321/321L chitsulo chosapanga dzimbiri capillary chubu Association of white matter hyperintensity ndi coronary artery calcification mwa anthu athanzi: kafukufuku wagawo

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White matter hyperintensity (WWH) ndizomwe zimapezeka kwambiri pamaganizidwe a maginito a resonance (MRI) muubongo ndipo zimadziwika kuti zimawonetsa matenda ang'onoang'ono muubongo.Cholinga cha phunziro lathu chinali kufufuza mgwirizano wa coronary artery calcium (CCA) ndi WMH ndikufotokozera mgwirizano pakati pa WMH ndi zifukwa zowopsa za atherosulinosis mwa anthu ambiri athanzi.Kafukufuku wobwerezawu adaphatikizapo anthu a 1337 omwe adalandira ubongo wa MRI ndi computed tomography ndi CAC kuunika kuchipatala chachipatala chapamwamba.GVM yaubongo imatanthauzidwa ngati mphambu ya Fazekas yopitilira 2 mfundo pa MRI yaubongo.Intracranial arterial stenosis (ICAS) idawunikidwanso ndikutsimikiziridwa pomwe angiography idawonetsa kupitilira 50% stenosis.Mabungwe a zinthu zoopsa, CAC ndi ICAS zambiri ndi ubongo wa HBG adayesedwa pogwiritsa ntchito kusanthula kobwerezabwereza.Mu kusanthula kosiyanasiyana, magulu omwe ali ndi ma CAC apamwamba kwambiri adawonetsa kuyanjana kowonjezereka ndi periventricular ndi hypertension yozama m'njira yodalira mlingo.Kukhalapo kwa ICAS kudalumikizidwanso kwambiri ndi ubongo wa HBH, ndipo pakati pamitundu yosiyanasiyana yazachipatala, zaka ndi matenda oopsa zinali zodziyimira pawokha.Pomaliza, mwa anthu athanzi, CAC idalumikizidwa kwambiri ndi ubongo wa WMH, womwe ungapereke umboni wozindikiritsa anthu omwe ali pachiwopsezo cha ubongo wa WMH potengera kuchuluka kwa CAC.

Chitsulo Chosapanga 321 Coil Tube Chemical Mapangidwe

Kapangidwe kake ka 321 koyilo yachitsulo chosapanga dzimbiri ndi motere:
- Mpweya: 0.08% Max
- Manganese: 2.00% max
Nickel: 9.00% min

321/321L chitsulo chosapanga dzimbiri 8 * 0.2 kapilari chubu

Zida Zamakina Zazitsulo Zachitsulo 321 Coil Tube

321/321L chitsulo chosapanga dzimbiri 8 * 0.2 kapilari chubu

Malinga ndi Stainless Steel 321 Coil Tube Manufacturer, makina amakina a zitsulo zosapanga dzimbiri 321 machubu amalembedwa pansipa: Kulimba Kwambiri (psi) Kuchuluka Kwambiri (psi) Elongation (%)

321/321L chitsulo chosapanga dzimbiri 8 * 0.2 kapilari chubu

White matter hyperintensity (WWH) ndizomwe zimapezeka kawirikawiri muzithunzithunzi za T2 zolemera ndi zowonongeka zamadzimadzi (MRI) inversion recovery (FLAIR) za ubongo1,2.Ngakhale kuti njira yeniyeni ya matenda a HHH sichidziwika, yasonyezedwa kuti ikugwirizana ndi zifukwa zomwe zimayambitsa matenda a atherosclerosis monga ukalamba, kuthamanga kwa magazi, shuga, kusuta, ndi kunenepa kwambiri, kutanthauza kuti chithandizo cha mitsempha ya mitsempha pa chitukuko cha HHH3,4,5 ,6.,7,8,9,10.Maphunziro a pathological awonetsanso kuti HHH imayambitsidwa ndi kusokonezeka kwa mitsempha ya mitsempha, motero kutsimikizira kuti HHH ndi chiwonetsero cha matenda a mitsempha yaing'ono mu ubongo11.Kuonjezera apo, SHG ndi yofunika kwambiri pachipatala monga momwe yasonyezedwera kuti imakhudza zochitika ndi zochitika za matenda osiyanasiyana a ubongo, kuphatikizapo kuchepa kwa chidziwitso, kusokonezeka maganizo, kuvutika maganizo, kusokonezeka kwa gait, ndi stroke12,13,14,15,16,17,18, 19 , 20, 21, 22, 23 .
Coronary calcium assessment (CAC) amaonedwa kuti ndi njira yabwino komanso yodalirika yodziwira kuti munthu akhoza kudwala matenda a atherosclerosis ndipo zasonyezedwa kuti zimagwirizana ndi ischemic stroke ndi cranial artery stenosis, komanso matenda a mtima24,25.Matenda a mitsempha yaing'ono ya ubongo amapezeka mosavuta ndi atherosulinosis ya mitsempha yayikulu ya intracranial chifukwa timitsempha tating'onoting'ono tomwe timatulutsa zinthu zoyera timachokera ku mitsempha yayikulu ya basilar.Kafukufuku wambiri wapeza mgwirizano pakati pa SHH ndi ziwopsezo za atherosulinosis kapena carotid atherosulinosis, komabe, ndi maphunziro ochepa okha omwe adayang'ana pa ubale pakati pa SAS kulemedwa ndi SHH, ndipo maphunzirowa adangochitika mwa akulu akulu kapena amuna 29, 30, 31 .32.
Ndi kuchuluka kwa kupezeka kwa neuroimaging m'zaka zaposachedwa, kufalikira kwapamwamba komanso kufunikira kwachipatala kwa HHH kumazindikirika mokulirapo ngati chidziŵitso cha kuchepa kwa chidziwitso ndi zotsatira za sitiroko19,20,21,22,23.Cholinga cha phunziroli chinali chakuti ngati chiwerengero cha CAC chingagwiritsidwe ntchito m'zochitika zachipatala kuti ziwonetsere chiopsezo cha SHH, cholosera za matenda osiyanasiyana a ubongo, chikhoza kukhala chida chothandiza komanso chothandiza kudziwa phindu la maphunziro ena aumunthu, monga monga MRI ya ubongo19,20,21,22,23.Tidaganiza kuti HHH imagwirizana kwambiri ndi CCA kulemedwa, chizindikiro cha atherosulinosis, mwa anthu ambiri athanzi mwa anthu wamba.Kuonjezera apo, tinayesetsa kuthandizira kumvetsetsa njira zomwe zimayambitsa chitukuko cha HHH pozindikira zifukwa zoyenera zachipatala.Choncho, cholinga chachikulu cha phunziroli chinali kufufuza mgwirizano wa CAC ndi WMH mu anthu athanzi.Kachiwiri, cholinga cha kafukufukuyu chinali kuwunikira ubale womwe ulipo pakati pa SHG ndi zinthu zomwe zingayambitse matenda a atherosulinosis.
Kafukufukuyu ndi kafukufuku wamagulu osiyanasiyana otengera kuchuluka kwa anthu.Tidafufuza zapakompyuta za omwe adachita nawo mayeso azachipatala, kuphatikiza MRI yaubongo ndi maginito resonance angiography (MRA), ku Gangbuk Samsung Hospital General Medical Centers ku Seoul ndi Suwon pakati pa Januware 2016 ndi Disembala 2019. CT) ndi kujambula muubongo ngati gawo la mayeso athunthu amthupi, omwe ndi njira zowunikira zaumoyo ku Korea.Mwachidziwitso, malamulo aku Korea amafuna kuti ogwira ntchito onse azikayezetsa kuchipatala kamodzi pachaka kapena kaŵirikaŵiri, kotero kuti ambiri ndi antchito kapena achibale a antchito amakampani osiyanasiyana kapena mabungwe aboma.
Mwa anthu a 3983, 2646 sanaphatikizidwe pazifukwa zotsatirazi: a) kusagwirizana ndi kugwiritsa ntchito chidziwitso chachipatala pazifukwa zilizonse zofufuza m'mafunso odzipangira okha asanayesedwe (n = 376);ngati mayesero obwerezabwereza adachitidwa panthawiyi (n = 43), anthu omwe ali ndi mayesero obwerezabwereza sanaphatikizidwe, ndipo kujambula kwa CT ndi ubongo ndi kuwunika kwa CAC komwe kunachitika tsiku lomwelo kapena panthawi yaposachedwa kwambiri adasankhidwa kuti aphunzire;(c) dementia yodziwika bwino, matenda a Parkinson.mbiri, hydrocephalus, opaleshoni yam'mbuyo yaubongo, chotupa muubongo, matenda a moyamoya, sitiroko kapena kutaya magazi (n = 47);(d) anthu omwe ali ndi zotupa zazikulu muubongo zomwe zimazindikiridwa ndi kusanthula kwazithunzi, mwachitsanzo, chifukwa cha encephalomalacia isanachitike chifukwa cha sitiroko (chiyerekezo cham'mimba mwake chachikulu kuposa 15 mm) kapena kukha magazi kwakale kowopsa, kuwonongeka kwa arteriovenous, kapena neoplastic lesion (n = 46);(e) anthu omwe ali ndi MRI kapena MRA osakwanira kusanthula zithunzi (n = 2);(f) anthu omwe sanachite CT pamlingo wa CAC (n = 1796);(g) anthu omwe analibe manambala ofunikira kuti awunikenso, kuphatikiza index mass index (BMI) ndi homocysteine ​​​​levels (n = 336).Tchati cholembera anthu ochita nawo kafukufuku chikuwonetsedwa pa Chithunzi 1.
Phatikizani ndondomeko ya omwe akutenga nawo mbali.MRI magnetic resonance imaging, MRA magnetic resonance angiography, periventricular white matter hyperintensity PVWMH, deep white matter hyperintensity DWH.
Choncho, maphunziro a 1337 (zaka zapakati pa 51.63 ± 9.20 zaka, zaka za 20-89 zaka, 1157 [86.54%] odwala amuna) anaphatikizidwa mu phunziroli.Onse omwe adatenga nawo gawo adawunikidwa motsata zomwe zapezedwa zachipatala ndi ma radiographic.Phunziroli linachitidwa motsatira mfundo za Declaration of Helsinki ndipo linavomerezedwa ndi Institutional Review Board (IRB) ya Gangbuk Samsung Hospital (IRB No. 2020-12-036-006).IRB pachipatala cha Kangbuk Samsung idasiya chivomerezo chodziwitsidwa chifukwa chogwiritsa ntchito deta yosazindikirika komanso kapangidwe ka kafukufuku wakale.Njira zonse zofufuzira zidachitidwa motsatira malangizo ndi malamulo oyenera.
Tinasonkhanitsa zokhudzana ndi zachipatala kuphatikizapo jenda, zaka, BMI, systolic ndi diastolic blood pressure, mbiri ya kusuta, masewera olimbitsa thupi, kuzindikira ndi kuchiza matenda oopsa, shuga, hyperlipidemia, ndi matenda a mtima.Kuchokera m'mafunso odzipangira okha, tinasonkhanitsa zokhudza mbiri yachipatala ya munthu aliyense ndi mbiri ya kusuta fodya, komanso ngati ankachita masewera olimbitsa thupi nthawi zonse kwa mphindi 10 osachepera katatu pa sabata.
Chifukwa onse omwe adatenga nawo gawo adayenera kukayezetsa ku Ganbuk Samsung Hospital General Medical Center, kuyezetsa kwa labotale kunachitika tsiku lomwelo monga MRI yaubongo ndi MRA pambuyo pa kusala kudya kwa maola 12, ndipo deta idaphatikizapo glucose, glycated hemoglobin (HbA1c), milingo. athunthu cholesterol, LDL cholesterol, HDL cholesterol, triglycerides ndi homocysteine.
Kuthamanga kwa magazi kumatanthauzidwa ngati kudya kwamakono kwa mankhwala osokoneza bongo, kuthamanga kwa magazi kwa systolic ≥ 140 mmHg.kapena kuthamanga kwa magazi kwa diastolic ≥ 90 mmHg33.Matenda a shuga amatanthauzidwa ngati kugwiritsa ntchito mankhwala osokoneza bongo, kusala shuga wamagazi ≥ 126 mg/dL, kapena HbA1c ≥ 6.5%.Dyslipidaemia imatanthauzidwa ngati kugwiritsidwa ntchito kwamakono kwa mankhwala ochepetsa lipid, mafuta a cholesterol ≥240 mg / dl, otsika kwambiri a lipoprotein cholesterol ≥160 mg/dl, high-density lipoprotein cholesterol <40 mg/dl, kapena triglycerides ≥200 mg/dl35.
Onse omwe adatenga nawo gawo adakumana ndi MRI yaubongo ndi MRA yokhala ndi koyilo yamutu wa eyiti pogwiritsa ntchito 1.5 T MRI scanner (Optima MR360, GE Healthcare, Milwaukee, Wisconsin kapena Signa HDxt, GE Healthcare, Milwaukee, Wisconsin).Protocol yojambula inali ndi zithunzi zolemetsa za axial T1 (nthawi yobwereza [TR]/echo nthawi [TE] = 417–450/9 ms kapena 400–450/10 ms), zithunzi zolemera T2 (TR/TE = 4343–4694 )./100-110 ms kapena 4084-4494/95-104 ms), zithunzi za FLAIR (TR/TE = 11000/127-138 ms kapena 8800/128-130 ms) ndi zithunzi za 3D za nthawi yaulendo (TOF) (TR /TE = 28/7 ms kapena 27/3 ms, makulidwe kagawo = 1.2 mm).Kukula kwa kagawo kunali 5 mm kwa ma protocol onse ojambulira kupatula TOF MRA.
Mlingo wa periventricular ndi deep WMH udawunikidwa padera malinga ndi phunziro lililonse la Fazekas scale1, monga momwe zasonyezedwera mu Supplementary Figure 1 pa intaneti.PVWMH inagoleredwa motere: 0=palibe, 1=chipewa kapena chotchinga chopyapyala, 2=halo yosalala, 3=kuchuluka kwamphamvu kwapang'onopang'ono kwa periventricular kumafikira kuzinthu zoyera kwambiri.DMH imayikidwa motere: 0 = palibe, 1 = punctate, 2 = zilonda zimayamba kugwirizanitsa, 3 = madera akuluakulu a confluence.Chifukwa ubongo wa HBH giredi 2 kapena kupitilira apo umadziwika kuti ndi wofunikira kwambiri chifukwa umakonda kukhala ndi zizindikiro komanso kakulidwe kake, tidagawa odwala a Fazekas a 2 ndi 3 kukhala PVBVH ndi DGBV36,37.
Kusanthula kwa TOF MRA, kutengera njira ya warfarin-aspirin symptomatic intracranial disease (WASID), imatanthauzira intracranial artery stenosis (ICAS) ngati intracranial artery stenosis yoposa 50% 38.Mitsuko yomwe inaphatikizidwa pakuwunika inali mtsempha wamkati wa carotid kuchokera ku gawo la cavernous kupita ku gawo la M2 la mitsempha yapakati ya ubongo, gawo la A2 la mtsempha wapakati wa ubongo, gawo la P2 la mitsempha ya posterior cerebral artery, basilar artery, ndi intracranial. mtsempha wamagazi.gawo la mtsempha wa vertebral.
Kuwunika konse kwa ma radiological kunachitika ndi katswiri wa neuroradiologist (JYK), yemwe samadziwa zonse zachipatala ndi labotale.Kudalirika kwa mawonekedwe owoneka pakati pa owonera adayesedwa ndi wachiwiri wophunzitsidwa ndi radiograph (JYC) pamitu 700 yosankhidwa mwachisawawa komanso mkati mwa miyezi iwiri mutatha kuwerenga koyamba.Unikani kudalirika mkati mwa wowonera.Kuwunika kowoneka kwa PVWMH, DWH, ndi ICAS kunawonetsa akatswiri abwino apakati (kappa wolemera wa Cohen: 0.7, 0.81, ndi 0.67, motsatana; n = 700) komanso katswiri wamkati (Cohen-weighted kappa: 0.92, 0.88, ndi 0 . 65, motsatana; n = 1339) protocol.
Chiwerengero cha CAC chinayesedwa mwa anthu omwe adachita CT kuti awone CAC mkati mwa zaka 5 za ubongo wa MRI ndi MRA39.Mwa anthu 1,337, 686 anali ndi sikani yaubongo tsiku lomwelo ndipo 651 tsiku lina mkati mwa zaka zisanu.
Malo a Seoul ndi Suwon adagwiritsa ntchito mAc (310 mA × 0.4 s) chubu panopa pa makulidwe a 2.5 mm, 400 ms nthawi yozungulira, 120 kV chubu voltage, ndi 124 kutengera ECG kusinthasintha kwa mlingo.Malingana ndi Agatston et al.40, CAC inawerengedwa kuchokera ku mitsempha yaikulu ya 4 ya epicardial coronary arteries (kumanzere kwakukulu, kumanzere kumtunda kutsika, kumanzere kwa circumflex, ndi mitsempha yolondola).Katswiri wa CT adachititsidwa khungu ndi chidziwitso chilichonse chokhudza nkhaniyi ndipo kuchuluka kwa CAC kudatsimikiziridwa pogwiritsa ntchito pulogalamu ya HEARTBEAT-CS (Philips, Cleveland, OH, USA).Zotsatira za CAC zimagawidwa m'magulu atatu: 0, 1-100, ndi> 100.
Makhalidwe oyambira adafanizidwa pakati pa maphunziro omwe ali ndi komanso opanda ubongo WMH pogwiritsa ntchito mayeso a χ2 pazosintha zamagulu ndi mayeso a Student's t kapena Mann-Whitney pazosintha mosalekeza, ngati kuli koyenera.Zosintha zomwe zimagawika nthawi zambiri zimawonetsedwa ngati ± kupatuka koyenera, pomwe zosintha zosagawika zimawonetsedwa ngati mtundu wapakati ndi interquartile.Zosintha za Dummy zidayambitsidwa chifukwa chosowa zamitundu yosiyanasiyana.
Multivariate logistic regression analysis idachitidwa kuti awerengere ma odds ratios (ORs) ndi 95% confidence intervals (CIs) kuti awone ubale pakati pa ubongo wa WMH ndi CAC zambiri komanso ziwopsezo za atherosulinosis.Popeza kuchuluka kwa HHH kumawonjezeka ndi zaka komanso kumasiyana malinga ndi kugonana, kusanthula konse kwamitundumitundu komwe kumachitidwa kuti awone mayanjano pakati pa mitundu ina ndi HHH18 yosinthidwa zaka ndi kugonana.Njira ina yosinthira zinthu zambiri idagwiritsidwa ntchito kuwunika ngati kuchuluka kwa CAC kuli ndi mgwirizano wodziyimira pawokha ndi ubongo wa SHG, ngakhale atasintha zinthu zowopsa za atherosulinosis ndi ICAS monga zinthu zosokoneza zomwe zanenedwa kuti zimagwirizanitsidwa ndi SHH m'malipoti am'mbuyomu10, 26, 27, 41 Chitsanzo cha 1 chinasinthidwa malinga ndi msinkhu ndi jenda, Chitsanzo 2 chinasinthidwa chifukwa cha msinkhu, jenda, ndi zifukwa zomwe zimayambitsa matenda a atherosclerosis (BMI, kuthamanga kwa magazi, shuga, dyslipidaemia, wosuta wamakono kapena wakale, kuchita masewera olimbitsa thupi nthawi zonse, mbiri ya matenda a mtima ndi cystine levels. ).kusinthidwa;Model 3 idasinthidwa malinga ndi zaka, jenda, ziwopsezo za atherosulinosis, komanso kupezeka kwa ICAS.Kukhalapo kwa ubongo wa WMH kunayesedwa molingana ndi magulu a CAC pogwiritsa ntchito CAC score 0 ngati benchmark.
Kusanthula kwa ziwerengero kunachitika pogwiritsa ntchito mtundu wa Stata 16.1 (StataCorp, College Station, Texas, USA) ndi R studio mtundu 3.6.3 (RStudio, Boston, Massachusetts, USA).Makhalidwe a p-awiri <0.05 adawonedwa ngati ofunika kwambiri.
Makhalidwe oyambirira a anthu a 1337 akuwonetsedwa mu Table 1. Zaka zowerengeka za otenga nawo mbali, zomwe zimayesedwa kuyambira nthawi ya MRI ya ubongo, zinali zaka 51.63 ± 9.20, ndipo 86.54% ya anthu omwe amaphunzira anali amuna.Zomwe zimayambitsa matenda a atherosulinosis m'gululi zinali kusuta kwaposachedwa kapena kwakanthawi (57.82%), kutsatiridwa ndi dyslipidemia (51.76%) ndi matenda oopsa (28.65%).Pankhani ya ma radiological variables, odwala 158 (11.82%) anali ndi PVWMH, 148 (11.07%) anali ndi DWH, ndipo 21 (1.57%) anali ndi ICAS.Pankhani ya CAC, anthu 849 (63.5%) anali ndi CAC ya 0, 332 (24.83%) anali ndi pakati pa 0 ndi 100, ndipo 156 (11.67%) anali ndi mphambu yoposa 100.
Pakuwunika kosagwirizana, zaka, jenda, komanso zifukwa zambiri zowopsa za atherosulinosis, kupatula BMI, dyslipidemia, ndi kusuta kwaposachedwa kapena kwakale, zidalumikizidwa kwambiri ndi kukhalapo kwa ubongo HHH (p <0.05) (Table 2).Anthu omwe ali ndi PVWMH ndi DWH anali okalamba ndipo anali ndi vuto lalikulu la matenda oopsa, matenda a shuga, mbiri ya matenda a mtima, CAC, ndi ICAS kusiyana ndi anthu omwe alibe PVWMH ndi DMH.Mu kusanthula kosasintha, chiwerengero chachikulu cha amayi ndi maphunziro a gulu la WMH adanena kuti amachita masewera olimbitsa thupi nthawi zonse.Wapakati (interquartile range; IQR) CAC anali 62 (IQR 0-269.5) mu gulu la PVWMH ndi 46.5 (IQR 0-192) mu gulu la DWH.Kugawidwa kwa magulu a CAC ndi kupezeka kwa PVWMH ndi DWH kumawonetsedwa mkuyu.2. Chigawo cha magulu omwe ali ndi ziwerengero zapamwamba za CAC chinawonjezeka ndi digiri ya comorbid WMH.
Maperesenti a magulu a CAC potengera kukhala ndi PVMWH (a), DWMH (b), ndi PVWMH kapena DWMH (c).Kuwerengera kwa mitsempha ya coronary ya SAS, white matter hyperintensity SHG, periventricular white matter hyperintensity HVBV, white matter hyperintensity SHVH.
Multivariate regression analysis yosinthidwa kwa zaka (OR 1.13; 95% CI 1.10-1.16; OR 1.11; 95% CI 1.08-1.14) ndi matenda oopsa (OR 2.29; 95% CI 1.50-3.50, OR 1.208, 1.98-1.98%) .motsatana) ndi PVWMH mutatha kusintha zaka, kugonana, chiopsezo cha atherosclerosis (BMI, kuthamanga kwa magazi, shuga, dyslipidemia, wosuta wamakono kapena wakale, masewera olimbitsa thupi, mbiri ya matenda a mitsempha ya m'mitsempha, ndi ma homocysteine ​​​​) komanso zodziwikiratu zofunikira zachipatala za DWH ndi ICAS (onse p <0.05) (Table 3).Panalibe mgwirizano wofunikira pakati pa WMH yosinthidwa ndi kugonana, BMI, shuga kapena dyslipidemia, mbiri ya kusuta, kapena kuchita masewera olimbitsa thupi nthawi zonse.
Ngakhale atatha kusintha zinthu zosokoneza, magulu omwe ali ndi chiwerengero chapamwamba cha CAC anasonyeza kuwonjezereka kwa mgwirizano ndi ubongo wa GMI m'njira yodalira mlingo poyerekeza ndi magulu omwe ali ndi chiwerengero cha CAC cha 0. Kwa PVWMH ndi DSWH, magulu omwe ali ndi chiwerengero cha CAC choposa 100 ( OR 5.45; 95 % CI 3.11-9.54 kapena 3.66; 95% CI 2.10-6.38) inasonyeza kuyanjana kwakukulu kuposa magulu omwe ali ndi CAC scores 0 ku 100 (OR 2.22; 95% CI).1.36–3.61, KAPENA 1.59;95% CI 0.98–2.58).Poyerekeza kuyanjana ndi CAC pakati pa magulu a PVWMH ndi a DWH, mitundu yonse itatu yowunikira ma multivariate idawonetsa mayanjano apamwamba ndi PVWMH m'magulu onse a CAC ogoletsa.Kukhalapo kwa ICAS kunasonyezanso kuyanjana kwakukulu ndi PVWMH (OR 3.97, 95% CI 1.31-12.06) ndi DWH (OR 7.11, 95% CI 2.33-21.77).
Kusiyana kwa inflation coefficients kunawerengedwera kwa mitundu yonse yobwereranso kuti awone zomwe zingatheke kukhala multicollinearity, ndipo palibe zovuta za multicollinearity zomwe zinapezeka (Supplementary Table 1 pa intaneti).
Mu kafukufukuyu, chiwopsezo cha SHH chaubongo chinawonjezeka ndikuwonjezeka kwa CAC motengera mlingo, ndipo zotsatira zake zinali zofunika kwambiri pambuyo posintha zinthu zomwe zingayambitse matenda a atherosclerosis.Zotsatira zathu zimagwirizana ndi maphunziro apitalo omwe akuwonetsa mgwirizano pakati pa CAC ndi ubongo wa MRI zolakwika, kuthandizira kugwirizanitsa kwa CAC ndi ubongo waung'ono wa mitsempha ya mitsempha ya mitsempha komanso mitsempha yaikulu ya atherosclerosis29,30,31,32.
Chosangalatsa ndichakuti, mumitundu yonse itatu yowunikira ma multivariate, ma OR a ma CAC ambiri anali apamwamba pang'ono mu gulu la PVWMH kuposa gulu la DWH.Kusiyana kumeneku kungakhale chifukwa chakuti kusiyana kwa njira za pathophysiological ndi zoopsa zomwe zimaganiziridwa pakati pa PVWMH ndi DWH11,42,43.PVWMHs nthawi zambiri zimakhala zofananira m'magawo onse am'mimba, zomwe zikuwonetsa kusokonezeka kwapang'onopang'ono, pomwe ma DTMH nthawi zambiri amakhala ndi gawo lofananira, kutanthauza kuti amayamba chifukwa cha vuto la perfusion.Popeza chigawo cha periventricular chimaperekedwa ndi mitsempha yotsiriza ya medulla yaitali ndi nthambi za perforating [45], zimakhala zovuta kwambiri pamene njira zowonongeka zowonongeka nthawi zonse zimasokonezedwa ndi arteriosclerosis kapena lipoid hyalinosis [46, 47, 48, 49].Hypoperfusion ndi ischemia zimayamba.Makamaka, kafukufuku wambiri wasonyeza kuti mawonetseredwe a systemic atherosulinosis, monga kuthamanga kwa magazi, matenda a shuga, ndi kupezeka kwa aortic atherosclerosis, makamaka amagwirizana ndi PVWMH50,51,52,53, kuchirikiza zomwe tapeza kuti chiwerengero cha CAC, zaka, ndi mitsempha. matenda oopsa kwambiri anali ndi ma OR apamwamba a PVWMH kuposa a DWH mumitundu yonse.
Mu phunziro ili, kupezeka kwa ICAS kunali kogwirizana kwambiri ndi ubongo wa HHH, zotsatira zomwe zingathe kufotokozedwa ndi mfundo yakuti stenosis yaikulu ya mitsempha yaikulu ya intracranial imachepetsa kuphulika kwa ubongo wa m'deralo kapena m'madera, ndipo kuperewera kwapadera kumeneku kumapangitsa kuti mafuta a hyalinosis awonongeke. njira zoyambira.chitukuko cha WMH 26.54 .
Mogwirizana ndi maphunziro ambiri am'mbuyomu3, 27, 28, 55 omwe adachitika m'mitundu yosiyanasiyana, kafukufuku wathu adawonetsanso kuti zaka ndi kuthamanga kwa magazi zinali paokha komanso zogwirizana kwambiri ndi ubongo wa HBG pakuwunika kosiyanasiyana.Komabe, mgwirizano pakati pa HHH ndi zinthu zina zowopsa za atherosulinosis zawonetsa zotsatira zosakanikirana mu malipoti am'mbuyomu27,28,37,56.Zifukwa za zotsatira zosiyanazi zikhoza kukhala chifukwa cha kusiyana kwa chiwerengero cha anthu ophunzirira, njira zodziwira zoopsa, kapena njira zomwe zimagwiritsidwa ntchito pofufuza WMH, zomwe zimafuna kufufuza kwina.
Zolepheretsa zingapo za phunziroli ziyenera kuzindikiridwa.Choyamba, uku ndi kafukufuku wobwerezabwereza wa anthu aku Asia pachipatala cha monobrand.Pakhoza kukhala chiwopsezo chosankha kukondera chifukwa ambiri omwe adachita nawo kafukufukuyu anali azaka zogwira ntchito, ndipo opitilira theka anali amuna, chifukwa cha mawonekedwe apadera a South Korea, zomwe zimafuna kuti makampani aziwunika antchito awo pafupipafupi.Kuchepetsa kukondera m'maphunziro amagulu, maphunziro a nthawi yayitali, aatali, komanso oyembekezera monga Rotterdam Study57 kapena Framingham Study58 ayenera kuchitidwa.M'mbuyomu, pakhala pali malipoti ambiri ogwiritsira ntchito Phunziro la Rotterdam kuti aganizire za ubale pakati pa ubongo wa SHG ndi zinthu zosiyanasiyana zoopsa za atherosclerosis Association pakati pa magulu ndi maphunziro a Framingham 4, 59, 60, 61, 62, 63. maphunziro ayang'ana kwambiri mgwirizano pakati pa GIBD ndi CCA mu anthu wamba, zotsatira zathu ndizofunikira pachipatala.Chachiwiri, popeza kusanthula kwa MRI kumachitidwa mwachiwonekere ndi akatswiri a radiologists, kulingalira sikungakhale kokwanira.Komabe, tidayesetsa kuthana ndi izi mwa kuphatikiza kuchuluka kwa omwe adatenga nawo gawo ndikutanthauzira mitu yokhala ndi WMH yocheperako kapena yapamwamba ngati gulu labwino.Kuphatikiza apo, tidayesa kudalirika kwapakati-observer ndi intra-observer, ndipo zotsatira zake zidawonetsa kuvomerezana kwabwino.Zanenedwanso kale kuti pali kulumikizana kwakukulu pakati pa njira zowunika zowonera pogwiritsa ntchito sikelo ya Fazekas ndi kusanthula kwa volumetric komwe kumagwiritsidwa ntchito poyesa kalasi ya WMH64,65.Chachitatu, anthu omwe ali ndi zotupa muubongo sanaphatikizidwe pogwiritsa ntchito mafunso odzipangira okha omwe anali ndi mbiri yakale yachipatala komanso kusanthula zithunzi za anthu omwe ali ndi matenda owopsa ndipo sangasefe anthu omwe ali ndi matenda a subclinical.Kuphatikiza apo, pulogalamu yaubongo ya MRI yowunika zaumoyo m'chipatala chathu sichiphatikiza zithunzi zowonjezeredwa, kotero pali kuthekera kosowa kuzindikira kwa kukulitsa kwaubongo waubongo, zomwe sizikuwonekera pazithunzi za T1-zolemera, T2-zolemera ndi FLAIR, ndi kulondola sikwapamwamba.Poyerekeza ndi kupititsa patsogolo kwa MRA, kupezeka kwa ICAS kudawerengedwa kuti ndikotsika.Chachinayi, popeza ambiri mwa omwe adachita nawo kafukufukuyu anali ochokera ku anthu athanzi ndipo ambiri analibe matenda, chiwerengero cha anthu omwe akudwala ICAS chinali chochepa.
Komabe, kafukufukuyu anaphatikiza anthu athanzi kwambiri kuposa maphunziro am'mbuyomu akuyang'ana mgwirizano pakati pa SHG ndi SAS, ndipo malinga ndi zomwe tikudziwa, iyi ndi kafukufuku woyamba kuphatikiza akuluakulu athanzi popanda kutchula jenda kapena zaka.Zochepa za phunziroli 31,32.
Kufunika kwa ubongo wa WMH ndi matenda osiyanasiyana okhudzana ndi minyewa monga matenda a dementia ndi sitiroko kumawonekera chifukwa cha kuwonjezeka kwakukulu kwa kupezeka kwa kulingalira kwa ubongo ndi nthawi ya moyo, koma matendawa amakhalabe osagonjetsedwa.Kukhalapo kwa zotupa za HHH muubongo kumalumikizidwa ndi kuchepa kwakukulu kwachidziwitso, kukhumudwa, kukhumudwa, ndi sitiroko, ndipo pali umboni wokulirapo woti kuwongolera zinthu zina zowopsa za atherosulinosis kungalepheretse HHH12, 13, 14, 15, 16, 17, 18 , 19, 20, 21, 22, 23, 66, 67, 68, 69. Choncho, zotsatira zathu zingapereke umboni wowunikira anthu omwe ali pachiopsezo cha ubongo wa HHH, chinthu chofunikira kwambiri choopsa komanso chowonetsera matenda osiyanasiyana a ubongo, ponena za perekani CAC, potero kuzindikira odwala omwe angapindule ndi njira zowunikira komanso zochizira.kaya CAC imagwira ntchito yofunika komanso yodziimira pa chitukuko cha WMH mu maphunziro a nthawi yayitali komanso omwe akuyembekezeka kuchokera kumadera osiyanasiyana, magulu a zaka ndi mafuko, ndi zizindikiro zina za MRI za matenda a ubongo ang'onoang'ono a ubongo ayeneranso kuphatikizidwa kuti amvetse bwino.
Pomaliza, chiwerengero cha CAC komanso zaka ndi kuthamanga kwa magazi zinagwirizanitsidwa kwambiri ndi ubongo wa WMH mu chiwerengero chachikulu cha thanzi.Mlingo wa CAC ndi chisonyezo cha kulemedwa kwa atherosulinosis ndipo uli ndi gawo lolosera za chiopsezo cha HHH muubongo muzochita zamankhwala.
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