The Clinical Study Of Silent Cerebral Infarction And Its Risk Factors

Objective:To investigate the prevalence, clinical characteristics and radiological features,identify the independent risk factors of silent cerebral infarctions in health-screeningindividuals. On the one hand initially evaluate and screen patients with the coexistence ofmultiple risk factors , make sure if they have the need for further line of expensive headmagnetic resonance imaging , to avoid the unnecessary waste of medical resources causedby routine MRI screening; on the other hand, hope for thinking ahead to expand prevention and treatment of silent cerebral infarction, delay or reduce secondary stroke, cognitiveimpairment and depression complications.Methods:We conducted a cross-sectional study that included 1239 neurologically asymptomatic patients who consecutively visited the Department of Diagnosis and Treatment for VIP at Second Military Medical University affiliated Shanghai Changzheng Hospital. These patients all had undergone cranial MRI, carotid ultrasound, electrocardiogram and blood chemistry determinations as their routine health check from May 2006 to March 2010. After exclusions for the requested criteria, 1008 patients were enrolled in this study. Collect and sort relevant data; investigate the prevalence clinical characteristics and imaging features of SCI; Student's t-test was used to compare differences continuous variables between the groups with and without SCI, while the Chi-Square test was used for categorized variables; Multiple stepwise logistic regression model (sle = 0.10, sls = 0.15) was used to identify independent risk factors predisposing to the presence of SCI. A two-sided P value of less than 0.05 was considered significant. The analysis was performed with SAS 8.0.Results:1. 287 women and 721 men were included in this study. Their age ranged from 13 to 86 years and mean age was 48.84±10.01years. 328(32.5%) subjects were found to have one or more asymptomatic infarcts on MRI.2. The clinical syndromes were often transient, slight, and unspecific. For example, dizziness, headache, numbness, weakness, clumsiness and memory loss, inability to concentrate, and some short-term cognitive decline and so on.3. 65 patients had a single infarct, whereas 263 ones had multiple lesions. Moreover, infarcts of 34 cases were in the left hemisphere, 47 cases were in the right hemisphere infarct, the rest were distributed in both hemispheres. We found 679(83.4%) lacuna infarctions which 5-15mm in size and 135 infarctions with a size more than 15mm. Predilection sites were frontal lobe(213), centrum semiovale(184), basal ganglia(167), perventricular white matter(127), parietal lobe(45), temporal lobe(24), occipital lobe(18) and other locus(36).4. The univariate analysis showed that age, hypertension, diabetes mellitus, systolic pressure, low density lipoprotein cholesterol, lipoproteinα, uric acid, fasting blood glucose, glycosylated hemoglobin A1c and carotid intima-media thickness are statistically significant between SCI and non-SCI patients (P<0.05). Multivariate logistic analyses revealed that age, hypertension, diabetes mellitus, low density lipoprotein cholesterol, lipoproteinα, uric acid and carotid intima-media thickness were significantly associated with SCI. View from the odds ratio, subjects who have older ade, history of hypertension, diabetes mellitus, high serum low density lipoprotein cholesterol, lipopro- teinα, uric acid and increased carotid intima-media thickness are greater risk of suffering from SCI.Conclusion:SCI is a kind of common cerebral vascular disease. There are no specific neurological symptoms and signs; majority ischemic lesions are lacunar infarcts and mainly coexist in frontal lobe, centrum semiovale, basal ganglia and perventricular white matter; age, hypertension , diabetes mellitus, low density lipoprotein cholesterol, lipoproteinα, uric acid, and carotid intima-media thickness are independent risk fcators. And it can lead to stroke, cognitive decline, vascular dementia and pseudobulbar palsy could became worse and worse,So we should pay more attention to strengthen the prevention and treatment.