ASTM A249 269 enweghị nkebi 310 igwe anaghị agba nchara Tube, Njikọ nke ihe ọcha hyperintensity na akwara akwara akwara na ndị ahụ siri ike: ọmụmụ ihe gafere.

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ASTM A249 269 Igwe anaghị agba nchara 310 igwe anaghị agba nchara

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Ihe mejupụtara kemịkalụ niile na akụrụngwa anụ ahụ maka igwe anaghị agba nchara ka ọ na-eru:

Ihe na-acha ọcha hyperintensity (WWH) bụ nchọpụta a na-ahụkarị na imaging resonance imaging (MRI) nke ụbụrụ ma mara na ọ na-egosipụta obere ọrịa arịa na ụbụrụ.Ebumnuche nke ọmụmụ anyị bụ iji nyochaa njikọ nke calcium artery artery (CCA) na WMH na ịkọwapụta mmekọrịta dị n'etiti WMH na ihe ize ndụ maka atherosclerosis na ọnụ ọgụgụ buru ibu nwere ahụike.Ọmụmụ ihe a na-atụgharị anya gụnyere ndị 1337 bụ ndị na-enweta ụbụrụ MRI ma na-agbakọ tomography na nyocha CAC na ụlọ ọgwụ ụlọ ọgwụ dị elu.A kọwapụtara GVM nke ụbụrụ dị ka akara Fazekas nke karịrị isi 2 na MRI nke ụbụrụ.A na-enyochakwa stenosis intracranial arterial stenosis (ICAS) ma kwadoro mgbe angiography gosipụtara ihe karịrị 50% stenosis.Njikọ nke ihe ize ndụ, akara CAC na ICAS nwere ụbụrụ HBG ka a na-enyocha site na iji nyocha mgbanwe multivariate.N'ime nyocha dị iche iche, edemede nwere akara CAC dị elu gosiri mmụba dị elu na ọbara mgbali elu periventricular na nke dị omimi n'ụzọ dabere na dose.Ọnụnọ nke ICAS nwekwara njikọ dị ukwuu na ụbụrụ HBH, na n'etiti mgbanwe ụlọ ọgwụ, afọ na ọbara mgbali elu bụ ihe ize ndụ nke onwe.Na mmechi, na ndị mmadụ nwere ahụike, CAC nwere njikọ chiri anya na ụbụrụ WMH, nke nwere ike ịnye ihe akaebe iji chọpụta ndị mmadụ nọ n'ihe ize ndụ maka ụbụrụ WMH na ntụnyere akara CAC.
Ihe na-acha ọcha hyperintensity (WWH) bụ ihe a na-achọpụtakarị na T2-weighted and fluid-attenuated magnetik resonance imaging (MRI) mgbake inversion (FLAIR) usoro nke ụbụrụ1,2.Ọ bụ ezie na a maghị usoro pathophysiological kpọmkwem nke HHH, egosila na ọ na-ejikọta ya na ihe ize ndụ maka atherosclerosis dị ka ịka nká, ọbara mgbali elu, ọrịa shuga, ise siga, na oke ibu, na-atụ aro ntinye nke usoro vaskụla na mmepe nke HHH3,4,5. ,6.,7,8,9,10.Ọmụmụ ihe gbasara ọrịa egosiwokwa na HHH na-akpata site na mmebi nke iguzosi ike n'ezi ihe nke vaskụla, si otú a na-akwado na HHH bụ ngosipụta nke obere ọrịa arịa na ụbụrụ11.Tụkwasị na nke ahụ, SHG bụ ihe dị mkpa nke ụlọ ọgwụ dị ka egosipụtara na ọ na-emetụta mmetụta na prognosis nke ọrịa dị iche iche nke akwara ozi, gụnyere nkwụsị nke uche, nkwarụ, ịda mbà n'obi, ọgba aghara gait, na ọrịa strok12,13,14,15,16,17,18. 19, 20, 21, 22, 23.
A na-ahụta nyocha calcium coronary (CAC) dị ka ihe dabara adaba na nke a pụrụ ịdabere na ya nke nchikota nke onye ọ bụla nwere ike ibute atherosclerosis na egosila na ejikọtara ya na ọrịa strok ischemic na cranial artery stenosis, yana ọrịa obi obi24,25.Obere ọrịa arịa ụbụrụ na-ebikọ ngwa ngwa na atherosclerosis nke nnukwu akwara intracranial n'ihi na obere arịa ndị na-emepe emepe na-ebunye ihe ọcha na-esite na nnukwu akwara basilar.Ọtụtụ nchọpụta achọpụtala njikọ dị n'etiti SHH na ihe ize ndụ maka atherosclerosis ma ọ bụ carotid atherosclerosis, Otú ọ dị, ọ bụ nanị nnyocha ole na ole lekwasịrị anya na mmekọrịta dị n'etiti ibu arọ SAS na SHH, na ọmụmụ ihe ndị a ka e mere na ndị okenye ma ọ bụ ndị ikom 29, 30. 31 .32.
Site na nnweta neuroimaging na-abawanye n'afọ ndị na-adịbeghị anya, mmụba dị elu na mkpa ụlọ ọgwụ nke HHH ka a na-amatawanye dị ka onye amụma ọdịda ọgụgụ isi na nsonaazụ strok19,20,21,22,23.Ihe mkpali maka ọmụmụ ihe a bụ na, ọ bụrụ na enwere ike iji CAC mee ihe na omume ụlọ ọgwụ iji kọwaa ihe ize ndụ nke HHH, onye na-ahụ maka ọrịa dị iche iche nke akwara ozi, ọ nwere ike ịbụ ngwá ọrụ dị mma na nke bara uru iji chọpụta ndị ọrịa nwere ike irite uru na ya Ndị ọzọ ọmụmụ ndị mmadụ n'otu n'otu. , dị ka MRI nke ụbụrụ19,20,21,22,23.Anyị chere na n'ime ọnụ ọgụgụ buru ibu nke ndị nwere ahụike n'ozuzu mmadụ, HHH nwere njikọ chiri anya na ibu CAC, ihe na-egosi atherosclerosis.Tụkwasị na nke ahụ, anyị chọrọ inyere aka ịghọta usoro ndị na-ebute mmepe nke HHH site na ịchọta ihe ize ndụ ụlọ ọgwụ dị mkpa.Ya mere, isi ebumnuche nke ọmụmụ a bụ inyocha njikọ nke CAC na WMH n'ime ọnụ ọgụgụ dị mma.Nke abụọ, ebumnuche nke ọmụmụ a bụ ịkọwapụta mmekọrịta dị n'etiti SHG na ihe ize ndụ maka atherosclerosis.
Ọmụmụ ihe a bụ ọmụmụ ihe nlegharị anya n'ofe nke dabere na ọnụ ọgụgụ mmadụ niile.Anyị nyochara ọdụ data eletrọnịkị nke ndị sonyere nyocha ahụike, gụnyere ụbụrụ MRI na magnetik resonance angiography (MRA), na Gangbuk Samsung Hospital General Medical Centre na Seoul na Suwon n'etiti Jenụwarị 2016 na Disemba 2019. Ndị bi na ya gụnyere isiokwu ndị mere CAC gbakọọ tomography ( CT) na onyonyo ụbụrụ dị ka akụkụ nke nyocha anụ ahụ zuru oke, nke bụ ụzọ nyocha ahụike nkịtị na Korea.Maka ntụnye aka, iwu Korea chọrọ ka ndị ọrụ niile na-enyocha ahụike kwa afọ ma ọ bụ nke afọ ọ bụla, yabụ ọtụtụ ndị sonyere bụ ndị ọrụ ma ọ bụ ndị otu ezinụlọ nke ndị ọrụ ụlọ ọrụ dị iche iche ma ọ bụ otu gọọmentị ime obodo.
N'ime mmadụ 3983, 2646 ka ewepụrụ n'ihi ihe ndị a: a) enweghị nkwekọrịta na iji ozi ahụike maka ebumnuche nyocha ọ bụla na ajụjụ nyocha nke onwe ya tupu nyocha (n = 376);ọ bụrụ na a na-eme nyocha ugboro ugboro n'oge oge (n = 43), ndị mmadụ na-eme nyocha ugboro ugboro, a na-ewepụ CT na ụbụrụ ụbụrụ na nyocha CAC n'otu ụbọchị ma ọ bụ n'oge kacha nso nso a maka ọmụmụ ihe ahụ;(c) dementia amaara, ọrịa Parkinson.akụkọ ihe mere eme, hydrocephalus, ịwa ahụ ụbụrụ gara aga, ụbụrụ ụbụrụ, ọrịa moyamoya, ọrịa strok ma ọ bụ ọbara ọgbụgba (n = 47);(d) ndị nwere ọnya ụbụrụ dị ịrịba ama achọpụtara site na nyocha onyonyo, dịka ọmụmaatụ, n'ihi encephalomalacia bu ụzọ n'ihi ọrịa strok (ntụgharị diamita buru ibu karịa 15 mm) ma ọ bụ ọbara ọgbụgba na-akpata ọgba aghara, mmebi akwara arteriovenous, ma ọ bụ ọnya neoplastic (n = 46);(e) ndị nwere MRI ma ọ bụ MRA nke ezughị oke maka nyocha ihe oyiyi (n = 2);(f) ndị mmadụ na-enwetaghị CT na ọnụ ọgụgụ CAC (n = 1796);(g) ndị na-enweghị data ọnụọgụ achọrọ maka nyocha, gụnyere nchịkọta anụ ahụ (BMI) na ọkwa homocysteine ​​​​(n = 336).E gosipụtara eserese usoro maka ndị na-amụ akwụkwọ n'ọrụ na foto 1.
Tinye akwụkwọ mpịakọta nke ndị sonyere.MRI magnetik resonance imaging, MRA magnetik resonance angiography, periventricular ọcha okwu hyperintensity PVWMH, miri na-acha ọcha okwu hyperintensity DWMH.
Ya mere, isiokwu 1337 (pụtara afọ 51.63 ± 9.20 afọ, afọ 20-89 afọ, 1157 [86.54%) ndị ọrịa nwoke) gụnyere n'ọmụmụ ihe a.A na-enyocha ndị niile sonyere maka nyocha ụlọ ọgwụ na redio.Emere ọmụmụ ihe a dịka ụkpụrụ nkwupụta nke Helsinki si dị ma kwadoro ya site na Board Institutional Review Board (IRB) nke Gangbuk Samsung Hospital (IRB No. 2020-12-036-006).Ndị IRB dị na ụlọ ọgwụ Kangbuk Samsung wepụrụ nkwenye ahụ amatapụtara n'ihi iji data achọpụtara achọpụtara yana imewe ọmụmụ ihe nlegharị anya.Emere usoro nyocha niile dịka ntuziaka na ụkpụrụ dị mkpa si dị.
Anyị chịkọtara data ụlọ ọgwụ n'otu n'otu gụnyere okike, afọ, BMI, systolic na ọbara mgbali elu diastolic, akụkọ ihe mere eme ị smokingụ sịga, mmega ahụ, na nchoputa na ọgwụgwọ ọbara mgbali elu, ọrịa shuga, hyperlipidemia, na ọrịa obi.Site n'akwụkwọ ajụjụ ndị ejirila onwe ha ahazi, anyị na-anakọta data gbasara akụkọ ahụike onye ọ bụla na akụkọ banyere ise siga, yana ma ha na-emega ahụ́ siri ike maka ihe karịrị nkeji iri ọ dịkarịa ala ugboro atọ n'izu.
N'ihi na a na-ahazi ndị niile sonyere ka a nyochaa ya na Ganbuk Samsung Hospital General Medical Center, a na-eme nyocha ụlọ nyocha n'otu ụbọchị MRI nke ụbụrụ na MRA mgbe ngwa ngwa 12-hour, na data gụnyere glucose, glycated hemoglobin (HbA1c), ọkwa. nke mkpokọta cholesterol, LDL cholesterol, HDL cholesterol, triglycerides na homocysteine ​​​​.
Akọwapụtara ọbara mgbali elu akwara dị ka oriri ugbu a nke ọgwụ antihypertensive, ọbara mgbali systolic ≥ 140 mmHg.ma ọ bụ ọbara mgbali elu diastolic ≥90 mmHg33.A kọwapụtara ọrịa shuga dị ka iji ọgwụ antidiabetic eme ihe ugbu a, glucose ọbara na-ebu ọnụ ≥ 126 mg/dL, ma ọ bụ HbA1c ≥ 6.5%.A kọwapụtara dyslipidemia dị ka iji ọgwụ na-ebelata lipid ugbu a, mkpokọta cholesterol ≥240 mg/dl, cholesterol lipoprotein dị obere ≥160 mg/dl, cholesterol lipoprotein dị elu <40 mg/dl, ma ọ bụ triglycerides ≥200 mg/dl35.
Ndị niile sonyere nwere MRI nke ụbụrụ na MRA nwere eriri isi ọwa asatọ na-eji nyocha 1.5 T MRI (Optima MR360, GE Healthcare, Milwaukee, Wisconsin ma ọ bụ Signa HDxt, GE Healthcare, Milwaukee, Wisconsin).Usoro ihe nlere anya nwere ihe onyonyo axial T1 (oge nkwughari [TR]/oge echo [TE] = 417-450/9 ms ma ọ bụ 400-450/10 ms), onyonyo T2 (TR/TE = 4343-4694). ) ./ 100-110 ms ma ọ bụ 4084-4494/95-104 ms), ihe oyiyi FLAIR (TR/TE = 11000/127-138 ms ma ọ bụ 8800/128-130 ms) na 3D oge ụgbọ elu (TOF) oyiyi (TR /TE = 28/7 ms ma ọ bụ 27/3 ms, iberi ọkpụrụkpụ = 1.2 mm).Ọkpụrụkpụ iberibe bụ 5 mm maka ụkpụrụ onyonyo niile ewezuga TOF MRA.
A tụlere ogo nke periventricular na nke miri emi WMH iche iche dabere na nha Fazekas nke isiokwu ọ bụla siri dị, dị ka egosiri na eserese 1 nke ntanetị.Akara PVWMH dị ka ndị a: 0=ọ dịghị onye, ​​1=okpu ma ọ bụ nke dị gịrịgịrị, 2=halo dị nro, 3= hyperintensity periventricular na-adịghị agafe agafe na-agbatị n'ime ihe ọcha dị omimi.A na-ekewa DWMH dị ka ndị a: 0 = adịghị, 1 = punctate, 2 = ọnya na-amalite ịgbakọta, 3 = nnukwu ebe mgbagwoju anya.N'ihi na ụbụrụ HBH ọkwa 2 ma ọ bụ karịa ka amara na ọ dị mkpa ụlọ ọgwụ n'ihi na ọ na-enwekarị mgbaàmà na ọganihu, anyị kewara ndị ọrịa nwere Fazekas ọnụọgụ 2 na 3 n'ime PVBVH na DGBV36,37.
Nyocha TOF MRA, dabere na warfarin-aspirin symptomatic intracranial ọrịa (WASID), na-akọwa intracranial artery stenosis (ICAS) dị ka intracranial artery stenosis karịa 50% 38.Ụgbọ mmiri ndị a gụnyere na nyocha ahụ bụ akwara carotid dị n'ime ya site na akụkụ cavernous ruo akụkụ M2 nke etiti ụbụrụ ụbụrụ ụbụrụ, akụkụ A2 nke ụbụrụ ụbụrụ ụbụrụ, akụkụ P2 nke ụbụrụ ụbụrụ ụbụrụ azụ, akwara basilar, na intracranial. akwara.akụkụ nke akwara vertebral.
Emere nyocha redio niile site n'aka onye na-ahụ maka akwara ozi (JYK), onye na-amaghị maka data ụlọ ọgwụ na ụlọ nyocha niile.A tụlere ntụkwasị obi nke ihe nlele anya n'etiti ndị na-ekiri ya site n'aka onye na-ahụ maka redio zụrụ azụ (JYC) na isiokwu 700 a na-ahọrọ na-enweghị usoro na n'ime oge ọnwa 2 ka agụchara mbụ.Nyochaa ntụkwasị obi n'ime onye na-ekiri ya.Ntụle anya nke PVWMH, DWMH, na ICAS gosipụtara ezigbo ọkachamara n'etiti (Cohen-weighted kappa: 0.7, 0.81, na 0.67, n'otu n'otu; n = 700) na n'ime-ọkachamara (Cohen-weighted kappa: 0.92, 0.88, na 0. 65, otu; n = 1339) protocol.
A na-enyocha akara CAC na ndị mmadụ mere CT iji chọpụta CAC n'ime afọ 5 nke ụbụrụ MRI na MRA39.N'ime mmadụ 1,337, 686 nwere nyocha ụbụrụ n'otu ụbọchị yana 651 n'ụbọchị ọzọ n'ime afọ ise.
Ebe Seoul na Suwon jiri mAc (310 mA × 0.4 s) tube dị ugbu a na ọkpụrụkpụ 2.5 mm, oge ntụgharị 400 ms, voltaji tube 120 kV, yana 124 ECG dabere na dose modulation.Dị ka Agatston et al.40 si kwuo, a gbakọrọ CAC site na 4 isi akwara akwara epicardial (isi aka ekpe, ihu aka ekpe na-agbada, sekọmflek ekpe, na akwara akwara nri).Ozi ọ bụla gbasara isiokwu ahụ mere ka onye ọrụ CT kpuo ìsì ma kpebie akara CAC ozugbo site na iji sọftụ HEARTBEAT-CS (Philips, Cleveland, OH, USA).E kewara akara CAC ụzọ atọ: 0, 1-100, na>100.
Atụnyere njirimara ntọala n'etiti isiokwu nwere ma na-enweghị cerebral WMH site na iji χ2 ule maka categorical variables na Student's t-ule ma ọ bụ Mann-Whitney ule maka mgbanwe na-aga n'ihu, dị ka o kwesịrị.A na-egosiputa mgbanwe ndị a na-ekesa nke ọma dị ka ± ọkọlọtọ ọkọlọtọ, ebe ndị na-abụghị nke a na-ekesa na-egosipụta dị ka etiti na etiti anọ.E webatara ụdị mgbanwe dummy maka ụkpụrụ efu nke ụdị mgbanwe dị iche iche.
Emere nyocha ihe nleba anya dị iche iche iji gbakọọ oke nha (ORs) na oge ntụkwasị obi 95% (CI) iji chọpụta mmekọrịta dị n'etiti ụbụrụ WMH na CAC na ihe ndị dị ize ndụ maka atherosclerosis.Ebe ọ bụ na mmụba HHH na-abawanye na afọ ma na-adịgasị iche site na mmekọahụ, a na-eme nyocha niile multivariate iji chọpụta mkpakọrịta dị n'etiti mgbanwe ndị ọzọ na HHH18 gbanwere maka afọ na mmekọahụ.A na-eji ụdị regression multivariate ọzọ iji chọpụta ma akara CAC nwere njikọ onwe ya na ụbụrụ SHG, ọbụlagodi mgbe emezigharịrị maka ihe ize ndụ atherosclerosis na ICAS dị ka ihe mgbagwoju anya nke a kọrọ na e jikọtara ya na SHH na akụkọ ndị gara aga10, 26, 27, 41. A na-edozi ihe nlereanya 1 maka afọ na okike, Ụdị 2 gbanwere maka afọ, okike, na ihe ize ndụ maka atherosclerosis (BMI, ọbara mgbali elu, ọrịa shuga, dyslipidemia, onye na-ese anwụrụ ugbu a ma ọ bụ onye na-ese anwụrụ, mmega ahụ mgbe niile, ọrịa akwara ọbara na-arịa ọrịa akwara na ọkwa cystine).gbanwee;A gbanwere ihe nlereanya 3 maka afọ, okike, ihe ize ndụ maka atherosclerosis, na ọnụnọ ICAS.A tụlere ọnụnọ nke ụbụrụ WMH dịka akara akara CAC si jiri akara CAC 0 dị ka akara nrịbama.
A na-eme nyocha ọnụ ọgụgụ site na iji ụdị Stata 16.1 (StataCorp, College Station, Texas, USA) na R studio version 3.6.3 (RStudio, Boston, Massachusetts, USA).A na-ewere p-ụkpụrụ ọdụdụ abụọ <0.05 dị ka ihe dị mkpa.
E gosipụtara njirimara ntọala nke ndị mmadụ 1337 na Tebụl 1. Ogologo afọ nke ndị sonyere, e mere atụmatụ site na oge MRI nke ụbụrụ, bụ 51.63 ± 9.20 afọ, na 86.54% nke ndị na-amụ ihe bụ nwoke.Isi ihe dị ize ndụ maka atherosclerosis na otu a bụ ise siga ugbu a ma ọ bụ gara aga (57.82%), dyslipidemia (51.76%) sochiri ya na ọbara mgbali elu (28.65%).N'ihe gbasara mgbanwe redio, ndị ọrịa 158 (11.82%) nwere PVWMH, 148 (11.07%) nwere DWMH, na 21 (1.57%) nwere ICAS.N'ihe gbasara akara CAC, isiokwu 849 (63.5%) nwere akara CAC nke 0, 332 (24.83%) nwere akara n'etiti 0 na 100, na 156 (11.67%) nwere akara karịa 100.
Na nyocha nke otu, afọ, okike, na ọtụtụ ihe ize ndụ maka atherosclerosis, ma e wezụga BMI, dyslipidemia, na ịṅụ sịga ugbu a ma ọ bụ n'oge gara aga, jikọtara ya na ọnụnọ nke ụbụrụ HHH (p <0.05) (Table 2).Ndị mmadụ nwere PVWMH na DWMH tọrọla ma nwee ibu dị ukwuu nke ọbara mgbali elu, ọrịa shuga, akụkọ ihe mere eme nke ọrịa akwara obi, CAC, na ICAS karịa ndị na-enweghị PVWMH na DWMH.Na nyocha nke otu, ọnụ ọgụgụ dị elu nke ụmụ nwanyị na isiokwu dị na otu WMH kọrọ na ha na-emega ahụ mgbe niile.Ọkara (oke n'etiti; IQR) CAC bụ 62 (IQR 0-269.5) na otu PVWMH yana 46.5 (IQR 0-192) n'ime otu DWMH.E gosipụtara nkesa nke otu CAC site na ọnụnọ PVWMH na DWMH na fig.2. Oke nke edemede nwere akara CAC dị elu mụbara site na ogo nke WMH comorbid.
Pasent nke ụdị akara CAC dabere na inwe PVMWH (a), DWMH (b), na PVWMH ma ọ bụ DWMH (c).Calcification nke akwara akwara nke SAS, ihe ọcha hyperintensity SHG, ihe ọcha periventricular hyperintensity HVBV, ihe na-acha ọcha miri emi hyperintensity SHVH.
Ntụle mgbanwe mgbanwe dị iche iche na-edozi maka afọ (OR 1.13; 95% CI 1.10-1.16; OR 1.11; 95% CI 1.08-1.14) na ọbara mgbali elu (OR 2.29; 95% CI 1.50-3.50, OR 1.0308, 1.0398, 1.098). .N'otu n'otu) bụ PVWMH mgbe emezigharị maka afọ, mmekọahụ, ihe ize ndụ nke atherosclerosis (BMI, ọbara mgbali elu, ọrịa shuga, dyslipidemia, onye na-ese anwụrụ ugbu a ma ọ bụ onye na-ese anwụrụ, mmega ahụ, akụkọ ihe mere eme nke ọrịa akwara obi, na ọkwa homocysteine ​​​​) na ndị na-ahụ maka ụlọ ọgwụ nwere onwe ha nke DWMH na ICAS (niile p <0.05) (Table 3).Enweghị mkpakọrịta dị ịrịba ama n'etiti WMH emeziri na mmekọahụ, BMI, ọrịa shuga ma ọ bụ dyslipidemia, akụkọ ihe mere eme nke ise siga, ma ọ bụ mmega ahụ mgbe nile.
Ọbụlagodi mgbe emezigharịrị maka ihe ndị na-agbagwoju anya, edemede nwere akara CAC dị elu gosipụtara mmekọrịta mụbara na ụbụrụ GMI n'ụzọ dabere na usoro ntụnye aka na akara CAC nke 0. Maka PVWMH na DWMH, ụdị nwere akara CAC karịrị 100 ( OR 5.45; 95% CI 3.11-9.54 ma ọ bụ 3.66; 95% CI 2.10-6.38) gosipụtara mkpakọrịta dị ukwuu karịa edemede nwere akara CAC nke 0 ruo 100 (OR 2.22; 95% CI).1.36–3.61, MA ọ bụ 1.59;95% CI 0.98-2.58).Mgbe a na-atụnyere mkpakọrịta na CAC n'etiti otu PVWMH na DWMH, ụdị nyocha atọ dị iche iche gosipụtara mkpakọrịta dị elu na PVWMH na ụdị akara akara CAC abụọ.Ọnụnọ nke ICAS gosikwara njikọ dị ịrịba ama na PVWMH (OR 3.97, 95% CI 1.31-12.06) na DWMH (OR 7.11, 95% CI 2.33-21.77).
A na-agbakọ ọnụọgụ ọnụ ahịa dị iche iche maka ụdị regression niile iji chọpụta multicollinearity nwere ike, ọ dịghịkwa nsogbu multicollinearity achọtara (Mgbakwunye 1 online).
N'ime ọmụmụ ihe a, ihe ize ndụ nke SHH cerebral na-abawanye na akara CAC na-abawanye n'ụzọ na-adabere na dose, na nsonaazụ ya dị ịrịba ama mgbe emezigharị maka ihe ize ndụ nke comorbid maka atherosclerosis.Nsonaazụ anyị kwekọrọ na ọmụmụ ihe gara aga na-egosi njikọ dị n'etiti CAC na ụbụrụ MRI na-adịghị mma, na-akwado njikọ nke CAC na obere arịa ụbụrụ cerebral atherosclerosis yana nnukwu arịa atherosclerosis29,30,31,32.
N'ụzọ na-akpali mmasị, n'ụdị nyocha multivariate atọ niile, OR maka akara CAC dị ntakịrị elu na otu PVWMH karịa na otu DWMH.Ọdịiche a nwere ike ịbụ n'ihi na a na-eche na ọdịiche dị na usoro pathophysiological na ihe ize ndụ dị n'etiti PVWMH na DWMH11,42,43.PVWMH na-enwekarị symmetrically na ma ụbụrụ hemispheres, na-atụ aro a mgbasa perfusion ọrịa, ebe DWMH na-enwekarị nkesa asymmetric, na-atụ aro na ha na-akpata site a focal perfusion nsogbu.Ebe ọ bụ na a na-enye mpaghara periventricular site na akwara akwara nke ogologo medulla na alaka ndị na-emepe emepe [45], ọ na-adị mfe karị mgbe usoro autoregulatory maka ịnọgide na-enwe perfusion ụbụrụ mgbe niile na-emebi site na arteriosclerosis ma ọ bụ lipoid hyalinosis [46, 47, 48, 49].Hypoperfusion na ischemia na-etolite.Karịsịa, ọtụtụ nchọpụta egosila na ngosipụta nke atherosclerosis systemic, dị ka ọbara mgbali elu, ọrịa shuga mellitus, na ọnụnọ nke atherosclerosis nke aortic, na-ejikọta ya na PVWMH50,51,52,53, na-akwado nchoputa anyị na akara CAC, afọ, na akwara akwara. ọbara mgbali elu nwere OR dị elu maka PVWMH karịa maka DWMH n'ụdị niile.
N'ime ọmụmụ ihe a, ọnụnọ nke ICAS nwere njikọ chiri anya na ụbụrụ HHH, nsonaazụ nke nwere ike ịkọwa n'eziokwu ahụ bụ na nnukwu stenosis nke nnukwu akwara intracranial na-ebelata perfusion nke mpaghara ma ọ bụ mpaghara mpaghara, na hypoperfusion a na-adịghị ala ala na-enye aka na fatty hyalinosis, nke bụ usoro n'okpuru.mmepe nke WMH 26.54.
N'ikwekọ na ọtụtụ ọmụmụ ihe gara aga3, 27, 28, 55 mere na agbụrụ dị iche iche, nchọpụta anyị gosikwara na afọ na ọbara mgbali elu na-adabere na ya na nke ọma jikọtara ya na ụbụrụ HBG na nyocha multivariate.Otú ọ dị, njikọ dị n'etiti HHH na ihe ndị ọzọ dị ize ndụ maka atherosclerosis egosiwo ihe mgbagwoju anya na akụkọ gara aga27,28,37,56.Ihe kpatara nsonaazụ ndị a dị iche iche nwere ike ịbụ n'ihi ọdịiche dị na ọnụọgụ ọmụmụ, njirisi maka ịchọpụta ihe ize ndụ, ma ọ bụ ụzọ eji nyochaa WMH, nke chọrọ ọmụmụ ihe ọzọ.
Ekwesịrị iburu n'uche ọtụtụ njedebe nke ọmụmụ ihe a.Nke mbụ, nke a bụ nyocha azụ azụ nke ndị Eshia na ebe ahụike monobrand.Enwere ike ịnwe ihe ize ndụ nke nhọrọ nhọrọ dịka ọnụ ọgụgụ buru ibu nke ndị na-amụ ihe na-arụ ọrụ afọ, na ihe karịrị ọkara n'ime ha bụ ụmụ nwoke, n'ihi àgwà pụrụ iche nke South Korea, nke chọrọ ka ụlọ ọrụ nyochaa ndị ọrụ ha mgbe nile.Iji belata enweghị mmasị na ọmụmụ otu, ogologo oge, ogologo oge na ọmụmụ ihe dị ka Rotterdam Study57 ma ọ bụ Framingham Study58 kwesịrị ime.Na mbụ, e nweela ọtụtụ akụkọ na-eji Rotterdam Study na-elekwasị anya na mmekọrịta dị n'etiti ụbụrụ SHG na ihe ize ndụ dị iche iche maka atherosclerosis Association n'etiti ndị otu na ọmụmụ Framingham 4,59,60,61,62,63.Agbanyeghị, ebe ọ nweghị ọmụmụ ihe ọ bụla lekwasịrị anya na njikọ dị n'etiti SHG na CCA na ọnụ ọgụgụ nkịtị, nsonaazụ anyị bụ mkpa ụlọ ọgwụ.Nke abụọ, ebe ọ bụ na a na-eme nyocha MRI anya site na ndị na-ahụ maka redio, ebumnuche nwere ike ọ gaghị ezuru.Agbanyeghị, anyị gbalịrị imeri mmachi a site n'ịgụnye ọnụ ọgụgụ buru ibu nke ndị sonyere na ịkọwa isiokwu nwere opekata mpe WMH dị oke oke ma ọ bụ karịa dị ka otu dị mma.Na mgbakwunye, anyị mere ule ntụkwasị obi nke inter-observer na intra-observer, nsonaazụ ya gosipụtara nkwekọrịta dị mma.A kọwokwa na mbụ na enwere njikọ dị elu n'etiti ụzọ ntule anya site na iji nha Fazekas na nyocha volumetric ejiri iji nyochaa ọkwa nke WMH64,65.Nke atọ, ewepụrụ ndị mmadụ nwere ọnya ụbụrụ site na iji akwụkwọ nyocha nke onwe nke gụnyere akụkọ ahụike gara aga na nyocha onyonyo nke ndị nwere ọrịa pụtara ìhè ma nwee ike ọ gaghị enyocha ndị nwere ọrịa subclinical.Tụkwasị na nke ahụ, mmemme MRI nke ụbụrụ maka nyocha ahụike n'ụlọ ọgwụ anyị anaghị agụnye ihe oyiyi emelitere, ya mere enwere ike ịchọta nchọpụta nke ọnya ụbụrụ na-eme ka ọ pụta ìhè na T1-weighted, T2-weighted and FLAIR images, na ọnụego ziri ezi dị elu.E jiri ya tụnyere nkwalite MRA, ọnụnọ ICAS ka ọ dị ntakịrị.Nke anọ, ebe ọ bụ na ọtụtụ n'ime ndị sonyere na ọmụmụ ihe a sitere na ndị nwere ahụike na ọtụtụ enweghị ọrịa ọ bụla, ọnụ ọgụgụ nke ndị na-ata ahụhụ na ICAS dị ntakịrị.
Otú ọ dị, ọmụmụ ihe a gụnyere ndị nwere ahụ ike karịa ọmụmụ ihe gara aga na-ele anya na njikọ dị n'etiti SHG na SAS, na ihe ọmụma anyị, nke a bụ ọmụmụ ihe mbụ na-agụnye ndị okenye nwere ahụike na-akọwapụtaghị okike ma ọ bụ afọ.Oke nke ọmụmụ 31,32.
Mkpa ụbụrụ WMH na ọrịa dị iche iche metụtara akwara ozi dị ka mgbaka na ọrịa strok ka a na-eme ka ọ pụta ìhè n'ihi mmụba dị egwu na nnweta ụbụrụ ụbụrụ na ndụ ndụ, mana ọrịa ndị a na-anọgide na-emeri.Ọnụnọ nke ọnya HHH na ụbụrụ jikọtara ya na mbelata ọgụgụ isi, mgbaka, ịda mbà n'obi, na ọrịa strok, na e nwere ihe àmà na-arịwanye elu na ịchịkwa ụfọdụ ihe ize ndụ maka atherosclerosis nwere ike igbochi HHH12, 13, 14, 15, 16, 17, 18. , 19, 20, 21, 22, 23, 66, 67, 68, 69. Ya mere, nsonaazụ anyị nwere ike inye ihe akaebe maka nyocha ndị mmadụ nọ n'ihe ize ndụ maka ụbụrụ HHH, ihe dị mkpa dị ize ndụ na onye amụma maka ọrịa dị iche iche nke akwara ozi, na-ezo aka na akara CAC, si otú ahụ na-achọpụta ndị ọrịa nwere ike irite uru site na nchọpụta ike na ọgwụgwọ ọgwụgwọ.ma CAC na-arụ ọrụ dị mkpa na nke onwe ya na mmepe nke WMH na ogologo oge na ọmụmụ ihe ndị a na-atụ anya site na mpaghara dị iche iche, ọgbọ dị iche iche na agbụrụ agbụrụ, na akara MRI ndị ọzọ nke ọrịa obere arịa ụbụrụ kwesịrị ịgụnye maka nghọta zuru oke.
Na mmechi, akara CAC yana afọ na ọbara mgbali elu jikọtara nke ọma na ụbụrụ WMH n'ime ọnụ ọgụgụ buru ibu nwere ahụike.Akara CAC bụ ihe na-egosi ibu atherosclerotic ma nwee ọrụ nwere ike ibu amụma ihe ize ndụ nke HHH cerebral na omume ụlọ ọgwụ.
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