Correlation Between White Matter Lesion And Intracranial Or Extracranial Atherosclerosis

ObjectiveWhite matter lesion(WML)is associated with cognitive decline,gait instability,mood disorder,urinary incontinence,the occurrence and development of ischemic stroke to some extent.With the progress of the aging society and the development of imaging technology,the prevalence and detection rate of WML has increased significantly.Many studies have explored the relevance of atherosclerotic stenosis and WML in recent years,but the majority of which only focus on the intracranial or extracranial segment of cerebral arteries.This research is designed to evaluate the degree of white matter lesion,the atherosclerosis of both intracranial and extracranial arteries,and their relationship in hospitalized patient population over 50 years old,so that it may be helpful to discover the potential risk factors of WML and provide clinical clues for its early prevention and treatment.MethodsA total of 460 hospitalized patients in Department of Neurology,Zhongda Hospital,Southeast University from October 2018 to June 2019 were included in this study after meeting the inclusion and exclusion criteria.The general information,hematological examination data and imaging data of all subjects were collected retrospectively.Record the general information of the enrolled patients: including gender,age,history of hypertension,diabetes,hyperlipidemia,smoking,drinking;hematological test data: fasting blood samples were collected within 24 hours of admission to detect triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),D-dimer,glycosylated hemoglobin,homocysteine,uric acid,creatinine and other indicators;and imaging data: ultrasound grading score of carotid plaque,diagnosis of WML and evaluation of its severity on magnetic resonance imaging(MRI)as well as cerebral arteries stenosis assessment on magnetic resonance angiography(MRA)respectively.Results1.There is statistical difference between no WML group and WML group in age,history of hypertension,drinking history,Neutrophil to lymphocyte ratio(NLR),D-dimer,blood lipid profile(TC,TG,LDL)and homocysteine levels(p<0.05),while differences in gender,history of diabetes,history of hyperlipidemia,history of smoking,creatinine,uric acid,and glycated hemoglobin levels are not statistically significant(p>0.05).2.The baseline data of patients with varying severity of WML is compared,indicating statistical differences in age,history of hypertension,history of hyperlipidemia,drinking history,D-dimer,creatinine,blood lipids(TC,LDL,HDL)and homocysteine found among mild,moderate and severe WML group(p<0.05).After a pairwise comparison between the three groups,it suggests that WML deteriorates with increasing age.3.Carotid plaque grading and comprehensive scores of cerebral arteries stenosis are positively correlated with WML grading(p<0.001),and the correlation coefficients are 0.434 and 0.320 respectively.4.Compared with the non-vascular stenosis group,there is no statistically significant difference in the simple extracranial vascular stenosis between the non-WML and WML groups(p>0.05),while there are statistical differences in the simple intracranial vascular stenosis(p=0.000)as well as intracranial and extracranial arteries stenosis(p=0.001)in the two groups.The single and multiple stenosis of intracranial vessels,the concurrent stenosis of intracranial and extracranial vessels are statistically significant in the non-WML and WML groups(p<0.05).However,there is no statistical difference in extracranial vascular stenosis between the two groups.The differences of WML prevalence(p=0.134)and WML grading(p=0.799)among groups with different degrees of stenosis are not statistically significant.5.Multivariate binary unconditional logistic regression analysis is performed by using baseline data,comprehensive scores of vascular stenosis and carotid plaque grading as independent variables,while WML prevalence as dependent variable.The result shows that age is an independent risk factor for WML with an odds ratio(OR)value of 1.186(p=0.000).ConclusionAge is an independent risk factor for the prevalence of WML,and age is closely related to the severity of WML.Carotid plaque grading and cerebral artery stenosis are positively correlated with white matter lesions,especially in patients with intracranial artery stenosis.WML is related to both extracranial and intracranial atherosclerosis,and patients with more severe atherosclerosis tend to have a heavier load of WML,but no causal association can be drawn.Detection of high-risk patients suffering from WML and control of relevant risk factors may help to prevent its occurrence and development in clinical practice.