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Ibintu byera hyperintensity (WWH) ni ubushakashatsi busanzwe kuri magnetic resonance imaging (MRI) yubwonko kandi bizwiho kwerekana indwara ntoya mu bwonko.Icyari kigamijwe mu bushakashatsi bwacu kwari ugukora iperereza ku ishyirahamwe rya calcium ya arteriire (CCA) na WMH no gusobanura isano iri hagati ya WMH n’impamvu zishobora gutera aterosklerose mu baturage benshi bafite ubuzima bwiza.Ubu bushakashatsi bwisubireho bwarimo abantu 1337 bakorewe ubwonko bwa MRI kandi babara tomografiya hamwe nisuzuma rya CAC ku kigo nderabuzima cya kaminuza.GVM yubwonko yasobanuwe nkamanota ya Fazekas amanota arenga 2 kuri MRI yubwonko.Intracranial arterial stenosis (ICAS) nayo yarasuzumwe kandi yemezwa mugihe angiografiya yerekanaga stenosis zirenga 50%.Amashyirahamwe yibintu bishobora guteza ingaruka, amanota ya CAC na ICAS hamwe n'ubwonko HBG yasuzumwe hifashishijwe isesengura ryinshi.Mu isesengura ryinshi, ibyiciro bifite amanota menshi ya CAC byerekanaga umubano wiyongereye hamwe na hypertension ya periventricular na hypertension yimbitse muburyo bukabije.Kubaho kwa ICAS nabyo byari bifitanye isano cyane nubwonko HBH, kandi mubihinduka byamavuriro, imyaka na hypertension byari ibintu byigenga byigenga.Mu gusoza, mubantu bazima, CAC yari ifitanye isano cyane nubwonko WMH, bushobora gutanga ibimenyetso byerekana abantu bafite ibyago byubwonko bwa WMH hifashishijwe amanota ya CAC.

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Ibintu byera hyperintensity (WWH) nibisanzwe mubisubizo bya T2 biremereye kandi byamazi ya magnetiki resonance imaging (MRI) inversion recovery (FLAIR) ikurikirana ryubwonko1,2.Nubwo uburyo nyabwo bwa pathophysiologique ya HHH butazwi, byagaragaye ko bufitanye isano n’impamvu zishobora gutera aterosklerose nko gusaza, hypertension, diyabete, itabi, n’umubyibuho ukabije, byerekana uruhare rw’imitsi y'amaraso mu iterambere rya HHH 3,4,5 , 6., 7,8,9,10.Ubushakashatsi bw’ubuvuzi bwerekanye kandi ko HHH iterwa no kwangirika kw’imitsi iva mu mitsi, bityo ikemeza ko HHH ari indwara y’indwara ntoya mu bwonko11.Byongeye kandi, SHG ifite akamaro k’ubuvuzi kuko byagaragaye ko igira ingaruka ku kwandura no guhanura indwara zitandukanye z’imitsi, harimo kugabanuka kwubwenge, guta umutwe, kwiheba, guhungabana, hamwe na stroke12,13,14,15,16,17,18, 19, 20, 21, 22, 23.
Isuzuma rya calcium ya Coronary (CAC) rifatwa nkigipimo cyoroshye kandi cyizewe cyerekana ko umuntu ashobora kwandura indwara ya aterosklerose kandi byagaragaye ko ifitanye isano na stroke ischemic stroke na cranial arter stenosis, hamwe n'indwara z'umutima 24,25.Indwara ntoya yubwonko bworoshye kubana byoroshye na atherosklerose yimitsi nini yo mu nda kuko imiyoboro mito mito itanga ibintu byera ikomoka kumitsi minini ya basilar.Ubushakashatsi bwinshi bwerekanye isano iri hagati ya SHH nimpamvu zishobora gutera aterosklerose cyangwa carotide atherosclerose, ariko, ubushakashatsi buke gusa bwibanze ku isano iri hagati yumutwaro wa SAS na SHH, kandi ubu bushakashatsi bwakozwe gusa mubantu bakuze cyangwa abagabo 29, 30, 31.32.
Hamwe no kwiyongera kwa neuroimaging mu myaka yashize, ubwinshi bw’ubuvuzi n’akamaro k’amavuriro ya HHH biragenda bizwi nk’impanuro yo kugabanuka kwubwenge hamwe n’ibizava mu bwonko 19,20,21,22,23.Icyateye ubu bushakashatsi ni uko niba amanota ya CAC ashobora gukoreshwa mu mavuriro kugira ngo hamenyekane ingaruka za SHH, wahanuye indwara zitandukanye z’imitsi, bishobora kuba igikoresho cyoroshye kandi cyingirakamaro mu kumenya inyungu zishoboka z’izindi nyigisho z’abantu, nkizo nka MRI y'ubwonko19,20,21,22,23.Twakekereje ko HHH ifitanye isano rya bugufi n'umutwaro wa CCA, ikimenyetso cya aterosklerozose, ku mubare munini w'abantu bafite ubuzima bwiza mu baturage muri rusange.Twongeyeho, twashatse gufasha gusobanukirwa nuburyo bushingiye ku iterambere rya HHH tumenye ingaruka ziterwa n’amavuriro.Rero, intego nyamukuru yubu bushakashatsi kwari ugukora iperereza ku ishyirahamwe rya CAC na WMH mubaturage bazima.Icya kabiri, intego yubu bushakashatsi yari iyo gusobanura isano iri hagati ya SHG nimpamvu ziterwa na aterosklerose.
Ubu bushakashatsi nubushakashatsi bwambukiranya ibice bushingiye ku baturage muri rusange.Twashakishije ububiko bwa elegitoronike bwabitabiriye kwipimisha kwa muganga, harimo ubwonko bwa MRI na magnetic resonance angiography (MRA), mu bitaro bikuru by’ubuvuzi bya Gangbuk Samsung i Seoul na Suwon hagati ya Mutarama 2016 na Ukuboza 2019. Muri abo baturage harimo amasomo yakozwe na CAC yabazwe na tomografiya ( CT) hamwe no gufata amashusho mu bwonko mu rwego rwo kwisuzumisha ku mubiri, ni uburyo busanzwe bwo gusuzuma ubuzima muri Koreya.Kubisobanura, amategeko ya koreya arasaba abakozi bose kwisuzumisha buri mwaka cyangwa imyaka ibiri, bityo abayitabira benshi ni abakozi cyangwa abagize umuryango w'abakozi b'ibigo bitandukanye cyangwa imiryango y'inzego z'ibanze.
Mu bantu 3983, 2646 ntibakuweho kubera impamvu zikurikira: a) kutemeranya no gukoresha amakuru y’ubuvuzi ku mpamvu iyo ari yo yose y’ubushakashatsi mu kibazo cyabajijwe wenyine mbere y’ikizamini (n = 376);niba ibizamini bisubirwamo byarakozwe mugihe (n = 43), abantu bafite ibizamini bisubirwamo ntibakuweho, kandi CT nubwonko bwubwonko hamwe nisuzuma rya CAC ryakozwe kumunsi umwe cyangwa mugihe cya vuba cyatoranijwe kubushakashatsi;(c) guta umutwe bizwi, indwara ya Parkinson.amateka, hydrocephalus, kubagwa ubwonko mbere, ikibyimba mu bwonko, indwara ya moyamoya, inkorora cyangwa kuva amaraso (n = 47);.(e) abantu bafite MRI cyangwa MRA bafite ubuziranenge budahagije bwo gusesengura amashusho (n = 2);(f) abantu batigeze bakora CT ku gipimo cya CAC (n = 1796);.Igishushanyo mbonera cyo gushaka abitabira kwiga cyerekanwe ku gishushanyo 1.
Shyiramo urupapuro rwabitabiriye.MRI magnetic resonance imaging, MRA magnetic resonance angiography, periventricular yera ibintu hyperintensity PVWMH, ibintu byera byera hyperintensity DWMH.
Ni yo mpamvu, amasomo 1337 (bivuze imyaka 51,63 ± 9,20, imyaka iri hagati ya 20-89, 1157 [86.54%] abarwayi b’abagabo) yashyizwe muri ubu bushakashatsi.Abitabiriye amahugurwa bose basubijwe inyuma kubisubizo byubuvuzi na radiografiya.Ubu bushakashatsi bwakozwe hakurikijwe amahame y’itangazo rya Helsinki kandi bwemejwe n’ikigo gishinzwe gusuzuma (IRB) cy’ibitaro bya Samsung bya Gangbuk (IRB No 2020-12-036-006).IRB ku bitaro bya Samsung bya Kangbuk yaretse ibyangombwa bisabwa kugira ngo umuntu yemerwe kubera gukoresha amakuru atamenyekanye ndetse n'ubushakashatsi bwihuse.Uburyo bwose bwubushakashatsi bwakozwe hakurikijwe amabwiriza n'amabwiriza bijyanye.
Twakusanyije amakuru y’amavuriro arimo uburinganire, imyaka, BMI, umuvuduko wamaraso wa sisitemu na diastolique, amateka y itabi, imyitozo ngororamubiri, no gusuzuma no kuvura hypertension, diyabete, hyperlipidemiya, n'indwara z'umutima.Duhereye kubibazo bisanzwe byiyobora, twakusanyije amakuru kumateka yubuvuzi bwa buri muntu namateka y itabi, ndetse no kumenya niba bakora imyitozo ngororamubiri ikomeye muminota irenga 10 byibuze inshuro 3 mucyumweru.
Kubera ko abitabiriye amahugurwa bose bari bateganijwe gusuzumwa mu kigo cy’ubuvuzi rusange cya Ganbuk Samsung, ibizamini bya laboratoire byakozwe umunsi umwe na MRI yo mu bwonko na MRA nyuma y’amasaha 12 yisonzesha, kandi amakuru yarimo glucose, glycated hemoglobine (HbA1c), urwego ya cholesterol yuzuye, cholesterol ya LDL, cholesterol ya HDL, triglyceride na homocysteine.
Umuvuduko ukabije w'amaraso wasobanuwe nko gufata ubu imiti igabanya ubukana, umuvuduko w'amaraso wa sisitemu ≥ 140 mmHg.cyangwa umuvuduko w'amaraso wa diastolique ≥ 90 mmHg33.Diyabete yasobanuwe nko gukoresha imiti igabanya ubukana bwa antidiabete, kwiyiriza ubusa glucose ≥ 126 mg / dL, cyangwa HbA1c ≥ 6.5%.Dyslipidaemia yasobanuwe nkikoreshwa ryibiyobyabwenge bigabanya lipide, cholesterol yose ≥240 mg / dl, cholesterol ya lipoprotein nkeya 60160 mg / dl, cholesterol ya lipoprotein yuzuye cyane <40 mg / dl, cyangwa triglyceride ≥200 mg / dl35.
Abitabiriye amahugurwa bose bakorewe MRI yo mu bwonko na MRA hamwe na coil yo mu mutwe umunani ikoresha icyuma cya 1.5 T MRI (Optima MR360, GE Healthcare, Milwaukee, Wisconsin cyangwa Signa HDxt, GE Healthcare, Milwaukee, Wisconsin).Amashusho yerekana amashusho yari agizwe namashusho ya T1 afite uburemere (igihe cyo gusubiramo [TR] / igihe cya echo [TE] = 417–450 / 9 ms cyangwa 400-450 / 10 ms), amashusho aremereye T2 (TR / TE = 4343–4694 )./ 100-110 ms cyangwa 4084-4494 / 95-104 ms), amashusho ya FLAIR (TR / TE = 11000 / 127-138 ms cyangwa 8800 / 128-130 ms) hamwe na 3D igihe-cyo guhaguruka (TOF) amashusho (TR) / TE = 28/7 ms cyangwa 27/3 ms, ibice by'ubugari = 1,2 mm).Ubunini bwibice bwari mm 5 kuri protocole zose zerekana amashusho usibye TOF MRA.
Urwego rwa periventricular na deep WMH rwasuzumwe ukundi ukurikije igipimo cya Fazekas1, nkuko bigaragara ku gishushanyo cya 1 kumurongo.PVWMH yatsinzwe kuburyo bukurikira: 0 = ntayo, 1 = cap cyangwa umurongo muto, 2 = halo yoroshye, 3 = hyperintensity idasanzwe ya periventricular igera mubintu byera byera.DWMH ishyizwe muburyo bukurikira: 0 = idahari, 1 = gutuza, 2 = ibikomere bitangira guhuriza hamwe, 3 = ahantu hanini ho guhurira.Kuberako ubwonko HBH icyiciro cya 2 cyangwa kirenga bizwi ko bifite akamaro mubuvuzi kuko bukunze kugaragaramo ibimenyetso no gutera imbere, twagabanije abarwayi bafite Fazekas amanota 2 na 3 muri PVBVH na DGBV36,37.
Isesengura rya TOF MRA, rishingiye ku buryo bwa warfarin-aspirine ibimenyetso byerekana indwara zifata interacranial (WASID), risobanura imiyoboro y'amaraso (ICAS) nk'imitsi iva mu mitsi irenga 50% 38.Imiyoboro yashyizwe mu isesengura ni imiyoboro y'imbere ya karoti kuva mu gice cy’ubuvumo kugeza ku gice cya M2 cy'imitsi yo hagati yo mu bwonko bwo hagati, igice cya A2 cy'imitsi y'ubwonko bw'imbere, igice cya P2 cy'imitsi y'ubwonko bw'inyuma, imiyoboro y'ibanze, hamwe na interacranial. imiyoboro y'amaraso.igice cyumuvuduko wamaraso.
Isuzumabumenyi ryose ryakozwe na radiologue ryakozwe na neuroradiologue (JYK), utari uzi amakuru yose yubuvuzi na laboratoire.Ubwizerwe bw'igipimo kigaragara hagati y'indorerezi cyasuzumwe na radiyo ya kabiri yatojwe (JYC) ku masomo 700 yatoranijwe kandi mu gihe cy'amezi 2 nyuma yo gusoma bwa mbere.Suzuma ubwizerwe mu ndorerezi.Isuzuma ryerekanwa rya PVWMH, DWMH, na ICAS ryerekanye impuguke nziza hagati (Kappa ifite uburemere bwa kappa: 0.7, 0.81, na 0.67; 65, kimwe; n = 1339) protocole.
Amanota ya CAC yasuzumwe kubantu bakorewe CT kugirango basuzume CAC mugihe cyimyaka 5 ubwonko bwa MRI na MRA39.Mu bantu 1.337, 686 basuzumye ubwonko umunsi umwe na 651 kuwundi munsi mu myaka 5.
Ibigo bya Seoul na Suwon byakoresheje mAc (310 mA × 0.4 s) umuyoboro wa mm 2,5, uburebure bwa ms 400, umuvuduko wa kV 120, hamwe na 124 ya ECG iterwa na dose.Dukurikije Agatston et al.40, CAC yabazwe uhereye kuri arteri 4 nini ya epicardial coronary arteri (ibumoso nyamukuru, ibumoso imbere imanuka, ibumoso buzengurutse, hamwe nimiyoboro yimitsi).Umutekinisiye wa CT yahumwe amaso namakuru ayo ari yo yose yerekeye isomo maze amanota ya CAC ahita agenwa hakoreshejwe software ya HEARTBEAT-CS (Philips, Cleveland, OH, USA).Amanota ya CAC agabanijwe mu matsinda atatu: 0, 1-100, na> 100.
Ibiranga shingiro byagereranijwe hagati yamasomo hamwe na WMH idafite ubwonko ikoresheje χ2 ikizamini kubihinduka bitandukanye hamwe na t-test yabanyeshuri cyangwa ikizamini cya Mann-Whitney kubihinduka bikomeza, nkuko bikwiye.Mubisanzwe byagabanijwe bihinduka nkibisobanuro iation gutandukana bisanzwe, mugihe bitari bisanzwe bigabanywa impinduka zerekanwa nkurwego rwo hagati kandi rwuzuzanya.Impinduka za Dummy zatangijwe kubura indangagaciro zibyiciro bitandukanye.
Isesengura ryinshi rya logistic regression ryakozwe kugirango babaze ibipimo bitandukanijwe (ORs) hamwe na 95% intera intera (CIs) kugirango harebwe isano iri hagati yubwonko bwa WMH na CAC nibintu bishobora gutera aterosklerose.Kubera ko indwara ya HHH yiyongera uko imyaka igenda ishira kandi igatandukana bitewe nigitsina, isesengura ryinshi ritandukanye ryakozwe kugirango isuzume amashyirahamwe hagati yizindi mpinduka na HHH18 zahinduwe kumyaka no mubitsina.Ubundi buryo butandukanye bwo gusubira inyuma bwakoreshejwe kugirango harebwe niba amanota ya CAC afite ishyirahamwe ryigenga n’ubwonko SHG, ndetse na nyuma yo guhindura ibintu bishobora gutera indwara ya aterosklerozose na ICAS nkibintu bitera urujijo byavuzwe ko bifitanye isano na SHH muri raporo zabanje10, 26, 27, 41 Icyitegererezo cya 1 cyahinduwe ku myaka no ku gitsina, Model 2 yahinduwe ku myaka, igitsina, n’impamvu zishobora gutera aterosklerose (BMI, hypertension, diyabete, dyslipidaemia, abanywa itabi cyangwa abahoze banywa itabi, imyitozo isanzwe, indwara zifata imitsi y’indwara z'umutima n'urwego rwa cystine ).byahinduwe;Icyitegererezo cya 3 cyahinduwe kumyaka, igitsina, ibintu bishobora gutera aterosklerose, no kuba ICAS ihari.Kuba ubwonko bwa WMH bwarasuzumwe hakurikijwe amanota ya CAC ukoresheje amanota CAC 0 nkigipimo.
Isesengura mibare ryakozwe hifashishijwe verisiyo ya Stata 16.1 (StataCorp, College Station, Texas, USA) na R studio 3.6.3 (RStudio, Boston, Massachusetts, USA).Imirongo ibiri-p-agaciro <0.05 byafatwaga nkibyingenzi.
Ibiranga shingiro biranga abantu 1337 bigaragara mu mbonerahamwe ya 1. Imyaka mike y’abitabiriye, ugereranije n’igihe MRI yo mu bwonko yari ifite, ni 51,63 ± 9.20, naho 86.54% by’abaturage biga bari abagabo.Impamvu nyamukuru zishobora gutera aterosklerose muri iri tsinda ni itabi ryubu cyangwa ryashize (57.82%), rikurikirwa na dyslipidemiya (51,76%) na hypertension (28.65%).Ku bijyanye n’imihindagurikire ya radiologiya, abarwayi 158 (11.82%) bafite PVWMH, 148 (11.07%) bafite DWMH, naho 21 (1.57%) bafite ICAS.Ukurikije amanota ya CAC, amasomo 849 (63.5%) yagize amanota CAC ya 0, 332 (24.83%) yagize amanota hagati ya 0 na 100, naho 156 (11.67%) bafite amanota arenga 100.
Mu isesengura rimwe, imyaka, igitsina, hamwe n’impamvu nyinshi ziterwa na aterosklerose, usibye BMI, dyslipidemia, hamwe n’itabi rya none cyangwa ryashize, byari bifitanye isano cyane no kuba ubwonko HHH (p <0.05) (Imbonerahamwe 2).Abantu bafite PVWMH na DWMH bari bakuru kandi bafite umutwaro uremereye wa hypertension, diyabete, amateka yindwara zifata imitsi, CAC, na ICAS kurusha abantu badafite PVWMH na DWMH.Mu isesengura rimwe, umubare munini w’abagore n’amasomo mu itsinda rya WMH bavuze ko bakora imyitozo buri gihe.Hagati (intera interquartile; IQR) CAC yari 62 (IQR 0-269.5) mumatsinda ya PVWMH na 46.5 (IQR 0-192) mumatsinda ya DWMH.Ikwirakwizwa ryibyiciro bya CAC kuberako PVWMH na DWMH byerekanwe mugitabo.2. Umubare wibyiciro bifite amanota menshi ya CAC wiyongereye hamwe nurwego rwa comorbid WMH.
Ijanisha ry'amanota ya CAC ashingiye ku kugira PVMWH (a), DWMH (b), na PVWMH cyangwa DWMH (c).Kubara imitsi yimitsi ya SAS, ibintu byera hyperintensity SHG, periventricular yera ibintu hyperintensity HVBV, ibintu byera byera cyane hyperintensity SHVH.
Isesengura ryinshi ryisubiramo ryahinduwe kumyaka (OR 1.13; 95% CI 1.10-1.16; CYANGWA 1.11; 95% CI 1.08-1.14) na hypertension (OR 2.29; 95% CI 1.50–3.50, CYANGWA 1.98, 95% CI 1.30–3.02) .uko bikurikirana) ni PVWMH nyuma yo guhindura imyaka, igitsina, ibintu biterwa na aterosklerose (BMI, hypertension, diyabete, dyslipidemia, abanywa itabi cyangwa abahoze banywa itabi, imyitozo ngororamubiri, amateka yindwara zifata imitsi, hamwe n’urwego rwa homocysteine) hamwe n’ubuvuzi bwigenga bukomeye bw’amavuriro ya DWMH na ICAS (byose p <0.05) (Imbonerahamwe 3).Nta sano rikomeye ryari hagati ya WMH yahinduwe nigitsina, BMI, diyabete cyangwa dyslipidemiya, amateka y itabi, cyangwa imyitozo isanzwe.
Ndetse na nyuma yo guhindura ibintu bitera urujijo, ibyiciro bifite amanota menshi ya CAC byagaragaje umubano wiyongereye nubwonko GMI muburyo buterwa na dose ugereranije nibyiciro byerekanwe hamwe na CAC amanota 0. Kuri PVWMH na DWMH, ibyiciro bifite amanota CAC arenga 100 ( CYANGWA 5.45; 95% CI 3.11–9.54 cyangwa 3.66; 95% CI 2.10-6.38) yerekanye ishyirahamwe ryinshi kuruta ibyiciro bifite amanota CAC ya 0 kugeza 100 (OR 2.22; 95% CI).1.36–3.61, CYANGWA 1.59;95% CI 0.98–2.58).Iyo ugereranije ishyirahamwe na CAC hagati yitsinda rya PVWMH na DWMH, uburyo butatu bwo gusesengura ibintu byinshi bwerekanye amashyirahamwe yo hejuru na PVWMH mubyiciro byombi byatsinze amanota.Kubaho kwa ICAS byerekanaga kandi isano ikomeye na PVWMH (OR 3.97, 95% CI 1.31-12.06) na DWMH (OR 7.11, 95% CI 2.33-21.77).
Coefficient zitandukanye zifaranga zabazwe kuri moderi zose zisubira inyuma kugirango harebwe ibishobora kuba byinshi, kandi nta kibazo cyinshi cyabonetse (Imbonerahamwe yinyongera kumurongo 1).
Muri ubu bushakashatsi, ibyago byo mu bwonko SHH byiyongereye hamwe no kongera amanota ya CAC mu buryo buterwa na dose, kandi ibisubizo byagaragaye cyane mu mibare nyuma yo guhindura ibintu bishobora gutera indwara ziterwa na aterosklerose.Ibisubizo byacu bihuye nubushakashatsi bwibanze bwerekana isano iri hagati ya CAC n'ubwonko bwa MRI bidasanzwe, bikomeza gushyigikira ishyirahamwe CAC hamwe nubwonko buto bwubwonko bwitwa atherosclerose hamwe nubwato bunini bwa aterosklerose 29,30,31,32.
Igishimishije, muburyo butatu bwo gusesengura ibintu byinshi, ORs kumanota ya CAC yari hejuru gato mumatsinda ya PVWMH kuruta mumatsinda ya DWMH.Iri tandukaniro rishobora guterwa nuko itandukaniro mubikorwa bya patrophysiologique nibintu bishobora guterwa hagati ya PVWMH na DWMH11,42,43.PVWMHs ikunze kugaragara mubice byombi byubwonko bwubwonko, byerekana indwara ya diffuse perfusion, mugihe DWMHs ikunze gukwirakwiza asimmetrike, byerekana ko biterwa nindwara yibanze.Kubera ko akarere ka periventricular gatangwa na arteriire ya medula ndende na mashami atobora [45], irashobora kwibasirwa cyane cyane nuburyo bwimikorere ya autoregulatory yo gukomeza ubwonko bwubwonko bwangijwe na arteriosclerose cyangwa lipoid hyalinose [46, 47, 48, 49].Hypoperfusion na ischemia bitera imbere.By'umwihariko, ubushakashatsi bwinshi bwerekanye ko kwigaragaza kwa sisitemu yo mu bwoko bwa aterosklerose, nka hypertension, diabete mellitus, ndetse no kuba ateric atherosclerose, ahanini bifitanye isano na PVWMH50,51,52,53, bishyigikira ibyo twabonye ko amanota ya CAC, imyaka, na arterial hypertension yari ifite ORs hejuru ya PVWMH kuruta DWMH muburyo bwose.
Muri ubu bushakashatsi, kuba ICAS yari ifitanye isano rya bugufi n'ubwonko HHH, igisubizo gishobora gusobanurwa nuko stenosis ikomeye yimitsi nini yo mu nda igabanya ubwonko bwubwonko bwaho cyangwa bwakarere, kandi iyi hypoperfusion idakira igira uruhare runini rwa hyalinose. uburyo bwibanze.iterambere rya WMH 26.54.
Dukurikije ubushakashatsi bwinshi bwabanjirije3, 27, 28, 55 bwakozwe mu moko atandukanye, ubushakashatsi bwacu bwerekanye kandi ko imyaka na hypertension byari byigenga kandi bifitanye isano cyane n'ubwonko HBG mu isesengura ryinshi.Nyamara, isano iri hagati ya HHH nizindi mpamvu ziterwa na aterosklerose yerekanye ibisubizo bivanze muri raporo zabanjirije 27,28,37,56.Impamvu zibi bisubizo bitandukanye zishobora guterwa nubudasa bwabaturage biga, ibipimo byo kumenya ingaruka ziterwa ningaruka, cyangwa uburyo bukoreshwa mu gusesengura WMH, bisaba ubushakashatsi bwimbitse.
Inzitizi nyinshi zubu bushakashatsi zigomba kwitonderwa.Ubwa mbere, ubu ni ubushakashatsi bwisubireho bwabaturage ba Aziya mubigo nderabuzima bya monobrand.Hashobora kubaho ingaruka zo guhitamo kubogama kuko umubare munini wabitabiriye kwiga bari bafite imyaka yo gukora, kandi abarenga kimwe cya kabiri cyabo bakaba bari abagabo, kubera ibiranga umwihariko wa Koreya yepfo, bisaba ibigo kugenzura buri gihe abakozi babo.Kugabanya kubogama mubushakashatsi bwa cohort, ubushakashatsi bwigihe kirekire, burebure, nubushakashatsi nka Rotterdam Kwiga 57 cyangwa Kwiga Framingham 58 bigomba gukorwa.Mbere, hari raporo nyinshi zifashishije Inyigisho ya Rotterdam yibanda ku isano iri hagati yubwonko SHG nimpamvu zitandukanye zishobora gutera ishyirahamwe rya aterosklerozose hagati ya cohort nubushakashatsi Framingham 4, 59, 60, 61, 62, 63. Icyakora, kubera ko ntanimwe ihari ubushakashatsi bwibanze ku isano iri hagati ya GIBD na CCA mubaturage basanzwe, ibisubizo byacu bifitanye isano nubuvuzi.Icya kabiri, kubera ko isesengura rya MRI rikorwa muburyo bwa radiologiste, ibintu ntibishobora kuba bihagije.Ariko, twagerageje gutsinda iyi mbogamizi dushyiramo umubare munini wabitabiriye no gusobanura amasomo byibuze WMH iringaniye cyangwa irenga nkitsinda ryiza.Mubyongeyeho, twakoze inter-indorerezi na intra-indorerezi ibizamini byiringirwa, kandi ibisubizo byagaragaje amasezerano meza.Byatangajwe kandi mbere ko hari isano iri hagati yuburyo bwo gusuzuma amashusho ukoresheje igipimo cya Fazekas hamwe nisesengura rya volumetric ryakoreshejwe mu gusuzuma amanota ya WMH64,65.Icya gatatu, abantu bafite ibikomere byubwonko ntibakuweho bakoresheje ikibazo cyabajijwe ubwacyo gikubiyemo amateka yubuvuzi bwambere hamwe nisesengura ryamashusho kubantu bafite uburwayi bweruye kandi ntibashobora gushungura abantu barwaye indwara zidasanzwe.Byongeye kandi, gahunda ya MRI ubwonko bwo gusuzuma ubuzima mubitaro byacu ntabwo ikubiyemo amashusho yongerewe, bityo rero haribishoboka ko habura isuzumabumenyi ryubwonko bw’ubwonko bw’indwara, ibyo bikaba bitagaragara ku mashusho ya T1, uburemere bwa T2 na FLAIR, na ubunyangamugayo ntabwo buri hejuru.Ugereranije no kuzamura MRA, kuba ICAS yarabonetse nkaho ari hasi.Icya kane, kubera ko benshi mu bitabiriye ubu bushakashatsi bakomoka mu baturage bafite ubuzima bwiza kandi benshi bakaba nta ndwara iyo ari yo yose, umubare w'amasomo arwaye ICAS wari muto.
Nyamara, ubu bushakashatsi bwarimo abantu bafite ubuzima bwiza kurusha ubushakashatsi bwabanje kureba isano iri hagati ya SHG na SAS, kandi kubumenyi bwacu, ubu ni ubushakashatsi bwambere bwashyizwemo abantu bakuru bafite ubuzima bwiza batagaragaje igitsina cyangwa imyaka.Imipaka yubushakashatsi 31,32.
Akamaro k'ubwonko WMH hamwe n’indwara zitandukanye zifitanye isano n’imyakura nka démée na stroke bigaragazwa n’ubwiyongere bukabije bwo kubona amashusho y’ubwonko ndetse n’icyizere cyo kubaho, ariko izi ndwara ntizitsindwa.Kuba HHH ibisebe byubwonko bifitanye isano no kugabanuka kwubwenge bukabije, guta umutwe, kwiheba, ndetse nubwonko, kandi hari ibimenyetso byinshi byerekana ko kugenzura ibintu bimwe na bimwe bishobora gutera indwara ya aterosklerozose bishobora kwirinda HHH12, 13, 14, 15, 16, 17, 18 . amanota CAC, bityo umenye abarwayi bashobora kungukirwa no kwisuzumisha no kuvura.niba CAC igira uruhare runini kandi rwigenga mugutezimbere WMH mubushakashatsi bwigihe kirekire kandi buteganijwe kuva mu turere dutandukanye, amatsinda y’amoko, ndetse n’ibindi bimenyetso bya MRI by’indwara zifata ubwonko bw’ubwonko na byo bigomba gushyirwamo kugira ngo byumvikane neza.
Mu gusoza, amanota ya CAC kimwe n'imyaka hamwe na hypertension byari bifitanye isano cyane n'ubwonko WMH mubantu benshi bafite ubuzima bwiza.Amanota ya CAC ni ikimenyetso cyerekana umutwaro wa aterosklerotike kandi ufite uruhare runini mu guhanura ibyago byubwonko bwa HHH mubikorwa byubuvuzi.
Amakuru yashyizweho yasesenguwe muri ubu bushakashatsi ntabwo aboneka kumugaragaro kuko arimo amakuru yihariye yumuntu ku giti cye.Aya makuru aboneka mu bitaro by’ubuvuzi bya Kangbuk bya Samsung byose bisabwe n’abashakashatsi babishoboye.Buri cyifuzo kizasubirwamo ninama ishinzwe isuzuma ryibitaro bya Gangbuk Samsung kandi abashinzwe iperereza bazashobora kubona amakuru bakurikije ibikubiye mu cyemezo.
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