective olusekelwe kuluntu jikelele.Siphendle uvimba weenkcukacha ze-elektroniki zabathathi-nxaxheba abaye benza uviwo lwezonyango, kuquka iMRI yobuchopho kunye nemagnethi resonance angiography (MRA), kwiSibhedlele iGangbuk Samsung General Medical Centres eSeoul naseSuwon phakathi kukaJanuwari 2016 noDisemba 2019. CT) kunye nokucinga kwengqondo njengenxalenye yovavanyo olubanzi lomzimba, eziyindlela eqhelekileyo yokuhlola impilo eKorea.Ukwenza ireferensi, umthetho waseKorea ufuna ukuba bonke abasebenzi baye rhoqo ngonyaka okanye kabini ngonyaka, ngoko ke uninzi lwabathathi-nxaxheba ngabasebenzi okanye amalungu osapho abasebenzi beenkampani ezahlukeneyo okanye imibutho karhulumente wasekhaya.
Kubantu abangama-3983, i-2646 yayingabandakanywanga ngenxa yezi zizathu zilandelayo: a) ukungavumelani nokusetyenziswa kolwazi lwezonyango kuzo naziphi na iinjongo zophando kwi-questionnaire ekwazi ukulawula phambi koviwo (n = 376);ukuba iimvavanyo eziphindaphindiweyo zenziwa ngexesha (n = 43), abantu abaneemvavanyo eziphindaphindiweyo abazange bafakwe, kunye ne-CT kunye ne-brain imaging kunye novavanyo lwe-CAC olwenziwa ngosuku olufanayo okanye kwixesha elidlulileyo langoku likhethwe kwisifundo;(c) isifo sengqondo esiyingozi esaziwayo, isifo sikaParkinson.imbali, i-hydrocephalus, utyando lwangaphambili lwengqondo, i-tumor yengqondo, isifo se-moyamoya, i-stroke okanye i-hemorrhage (n = 47);(d) abantu abanezilonda ezibalulekileyo zobuchopho ezifunyenwe ngokuhlalutya umfanekiso, umzekelo, ngenxa ye-encephalomalacia yangaphambili ngenxa ye-stroke (umlinganiselo omkhulu we-diameter enkulu kune-15 mm) okanye i-hemorrhage endala ebuhlungu, i-arteriovenous malformation, okanye i-neoplastic lesion (n = 46);(e) abantu abane-MRI okanye i-MRA yomgangatho onganeleyo wokuhlalutya umfanekiso (n = 2);(f) abantu abangazange bangene kwi-CT kwisikali se-CAC (n = 1796);(g) abantu abangenalo idatha yamanani efunekayo ukuhlalutya, kubandakanywa i-index mass body (BMI) kunye namanqanaba e-homocysteine ​​​​(n = 336).Iflowu tshati yokugaya abathathi-nxaxheba bophando iboniswe kuMfanekiso 1.
Bandakanya iflowutshati yabathathi-nxaxheba.I-MRI magnetic resonance imaging, MRA magnetic resonance angiography, periventricular white matter hyperintensity PVWMH, ubunzulu bomcimbi omhlophe hyperintensity DWM.
Ngaloo ndlela, izifundo ze-1337 (iminyaka yobudala eyi-51.63 ± 9.20 iminyaka, iminyaka yobudala be-20-89 iminyaka, i-1157 [86.54%] izigulane zamadoda) zifakwe kolu cwaningo.Bonke abathathi-nxaxheba baye bavavanywa ngokuphindaphindiweyo kwiziphumo zeklinikhi kunye ne-radiographic.Olu pho nonongo luqhutywe ngokuhambelana nemigaqo yeSibhengezo saseHelsinki kwaye yavunywa yiBhodi yokuHlola iZiko (IRB) yeSibhedlele saseGangbuk Samsung (IRB No. 2020-12-036-006).I-IRB kwiSibhedlele sase-Kangbuk Samsung iye yarhoxisa imfuneko yemvume enolwazi ngenxa yokusetyenziswa kwedatha engachongwanga kunye noyilo lophononongo olwenziwayo.Zonke iindlela zophando zenziwe ngokuhambelana nezikhokelo kunye nemimiselo efanelekileyo.
Siqokelele idatha yeklinikhi nganye kubandakanywa isini, ubudala, i-BMI, i-systolic kunye ne-diastolic blood pressure, imbali yokutshaya, umsebenzi womzimba, kunye nokuxilongwa kunye nonyango lwe-hypertension, isifo seswekile, i-hyperlipidemia, kunye nesifo senhliziyo.Kuluhlu lwemibuzo oluzilawulelayo olusemgangathweni, siqokelele idatha kwimbali yonyango yomntu ngamnye kunye nembali yokutshaya, kunye nokuba bebezibandakanya rhoqo na ukwenza umthambo onamandla ngaphezu kwemizuzu eli-10 ubuncinci amaxesha ama-3 ngeveki.
Ngenxa yokuba bonke abathathi-nxaxheba babecetywe ukuba bahlolwe kwi-Ganbuk Samsung Hospital General Medical Centre, iimvavanyo zebhubhoratri zenziwa ngosuku olufanayo ne-MRI yengqondo kunye ne-MRA emva kokukhawuleza kweeyure ze-12, kwaye idatha ibandakanya i-glucose, i-glycated hemoglobin (HbA1c), amanqanaba. ye-cholesterol epheleleyo, i-cholesterol ye-LDL, i-cholesterol ye-HDL, i-triglycerides kunye ne-homocysteine.
Uxinzelelo lwe-arterial hypertension luchazwa njengokuthathwa kwangoku kweziyobisi ezichasayo, uxinzelelo lwegazi lwe-systolic ≥ 140 mmHg.okanye uxinzelelo lwegazi lwe-diastolic ≥ 90 mmHg33.Isifo seswekile sichazwe njengokusetyenziswa kweziyobisi zangoku ze-antidiabetic, ukuzila i-glucose yegazi ≥ 126 mg / dL, okanye i-HbA1c ≥ 6.5%.I-Dyslipidaemia yachazwa njengokusetyenziswa kwangoku kwezidakamizwa zokunciphisa i-lipid, i-cholesterol epheleleyo ≥240 mg / dl, i-cholesterol ephantsi-density lipoprotein ≥160 mg / dl, i-high-density lipoprotein cholesterol <40 mg / dl, okanye i-triglycerides ≥200 mg / dl35.
Bonke abathathi-nxaxheba bafumana i-MRI yengqondo kunye ne-MRA nge-coil ye-channel esibhozo ye-channel esebenzisa i-1.5 T MRI scanner (i-Optima MR360, i-GE Healthcare, i-Milwaukee, i-Wisconsin okanye i-Signa HDxt, i-GE Healthcare, i-Milwaukee, i-Wisconsin).Iprotocol yokucinga yayiquka imifanekiso ye-axial T1-weighted (ixesha lokuphindaphinda [TR]/ixesha le-echo [TE] = 417–450/9 ms okanye 400–450/10 ms), imifanekiso ene-T2-weighted (TR/TE = 4343–4694 )./ 100-110 ms okanye 4084-4494/95-104 ms), imifanekiso yeFLAIR (TR/TE = 11000/127-138 ms okanye 8800/128-130 ms) kunye nemifanekiso ye-3D yexesha lokuhamba (TOF) (TR /TE = 28/7 ms okanye 27/3 ms, ubukhulu besilayi = 1.2 mm).Ubukhulu bezilayi be-5 mm kuzo zonke iiprothokholi zomfanekiso ngaphandle kwe-TOF MRA.
Iqondo le-periventricular kunye nenzulu ye-WMH yavavanywa ngokwahlukeneyo ngokwesifundo ngasinye sikaFazekas scale1, njengoko kubonisiwe kuMzobo owongezelelweyo 1 kwi-intanethi.I-PVWMH yafumana amanqaku ngolu hlobo lulandelayo: 0=akukho, 1=ikepusi okanye i-lining ebhityileyo, 2=i-halo egudileyo, 3=i-periventricular hyperintensity engaqhelekanga idlulela kumbandela omhlophe onzulu.I-DMH ihlelwa ngolu hlobo lulandelayo: 0 = engekho, 1 = i-punctate, 2 = izilonda ziqala ukudibanisa, 3 = iindawo ezinkulu zokudibanisa.Ngenxa yokuba ingqondo ye-HBH yebanga lesi-2 okanye ngaphezulu isaziwa njengeyona nto ibalulekileyo ekliniki kuba ithanda ukuba neempawu kunye nokuqhubekela phambili, sahlulahlula izigulane ezineFazekas amanqaku 2 kunye no-3 kwi-PVBVH kunye ne-DGBV36,37.
Uhlalutyo lwe-TOF MRA, olusekelwe kwindlela ye-warfarin-aspirin symptomatic intracranial disease (WASID), ichaza i-intracranial artery stenosis (ICAS) njenge-intracranial artery stenosis enkulu kune-50% ye-38.Iinqanawa ezibandakanyiweyo kuhlalutyo ziyi-carotid artery yangaphakathi ukusuka kwi-cavernous segment ukuya kwi-M2 ye-middle cerebral artery, i-A2 ye-anterior cerebral artery, i-P2 ye-posterior cerebral artery, i-basilar artery, kunye ne-intracranial. umthambo.inxalenye yomthambo we-vertebral.
Zonke iimvavanyo ze-radiological zenziwa yi-neuroradiologist (JYK), owayengayazi yonke idatha yeklinikhi kunye nelebhu.Ukuthembeka kwesikali esibonakalayo phakathi kwababukeli kwavavanywa ngumdlali we-radiographer wesibini oqeqeshwe (JYC) kwizifundo ze-700 ezikhethiweyo kunye nesithuba seenyanga ze-2 emva kokufundwa kokuqala.Vavanya ukuthembeka ngaphakathi komkhi-mkhanyo.Uvavanyo olubonakalayo lwe-PVWMH, i-ICAS, kunye ne-ICAS ibonise i-DWM ephakathi kweengcali (i-Cohen-weighted kappa: 0.7, 0.81, kunye ne-0.67, ngokulandelanayo; n = 700) kunye neengcali (i-Cohen-weighted kappa: 0.92, 0.88, kunye ne-0. 65, ngokulandelelana;n = 1339) iprotocol.
Amanqaku e-CAC ahlolwe kubantu abaye bafumana i-CT ukuvavanya i-CAC kwiminyaka eyi-5 ye-brain MRI kunye ne-MRA39.Kubantu abayi-1,337, abangama-686 babenovavanyo lwengqondo kwangolo suku olunye kunye nama-651 ngolunye usuku kwiminyaka emi-5.
Amaziko aseSeoul naseSuwon asebenzisa i-mAc (310 mA × 0.4 s) ityhubhu yangoku kwi-2.5 mm ubukhulu, i-400 ms ixesha lokujikeleza, i-120 kV tube voltage, kunye ne-124 ECG-exhomekeke kwi-dose modulation.Ngokutsho kwe-Agatston et al.40, i-CAC ibalwa ukusuka kwi-4 enkulu ye-epicardial coronary arteries (ikhohlo engundoqo, ekhohlo i-anterior ehla, i-circumflex ekhohlo, kunye ne-right coronary arteries).I-CT technician yayiyimfama naluphi na ulwazi malunga nesifundo kwaye inqaku le-CAC lamiselwa ngokuzenzekelayo ngokusebenzisa i-software ye-HEARTBEAT-CS (Philips, Cleveland, OH, USA).Amanqaku eCAC ahlulwe abe ngamaqela amathathu: 0, 1-100, kunye > 100.
Iimpawu ezisisiseko zithelekiswe phakathi kwezifundo kunye nangaphandle kwe-WMH yobuchopho kusetyenziswa uvavanyo lwe-χ2 lweenguqu zecategorical kunye novavanyo lwe-t-te yoMfundi okanye uvavanyo lweMann-Whitney lwezinto eziguquguqukayo eziqhubekayo, njengoko kufanelekile.Iinguqu ezisasazwayo ngokuqhelekileyo zibonakaliswa njengentsingiselo ± ukutenxa okusemgangathweni, ngelixa iinguqu ezingasasazwanga ngokuqhelekileyo zibonakaliswa njengoluhlu oluphakathi kunye ne-interquartile.Uguquguquko lwe-Dummy lwaziswa kumaxabiso alahlekileyo eenguqu zodidi.
Uhlalutyo lwe-Multivariate logistic regression analysis lwenziwa ukubala i-odds ratios (ORs) kunye ne-95% yexesha lokuzithemba (CIs) ukuvavanya ubudlelwane phakathi kobuchopho be-WMH kunye namanqaku e-CAC kunye nemingcipheko ye-atherosclerosis.Ekubeni ukuxhaphaka kwe-HHH kwanda ngokubudala kwaye kuyahluka ngokwesondo, zonke ii-multivariate zokuhlalutya okwenziwa ukuvavanya imibutho phakathi kwezinye izinto eziguquguqukayo kunye ne-HHH18 ehlengahlengiswa iminyaka kunye nesondo.Enye imodeli yokubuyisela izinto ezininzi isetyenziselwe ukuvavanya ukuba inqaku le-CAC linombutho ozimeleyo kunye nobuchopho be-SHG, nasemva kokulungiswa kwezinto ezinobungozi be-atherosclerosis kunye ne-ICAS njengezinto eziphazamisayo eziye zaxelwa ukuba zidibene ne-SHH kwiingxelo zangaphambili10, 26, 27, 41 Umzekelo we-1 wahlengahlengiswa iminyaka kunye nesini, iModeli ye-2 yahlengahlengiswa iminyaka yobudala, isini, kunye nemingcipheko ye-atherosclerosis (BMI, uxinzelelo lwegazi, isifo sikashukela, i-dyslipidaemia, ukutshaya kwangoku okanye kwangaphambili, ukuzivocavoca rhoqo, isifo se-coronary isifo senhliziyo kunye namanqanaba e-cystine. ).ukulungiswa;Imodeli ye-3 yalungiselelwa iminyaka, isini, imingcipheko ye-atherosclerosis, kunye nobukho be-ICAS.Ubukho bengqondo ye-WMH yavavanywa ngokweendidi zamanqaku e-CAC kusetyenziswa inqaku le-CAC 0 njengebhentshi.
Uhlalutyo lwamanani lwenziwa kusetyenziswa i-Stata version 16.1 (StataCorp, College Station, Texas, USA) kunye ne-R studio version 3.6.3 (RStudio, Boston, Massachusetts, USA).Amaxabiso e-p anemisila emibini <0.05 aye athathwa njengebalulekile ngokwezibalo.
Iimpawu ezisisiseko zabantu be-1337 ziboniswe kwiThebhile 1. Iminyaka yobudala yabathathi-nxaxheba, eqikelelwa ukususela kwixesha le-MRI yengqondo, yayiyi-51.63 ± 9.20 iminyaka, kwaye i-86.54% yabemi bokufunda yayingamadoda.Imiba ephambili yengozi ye-atherosclerosis kweli qela langoku okanye elidlulileyo ukutshaya (57.82%), kulandelwa yi-dyslipidemia (51.76%) kunye noxinzelelo lwegazi (28.65%).Ngokumalunga nezinto eziguquguqukayo ngemitha, izigulane ezingama-158 (11.82%) zine-PVWMH, i-148 (11.07%) zine-DMH, kunye ne-21 (1.57%) zine-ICAS.Ngokumalunga namanqaku e-CAC, izifundo ze-849 (63.5%) zinenqaku le-CAC le-0, i-332 (24.83%) yayinamanqaku phakathi kwe-0 kunye ne-100, kwaye i-156 (11.67%) yayinamanqaku angaphezu kwe-100.
Kuhlalutyo olungaguquguqukiyo, ubudala, ubulili, kunye neyona nto inobungozi kwi-atherosclerosis, ngaphandle kwe-BMI, i-dyslipidemia, kunye nokutshaya kwangoku okanye okudlulileyo, kuhambelana kakhulu nobukho bengqondo ye-HHH (p <0.05) (Itheyibhile 2).Abantu abane-PVWMH kunye ne-DWMH babebadala kwaye babenomthwalo omkhulu we-hypertension, isifo sikashukela, imbali ye-coronary artery disease, i-CAC, kunye ne-ICAS kunabantu abangenawo i-PVWMH kunye ne-DMH.Kuhlalutyo olungaguqukiyo, umlinganiselo ophezulu wabasetyhini kunye nezifundo kwiqela le-WMH libike ukuba basebenzise rhoqo.I-median (uluhlu lwe-interquartile; IQR) i-CAC yayiyi-62 (IQR 0-269.5) kwiqela le-PVWMH kunye ne-46.5 (IQR 0-192) kwiqela le-DMH.Ukuhanjiswa kweendidi ze-CAC ngobukho be-PVWMH kunye ne-DWMH iboniswe kwifig.2. Umyinge weendidi ezinamanqaku aphezulu eCAC unyuswe ngeqondo le-comorbid WMH.
Ipesenti yeendidi zamanqaku e-CAC ngokusekelwe ekubeni ne-PVMWH (a), i-DMH (b), kunye ne-PVWMH okanye i-DMH (c).Ukubalwa kwemithambo ye-coronary ye-SAS, i-white matter hyperintensity SHG, i-periventricular white matter hyperintensity HVBV, i-deep white matter hyperintensity SHVH.
Uhlalutyo lwe-Multivariate regression lulungelelaniselwe ubudala (OKANYE 1.13; 95% CI 1.10-1.16; OKANYE 1.11; 95% CI 1.08-1.14) kunye noxinzelelo lwegazi (OKANYE 2.29; 95% CI 1.50-3.50, OKANYE 91.30% CI 91.9-3) .ngokulandelanayo) yi-PVWMH emva kokulungelelanisa iminyaka, isondo, izinto ezinobungozi be-atherosclerosis (i-BMI, uxinzelelo lwegazi, isifo seswekile, i-dyslipidemia, ukutshaya kwangoku okanye kwangaphambili, ukuzivocavoca, imbali yesifo se-coronary artery, kunye namanqanaba e-homocysteine ​​​​) kunye nokuzimela okubalulekileyo kweklinikhi yokuxela kwangaphambili kwe-DMH kunye I-ICAS (zonke p <0.05) (Itheyibhile 3).Kwakungekho nxulumano olubalulekileyo phakathi kwe-WMH ehlengahlengisiweyo kunye nesondo, i-BMI, isifo sikashukela okanye i-dyslipidemia, imbali yokutshaya, okanye ukuzivocavoca rhoqo.
Nangona emva kokulungelelaniswa kwezinto eziphazamisayo, iindidi ezinamanqaku aphezulu e-CAC abonisa ukunyuswa kobudlelwane kunye nobuchopho be-GMI ngendlela exhomekeke kwi-dose xa kuthelekiswa neendidi zereferensi kunye nenqaku le-CAC le-0. Kwi-PVWMH kunye ne-DWMH, iindidi ezinamanqaku e-CAC amakhulu kune-100 (i-100). OKANYE 5.45; 95 % CI 3.11-9.54 okanye 3.66; 95% CI 2.10-6.38) ibonise umbutho omkhulu kuneendidi kunye namanqaku e-CAC kwi-0 ukuya kwi-100 (OKANYE 2.22; 95% CI).1.36–3.61, OKANYE 1.59;95% CI 0.98-2.58).Xa kuthelekiswa nobudlelwane kunye ne-CAC phakathi kwe-PVWMH kunye namaqela e-DWMH, zonke iimodeli ezintathu zohlalutyo lwe-multivariate zibonise imibutho ephezulu kunye ne-PVWMH kuzo zombini iindidi zamanqaku e-CAC.Ubukho be-ICAS bubonise kwakhona umbutho obalulekileyo kunye ne-PVWMH (OR 3.97, 95% CI 1.31-12.06) kunye ne-DMH (OR 7.11, 95% CI 2.33-21.77).
Ukwahluka kwee-coefficients zokunyuka kwamaxabiso kubalwa kuzo zonke iimodeli zokuhlehla ukuvavanya i-multicollinearity enokubakho, kwaye akukho ngxaki ye-multicollinearity efunyenweyo (iTheyibhile eyoNgezelelweyo ye-1 kwi-intanethi).
Kolu phononongo, umngcipheko we-SHH wobuchopho unyukile ngokunyuka kwamanqaku e-CAC ngendlela exhomekeke kwithamo, kwaye iziphumo bezibaluleke ngokwezibalo emva kohlengahlengiso lwemiba yengozi ye-comorbid ye-atherosclerosis.Iziphumo zethu zihambelana nezifundo zangaphambili ezibonisa ukudibanisa phakathi kwe-CAC kunye ne-brain MRI engaqhelekanga, ngokuqhubekayo ukuxhasa umbutho we-CAC kunye ne-cerebral isitya esincinci se-atherosclerosis kunye nesitya esikhulu se-atherosclerosis29,30,31,32.
Okubangela umdla kukuba, kuzo zontathu iimodeli zohlalutyo lwe-multivariate, i-ORs yamanqaku e-CAC yayiphezulu kancinci kwiqela le-PVWMH kuneqela le-DMH.Lo mahluko unokuba ngenxa yokuba ukungafani kweenkqubo ze-pathophysiological kunye nezinto ezinobungozi zithathwa phakathi kwe-PVWMH kunye ne-DMH11,42,43.I-PVWMHs zihlala zikho ngokulinganayo kuzo zombini iihemispheres zecerebral, zicebisa ukuphazamiseka kwe-diffuse perfusion, ngelixa i-DMHs ihlala ine-asymmetric distribution, iphakamisa ukuba zibangelwa yi-focal perfusion disorder.Ekubeni ummandla we-periventricular unikezelwa yi-terminal arteries ye-medulla ende kunye ne-perforating amasebe [45], isengozini ngakumbi xa iindlela ezizenzekelayo zokugcina i-perfusion ye-cerebral rhoqo ziphazamiseka yi-arteriosclerosis okanye i-lipoid hyalinosis [46, 47, 48, 49].I-Hypoperfusion kunye ne-ischemia ikhula.Ngokukodwa, uphando oluninzi lubonise ukuba ukubonakaliswa kwe-atherosclerosis ye-systemic, njenge-hypertension, isifo sikashukela, kunye nobukho be-aortic atherosclerosis, zihambelana kakhulu ne-PVWMH50,51,52,53, exhasa iziphumo zethu ukuba amanqaku e-CAC, ubudala, kunye ne-arterial arterial. Uxinzelelo lwegazi oluphezulu lwalune-OR eziphezulu ze-PVWMH kune-DMH kuzo zonke iimodeli.
Kolu phononongo, ubukho be-ICAS babunxulunyaniswa ngokusondeleyo nengqondo ye-HHH, isiphumo esinokuchazwa kukuba i-stenosis ebalulekileyo yemithambo emikhulu ye-intracranial inciphisa ukutyhelwa kobuchopho kwasekhaya okanye kwengingqi, kwaye le hypoperfusion engapheliyo inegalelo kwi-hyalinosis enamafutha. iindlela ezisisiseko.uphuhliso lwe-WMH 26.54.
Ngokuhambelana nezifundo ezininzi zangaphambili3, i-27, i-28, i-55 eqhutywe kumaqela eentlanga ezahlukeneyo, uphando lwethu lubonise ukuba ubudala kunye noxinzelelo lwegazi lwaluzimeleyo kwaye ludibaniswa kakhulu nobuchopho be-HBG kwi-multivariate analysis.Nangona kunjalo, umbutho phakathi kwe-HHH kunye neminye imingcipheko ye-atherosclerosis ibonise iziphumo ezixubileyo kwiingxelo zangaphambili27,28,37,56.Izizathu zezi ziphumo zahlukeneyo zinokuba ngenxa yokungafani kwabantu bokufunda, iikhrayitheriya zokumisela izinto ezinobungozi, okanye iindlela ezisetyenziselwa ukuhlalutya i-WMH, ezifuna ukuqhubela phambili isifundo.
Kufuneka kuqatshelwe imida emininzi yolu phononongo.Okokuqala, olu luphononongo lokubuyela emva kwabantu baseAsia kwiziko lezonyango le-monobrand.Kusenokubakho umngcipheko wokukhetha ucalucalulo njengoko inani elikhulu labathathi-nxaxheba bebekwiminyaka yokusebenza, kwaye ngaphezulu kwesiqingatha sabo bengamadoda, ngenxa yeempawu ezizodwa zaseMzantsi Korea, nto leyo efuna ukuba iinkampani zihlole rhoqo abasebenzi bazo.Ukunciphisa i-bias kwizifundo zeqela, ixesha elide, ixesha elide, kunye nezifundo ezilindelekileyo ezifana neRotterdam Study57 okanye iFramingham Study58 kufuneka iqhutywe.Ngaphambili, kukho iingxelo ezininzi usebenzisa i-Rotterdam Study ukugxila kubudlelwane phakathi kwengqondo ye-SHG kunye nemiba eyahlukeneyo yengozi ye-atherosclerosis Association phakathi kwamaqela kunye nezifundo ze-Framingham 4, 59, 60, 61, 62, 63. Nangona kunjalo, ekubeni akukho nanye ekhoyo izifundo zijolise kubudlelwane phakathi kwe-GIBD kunye ne-CCA kubantu abaqhelekileyo, iziphumo zethu zinokubaluleka kwekliniki.Okwesibini, ekubeni uhlalutyo lwe-MRI lwenziwa ngokubonakalayo ngabagqirha be-radiologists, ukulungelelaniswa kungenakwanela.Nangona kunjalo, sizame ukunqoba lo mda ngokubandakanya inani elikhulu labathathi-nxaxheba kunye nokuchaza izifundo ezinobuncinci obuphakathi okanye obuphezulu be-WMH njengeqela elihle.Ukongeza, senze iimvavanyo zokuthembeka kwe-inter-observer kunye ne-intra-observer, kwaye iziphumo zibonise isivumelwano esihle.Kuye kwaxelwa ngaphambili ukuba kukho unxulumano oluphezulu phakathi kweendlela zovavanyo olubonakalayo kusetyenziswa isikali seFazekas kunye nohlalutyo lwevolumetric olusetyenziselwa ukuvavanya ibakala le-WMH64,65.Okwesithathu, abantu abanezilonda zobuchopho bebengabandakanywanga kusetyenziswa iphepha lemibuzo elizilawulayo elibandakanya imbali yangaphambili yonyango kunye nohlalutyo lwemifanekiso yabantu abanesifo esigqithisileyo kwaye abanakuhluza abantu abanesifo esinganyangekiyo.Ukongezelela, inkqubo ye-MRI yengqondo yokuhlolwa kwempilo kwisibhedlele sethu ayibandakanyi imifanekiso ephuculweyo, ngoko ke kukho ithuba lokungabikho kokuxilongwa kokuphuculwa kwengqondo ye-pathological, engabonakaliyo kwi-T1-weighted, T2-weighted and FLAIR images, kunye ukuchaneka akukho phezulu.Xa kuthelekiswa nophuculo lwe-MRA, ubukho be-ICAS bunikwe umlinganiselo ophantsi.Okwesine, ekubeni uninzi lwabathathi-nxaxheba kolu phononongo lwaluvela kubantu abanempilo kwaye abaninzi babengenaso nasiphi na isifo, umlinganiselo wezifundo eziphethwe yi-ICAS wawuncinci.
Nangona kunjalo, olu phononongo lubandakanya abantu abasempilweni ngakumbi kunezifundo zangaphambili ezijonge umbutho phakathi kwe-SHG kunye ne-SAS, kwaye kulwazi lwethu, olu luphononongo lokuqala olubandakanya abantu abadala abasempilweni ngaphandle kokuchaza isini okanye ubudala.Imida yophononongo 31,32.
Ukubaluleka kobuchopho be-WMH kunye nokuphazamiseka okuhlukahlukeneyo okunxulumene ne-neurological efana ne-dementia kunye ne-stroke kugxininiswe ngenxa yokwanda okumangalisayo kokufumaneka kwe-imaging yengqondo kunye nexesha lokuphila, kodwa ezi zifo zihlala zingoyiswa.Ubukho bezilonda ze-HHH ebuchotsheni bunxulunyaniswa nokuncipha okukhulu kwengqondo, ukudodobala kwengqondo, ukudakumba, kunye ne-stroke, kwaye kukho ubungqina obukhulayo bokuba ukulawula imingcipheko ethile ye-atherosclerosis kunokuthintela i-HHH12, 13, 14, 15, 16, 17, 18 , 19, 20, 21, 22, 23, 66, 67, 68, 69. Ngaloo ndlela, iziphumo zethu zinokubonelela ngobungqina bokuhlola abantu abasengozini ye-HHH yengqondo, umngcipheko obalulekileyo kunye ne-predictor yezifo ezahlukeneyo ze-neurological, ngokubhekiselele kwi amanqaku e-CAC, ngaloo ndlela kuchongwa izigulane ezinokuthi zixhamle kungenelelo loxilongo olunamandla kunye nonyango.ingaba i-CAC idlala indima ebalulekileyo kunye nokuzimela ekuphuhlisweni kwe-WMH kwizifundo ezinde kunye nezilindelekileyo ezivela kwimimandla eyahlukeneyo, amaqela eminyaka kunye namaqela eentlanga, kunye nezinye iimpawu ze-MRI zesifo somkhumbi omncinci we-cerebral kufuneka zifakwe kwakhona ukuqonda okubanzi.
Ukuqukumbela, amanqaku e-CAC kunye nobudala kunye noxinzelelo lwegazi lwalunxulunyaniswa kakhulu nengqondo ye-WMH kubantu abaninzi abasempilweni.Amanqaku e-CAC luphawu lomthwalo we-atherosclerotic kwaye unendima enokubakho ekuqikeleleni umngcipheko we-cerebral HHH ekusebenzeni kweklinikhi.
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