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

doi:10.3969/j.issn.1672-6731.2023.11.006

Chinese Journal of Contemporary Neurology and Neurosurgery ›› 2023, Vol. 23 ›› Issue (11): 986-992. doi: 10.3969/j.issn.1672-6731.2023.11.006

• Cerebral Small Vessel Disease • Previous Articles Next Articles

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

Zi-ang PAN¹, Ding-ding ZHANG², Zi-yue LIU¹, Mei-jun SHU¹, Fei-fei ZHAI¹, Ming YAO¹, Li-xin ZHOU¹^,², Jun NI¹^,², Zheng-yu JIN³, Qing DAI⁴, Shu-yang ZHANG⁵, Li-ying CUI¹, Fei HAN¹^,*(), Yi-cheng ZHU¹^,*()

1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2. 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
3. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
4. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
5. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Received:2023-08-27 Online:2023-11-25 Published:2023-11-30
Contact: Fei HAN, Yi-cheng ZHU
Supported by:
National High Level Hospital Clinical Research Funding of Peking Union Medical College Hospital(2022-PUMCH-D-007)

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

潘子昂¹, 张丁丁², 刘子悦¹, 舒美钧¹, 翟菲菲¹, 姚明¹, 周立新¹^,², 倪俊¹^,², 金征宇³, 戴晴⁴, 张抒扬⁵, 崔丽英¹, 韩菲¹^,*(), 朱以诚¹^,*()

1. 100730 中国医学科学院北京协和医学院北京协和医院神经科
2. 100730 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
3. 100730 中国医学科学院北京协和医学院北京协和医院放射科
4. 100730 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
5. 100730 中国医学科学院北京协和医学院北京协和医院心内科

通讯作者: 韩菲, 朱以诚
基金资助:
北京协和医院中央高水平医院临床科研专项(2022-PUMCH-D-007)

Abstract

Abstract:

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) cm³/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.

Key words: Cerebral small vessel diseases, Plaque, atherosclerotic, Carotid arteries, Longitudinal studies, Residence characteristics

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)cm³/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。

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

Zi-ang PAN, Ding-ding ZHANG, Zi-yue LIU, Mei-jun SHU, Fei-fei ZHAI, Ming YAO, Li-xin ZHOU, Jun NI, Zheng-yu JIN, Qing DAI, Shu-yang ZHANG, Li-ying CUI, Fei HAN, Yi-cheng ZHU. The effect of carotid atherosclerosis on the progression of cerebral small vessel disease: based on Shunyi Cohort Study[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(11): 986-992.

潘子昂, 张丁丁, 刘子悦, 舒美钧, 翟菲菲, 姚明, 周立新, 倪俊, 金征宇, 戴晴, 张抒扬, 崔丽英, 韩菲, 朱以诚. 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[J]. 中国现代神经疾病杂志, 2023, 23(11): 986-992.

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Figures/Tables 6

References 28

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变量	赋值
变量	0	1
新发腔隙或新发脑微出血	无	有
性别	女性	男性
吸烟	无	有
高血压	无	有
糖尿病	无	有
高脂血症	无	有
颈动脉斑块	无	有

变量	赋值
变量	0	1
新发腔隙或新发脑微出血	无	有
性别	女性	男性
吸烟	无	有
高血压	无	有
糖尿病	无	有
高脂血症	无	有
颈动脉斑块	无	有

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.941	0.256	13.540	0.000	2.562	1.552 ~ 4.228
年龄	0.061	0.016	14.395	0.000	1.063	1.030 ~ 1.096
高血压	1.039	0.271	14.731	0.000	2.826	1.663 ~ 4.804
糖尿病	0.694	0.318	4.771	0.029	2.003	1.074 ~ 3.734
高脂血症	- 0.113	0.255	0.197	0.657	0.893	0.542 ~ 1.471
BMI	0.014	0.034	0.161	0.688	1.014	0.948 ~ 1.085
吸烟	1.095	0.270	16.427	0.000	2.989	1.760 ~ 5.076
颈动脉斑块	0.875	0.256	11.659	0.001	2.400	1.452 ~ 3.967
随访时间	- 0.359	0.260	1.908	0.167	0.689	0.420 ~ 1.162

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.941	0.256	13.540	0.000	2.562	1.552 ~ 4.228
年龄	0.061	0.016	14.395	0.000	1.063	1.030 ~ 1.096
高血压	1.039	0.271	14.731	0.000	2.826	1.663 ~ 4.804
糖尿病	0.694	0.318	4.771	0.029	2.003	1.074 ~ 3.734
高脂血症	- 0.113	0.255	0.197	0.657	0.893	0.542 ~ 1.471
BMI	0.014	0.034	0.161	0.688	1.014	0.948 ~ 1.085
吸烟	1.095	0.270	16.427	0.000	2.989	1.760 ~ 5.076
颈动脉斑块	0.875	0.256	11.659	0.001	2.400	1.452 ~ 3.967
随访时间	- 0.359	0.260	1.908	0.167	0.689	0.420 ~ 1.162

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.268	0.368	0.530	0.467	1.307	0.636 ~ 2.688
年龄	0.042	0.019	5.139	0.023	1.043	1.006 ~ 1.081
高血压	0.925	0.296	9.798	0.002	2.523	1.413 ~ 4.503
糖尿病	0.559	0.347	2.592	0.107	1.748	0.886 ~ 3.450
吸烟	0.878	0.391	5.034	0.025	2.406	1.117 ~ 5.180
颈动脉斑块	0.282	0.299	0.890	0.345	1.326	0.738 ~ 2.384
常数项	- 4.151	2.205	3.544	0.060

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

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

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变量	回归系数	SE	t值	P值	标准化偏回归系数
性别	- 0.017	0.001	- 0.140	0.889	- 0.007
年龄	0.056	0.000	4.524	0.000	0.397
高血压	- 0.059	0.001	- 0.653	0.514	- 0.026
糖尿病	0.370	0.001	2.901	0.004	0.111
高脂血症	- 0.129	0.001	- 1.449	0.148	- 0.057
BMI	0.020	0.000	1.690	0.091	0.067
吸烟	0.288	0.010	0.300	0.766	0.051
颈动脉斑块	0.108	0.001	1.079	0.281	0.046
随访时间	- 0.207	0.001	- 2.405	0.016	- 0.090
截距	3.169	0.007	4.524	0.000

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变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.223	0.289	0.591	0.442	1.249	0.708 ~ 2.203
年龄	0.065	0.018	13.411	0.000	1.067	1.030 ~ 1.104
高血压	1.262	0.313	16.270	0.000	3.532	1.913 ~ 6.522
糖尿病	- 0.051	0.422	0.014	0.904	0.951	0.416 ~ 2.173
高脂血症	0.059	0.280	0.045	0.832	1.061	0.613 ~ 1.836
BMI	0.052	0.038	1.866	0.172	1.053	0.978 ~ 1.134
吸烟	- 0.222	0.380	0.341	0.559	0.801	0.380 ~ 1.687
颈动脉斑块	1.096	0.289	14.398	0.000	2.992	1.699 ~ 5.271
随访时间	- 0.303	0.287	1.117	0.291	0.739	0.421 ~ 1.295

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
性别	0.223	0.289	0.591	0.442	1.249	0.708 ~ 2.203
年龄	0.065	0.018	13.411	0.000	1.067	1.030 ~ 1.104
高血压	1.262	0.313	16.270	0.000	3.532	1.913 ~ 6.522
糖尿病	- 0.051	0.422	0.014	0.904	0.951	0.416 ~ 2.173
高脂血症	0.059	0.280	0.045	0.832	1.061	0.613 ~ 1.836
BMI	0.052	0.038	1.866	0.172	1.053	0.978 ~ 1.134
吸烟	- 0.222	0.380	0.341	0.559	0.801	0.380 ~ 1.687
颈动脉斑块	1.096	0.289	14.398	0.000	2.992	1.699 ~ 5.271
随访时间	- 0.303	0.287	1.117	0.291	0.739	0.421 ~ 1.295

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
年龄	0.030	0.021	2.029	0.154	1.030	0.989 ~ 1.073
高血压	0.911	0.335	7.381	0.007	2.486	1.289 ~ 4.796
颈动脉斑块	0.880	0.339	6.736	0.009	2.411	1.240 ~ 4.687
常数项	- 4.658	2.506	3.453	0.063

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
年龄	0.030	0.021	2.029	0.154	1.030	0.989 ~ 1.073
高血压	0.911	0.335	7.381	0.007	2.486	1.289 ~ 4.796
颈动脉斑块	0.880	0.339	6.736	0.009	2.411	1.240 ~ 4.687
常数项	- 4.658	2.506	3.453	0.063

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

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

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