Clinical Risk Factors Of White Matter Lesions In Patients With Ischemic Cerebral Disease

BackgroundIschemic cerebral white matter lesions(WML) are frequently observed on MRI and CT scans in healthy elderly persons,as well as in patients with atherosclerotic disease.Valentine et al.first describe the abnormality of the cerebral white matter on CT scans in 1980.They are regarded as manifestations of cerebral small vessel disease,and are associated with cognitive decline,dysarthria and gait disturbances. Some studies have observed an association between WML and future ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease. This study was undertaken to determine the relationship between the white matter lesions and plasma total homocysteine levels,carotid artery intima-media thickness, ischemic heart disease and traditional vascular risk factors.Current evidence suggests that vigorous treatment of these risk factors may prevent the development or progression of white matter lesions and the attendant risks of stroke and dementia.Subjects and methods217 consecutive patients(124 males,93 females,mean age 67±9 years) with ischemic cerebrovascular disease were included,from the neurological department of Anshan Central Hospital,between June,2006 and June,2008.WML were defined as hyperintense leisions on T2W-SE images with on or only minor corresponding hyperintense leisions on T1W-SE images.All patients underwent brain-magnetic resonance imaging to establish the presences or absence of WML,and then were divided into two groups:with WML(n=98),and no WML(n=119).Participants underwent standardized evaluations,including a neurological examination,blood pressure measurement,complete blood chemistry panel including plasma total homocysteine levels,ECG,magnetic resonance imaging(MRI), carotid artery ultrasonography.All patients gave informed consent.The values are given as mean±SD.We used SPSS.version 13.0 software for statistical analysis.Frequencies were compared usingγ2-tests and continuous variables with Student's t-test.For multiple comparisons,ANOVA followed by unpaired t-test was used.A p-value＜0.05 was regarded as statistically significant.Results①WML was present in 98(45.16%) subjects.The mean age of the WML group was higher(t=4.800,p＜0.001).The prevalence of hypertension was higher among the patients of the WML group(t=4.599,p=0.032).And the prevalence of ischemic heart disease(and/or atrial fibrillation) was higher in the WML group(t=5.769, p=0.016).The plasma total homocysteine levels was higher in the WML group (t=5.567,p＜0.001).Such results show that age,hypertension,ischemic heart disease, and plasma total homocysteine levels were the risk factors of WML.②The severity of the WML growed with age(F=10.398,P＜0.001).③A higher prevalence of hypertension was seen among the patients with more severe WML,but p=0.880,and was not regarded as statistically significant.④Severity of WML increased with higher plasma total homocysteine levels. (F=7.135,P＜0.001).ConclusionAge,hypertension,ischemic heart disease,and plasma total homocysteine levels were the risk factors of WML.The severity of the WML growed with age.A higher prevalence of hypertension was seen among the patients with more severe WML. Severity of WML increased with higher plasma total homocysteine levels.