321/321L tuubbada daboolka birta ah ee birta ah Iskaashatada walxaha cadcad ee xoogga leh oo leh caleenta halbowlaha halbowlaha ee shakhsiyaadka caafimaadka qaba: daraasad-qaybood

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Cadaadiska arrimaha cadaanka ah (WWH) waa baadhitaan caadi ah oo ku saabsan sawir-qaadista magnetic resonance imaging (MRI) ee maskaxda waxaana loo yaqaanaa inay ka tarjumayso cudurrada maraakiibta yaryar ee maskaxda.Ujeedada daraasaddeenu waxay ahayd in la baaro xidhiidhka kalsiyum halbowleyaasha halbowlaha ah (CCA) iyo WMH iyo in la caddeeyo xidhiidhka ka dhexeeya WMH iyo arrimaha khatarta ah ee atherosclerosis ee dad badan oo caafimaad qaba.Daraasaddan dib-u-eegista ah waxaa ka mid ahaa 1337 qof oo maray maskaxda MRI iyo sawir-gacmeed lagu sameeyay qiimeynta CAC ee xarun caafimaad oo isbitaal sare ah.GVM maskaxda waxaa lagu qeexay sida Fazekas dhibcaha ka badan 2 ee MRI ee maskaxda.Xididdada xididdada dhiigga ee intracranial (ICAS) ayaa sidoo kale la qiimeeyay oo la xaqiijiyay markii angiography ay muujisay in ka badan 50% stenosis.Ururada arrimaha khatarta ah, buundooyinka CAC iyo ICAS ee maskaxda HBG ayaa lagu qiimeeyay iyada oo la adeegsanayo falanqaynta dib u noqoshada kala duwan.Falanqaynta kala duwanaanshiyaha, qaybaha leh buundooyinka CAC sare waxay muujiyeen xiriir kordhay oo leh dhiig-karka wareega iyo qotodheer ee qaab-ku-tiirsane.Joogitaanka ICAS ayaa sidoo kale si weyn loola xiriiriyay maskaxda HBH, iyo doorsoomayaasha kiliinikada, da'da iyo dhiig-karka ayaa ahaa arrimo halis ah oo madaxbannaan.Gebogebadii, dadka caafimaadka qaba, CAC waxa ay si weyn ula xiriirtay maskaxda WMH, taas oo bixin karta caddayn lagu aqoonsanayo shakhsiyaadka khatarta ugu jira maskaxda WMH iyada oo la tixraacayo dhibcaha CAC.

Birta Aan Lahayn 321 Tuubbada Gariirada Kiimikada

Halabuurka kiimikada ee 321 tuubooyinka gariiradda birta ah ee birta ah waa sida soo socota:
- Kaarboon: 0.08% ugu badnaan
- Manganese: 2.00% ugu badnaan
- Nickel: 9.00% min

321/321L ahama 8*0.2 tube capillary

Qalabka Makaanikada ah ee Birta 321 Gariiradda Tubada

321/321L ahama 8*0.2 tube capillary

Marka loo eego Soo saaraha Tuubbada Gariirada 321, sifooyinka farsamada ee tuubooyinka birta 321 ee tuubooyinka gariiradda ayaa hoos lagu taxay: Xoog-jilicsanaanta (psi) Xoogga Wax-soosaarka (psi) Kordhinta (%)

321/321L ahama 8*0.2 tube capillary

Cadaadiska arrimaha cadaanka ah (WWH) waa baadhitaan caadi ah oo ku jira T2-miisaanka iyo dareeraha-magnetic resonance imaging (MRI) dib-u-soo-kabashada (FLAIR) ee taxanaha maskaxda1,2.Inkasta oo habka saxda ah ee pathophysiological ee HHH aan la garanayn, waxaa la muujiyay in lala xiriiriyo arrimaha khatarta ah ee atherosclerosis sida gabowga, hypertension, sonkorowga, sigaarka, iyo cayilka, taasoo soo jeedinaysa ka qayb qaadashada hababka xididdada dhiigga ee horumarinta HHH3,4,5 ,6.,7,8,9,10.Daraasadaha cilmi-nafsiga ayaa sidoo kale muujiyay in HHH ay sababto daacadnimada xididdada xididada oo daciifa, sidaas awgeed waxay xaqiijinaysaa in HHH ay tahay mid ka tarjumaysa cudurrada maraakiibta yaryar ee maskaxda11.Intaa waxaa dheer, SHG waa muhiimada kiliinikada sida lagu muujiyay in ay saameynayso dhacdooyinka iyo saadaasha xanuunka neerfayaasha kala duwan, oo ay ku jiraan hoos u dhaca garashada, waallida, niyad-jabka, qaska socodka, iyo istaroogga12,13,14,15,16,17,18, 19, 20, 21, 22, 23.
Qiimaynta kaalshiyamka halbowlaha ah (CAC) ayaa loo arkaa mid ku habboon oo la isku halayn karo oo lagu qiyaaso isu-ururinta shakhsiga ee u nuglaanta atherosclerosis waxaana la muujiyey inay la xidhiidho ischaemic stroke iyo stenosis artery cranial, iyo sidoo kale cudurada wadnaha24,25.Cudurka yar yar ee xididdada maskaxda ayaa si sahal ah ula noolaada atherosclerosis ee xididada waaweyn ee intracranial sababtoo ah weelasha dalool ee yar yar ee keena walxaha cad waxay ka soo jeedaan halbowlaha weyn ee basilar.Daraasado badan ayaa aqoonsaday xiriirka ka dhexeeya SHH iyo khatarta khatarta ah ee atherosclerosis ama carotid atherosclerosis, si kastaba ha ahaatee, daraasado yar oo kaliya ayaa diiradda saaray xiriirka ka dhexeeya culeyska SAS iyo SHH, daraasaddan waxaa lagu sameeyay kaliya dadka waaweyn ama ragga 29, 30, 31 .32.
Iyada oo ay sii kordhayso helitaanka neuroimaging sannadihii la soo dhaafay, faafitaanka sare iyo muhiimadda bukaan-socodka ee HHH ayaa si sii kordheysa loogu aqoonsanayaa saadaalinta hoos u dhaca garashada iyo natiijada istaroogga19,20,21,22,23.Dhiirigelinta daraasaddan ayaa ahayd in haddii dhibcaha CAC loo isticmaali karo dhaqanka kiliinikada si loo saadaaliyo khatarta SHH, saadaaliyaha cudurrada neerfaha ee kala duwan, waxay noqon kartaa qalab ku habboon oo faa'iido leh si loo go'aamiyo faa'iidada suurtagalka ah ee daraasadaha kale ee aadanaha, sida sida MRI ee maskaxda19,20,21,22,23.Waxaan qiyaasnay ​​in HHH ay si dhow ula xiriirto culeyska CCA, tilmaame atherosclerosis, tiro badan oo shaqsiyaad caafimaad qaba oo guud ahaan ah.Intaa waxaa dheer, waxaan raadinay inaan caawino fahamka hababka hoos yimaada horumarinta HHH anagoo aqoonsanayna arrimaha khatarta caafimaad ee khuseeya.Haddaba, yoolka ugu weyn ee daraasaddan ayaa ahayd in la baaro xiriirka CAC iyo WMH ee dadka caafimaadka qaba.Marka labaad, ujeedada daraasaddan waxay ahayd in la caddeeyo xiriirka ka dhexeeya SHG iyo arrimaha khatarta ah ee atherosclerosis.
Daraasadani waa daraasad dib-u-eegis ah oo ku salaysan dadweynaha guud.Waxaan ka raadinay xogta elektarooniga ah ee ka qaybgalayaasha maray baadhitaano caafimaad, oo ay ku jiraan MRI maskaxda iyo magnetic resonance angiography (MRA), at Gangbuk Samsung Hospital General Medical Centers ee Seoul iyo Suwon intii u dhaxaysay Janaayo 2016 iyo Disembar 2019. Dadka waxaa ku jiray maaddooyin lagu sameeyay CAC xisaabinta tomography ( CT) iyo sawir-qaadista maskaxda oo qayb ka ah baaritaanno jireed oo dhammaystiran, kuwaas oo ah hababka baarista caafimaadka ee Kuuriya.Tixraac ahaan, sharciga Kuuriya wuxuu u baahan yahay dhammaan shaqaalaha inay maraan baaritaanno caafimaad oo joogto ah oo sannadle ah ama labadii sanaba mar, sidaa awgeed ka qaybgalayaasha badani waa shaqaale ama xubnaha qoyska ee shaqaalaha shirkado kala duwan ama ururada dawladda hoose.
3983 ka mid ah, 2646 ayaa laga saaray sababahan soo socda awgood: a) khilaaf isticmaalka macluumaadka caafimaadka ee ujeeddooyin kasta oo cilmi baaris ah oo ku jira su'aalo is-maamulid ka hor baaritaanka (n = 376);haddii imtixaannada soo noqnoqda la sameeyay muddada (n = 43), shakhsiyaadka leh imtixaannada soo noqnoqda ayaa laga saaray, iyo CT iyo sawir-qaadista maskaxda ee qiimeynta CAC ee la sameeyay isla maalintaas ama wakhtiga ugu dambeeyay ayaa loo doortay daraasadda;(c) Waallida la yaqaan, cudurka Parkinson.taariikhda, hydrocephalus, qalliin hore ee maskaxda, buro maskaxda, cudurka moyamoya, istaroogga ama dhiigbaxa (n = 47);(d) Shakhsiyaadka qaba dhaawacyada maskaxda ee muhiimka ah oo lagu ogaado falanqaynta sawirka, tusaale ahaan, sababtoo ah hore ee encephalomalacia sababtoo ah istaroogga (qiyaasta dhexroorka weyn ee ka weyn 15 mm) ama dhiig-baxa jireed ee jirrada, cilladda arteriovenous, ama neoplastic lesion (n = 46);(e) dadka leh MRI ama MRA oo aan tayadoodu ku filnayn falanqaynta sawirka (n = 2);(f) Shakhsiyaadka aan marin CT ee miisaanka CAC (n = 1796);(g) Shakhsiyaadka aan haysan xogta tirada ee looga baahan yahay falanqaynta, oo ay ku jiraan index mass index (BMI) iyo heerarka homocysteine ​​​​(n = 336).Jaantuska socodka shaqo qorista ka qaybgalayaasha daraasadda ayaa lagu muujiyay sawirka 1.
Ku dar jaantuska socodka ka qaybgalayaasha.MRI magnetic resonance imaging, MRA magnetic resonance angiography, PVWMH arrin cad oo wareeg ah, dhiig-karka cad ee qoto dheer DWMH.
Sidaa darteed, maadooyinka 1337 (da'da celceliska 51.63 ± 9.20 sano, da'da 20-89 sano, 1157 [86.54%) bukaanada lab ah) ayaa lagu daray daraasaddan.Dhammaan ka qaybgalayaasha ayaa dib loo qiimeeyay natiijooyinka caafimaad iyo shucaaca.Daraasaddan waxaa loo sameeyay si waafaqsan mabaadi'da Bayaanka Helsinki waxaana ansixiyay Guddiga Dib-u-eegista Hay'adaha (IRB) ee Isbitaalka Gangbuk Samsung (IRB No. 2020-12-036-006).IRB ee Cisbitaalka Kangbuk Samsung waxay ka dhaaftay shuruudii ogolaanshaha la wargaliyay sababtoo ah isticmaalka xogta aan la aqoonsan iyo naqshadaynta daraasadda.Dhammaan hababka cilmi-baarista waxaa loo sameeyay si waafaqsan tilmaamaha iyo xeerarka khuseeya.
Waxaan soo aruurinay xog caafimaad oo gaar ah oo ay ku jiraan jinsiga, da'da, BMI, cadaadiska dhiigga ee systolic iyo diastolic, taariikhda sigaarka, dhaqdhaqaaqa jireed, iyo ogaanshaha iyo daaweynta hypertension, sonkorowga, hyperlipidemia, iyo cudurada wadnaha.Laga soo bilaabo su'aalo-waraysiyada is-maamulka ee caadiga ah, waxaan ka soo uruurinay xogta shakhsi kasta taariikhdiisa caafimaad iyo taariikhda sigaarka, iyo sidoo kale haddii ay si joogto ah ugu hawlan yihiin dhaqdhaqaaq jireed oo xooggan in ka badan 10 daqiiqo ugu yaraan 3 jeer toddobaadkii.
Sababtoo ah dhammaan ka qaybgalayaasha waxaa loo qorsheeyay in lagu baaro Isbitaalka Ganbuk Samsung General Medical Center, shaybaarka shaybaarka ayaa la sameeyay isla maalinta MRI ee maskaxda iyo MRA ka dib markii ay soomeen 12-saacadood, iyo xogta waxaa ku jira glucose, hemoglobin glycated (HbA1c), heerarka. wadarta kolestaroolka, kolestaroolka LDL, kolestaroolka HDL, triglycerides iyo homocysteine.
Dhiig-karka halbowlaha waxaa lagu qeexay qaadashada hadda daawooyinka ka hortagga hypertensive, cadaadiska dhiigga systolic ≥ 140 mmHg.ama cadaadiska dhiigga diastolic ≥ 90 mmHg33.Sonkorowga waxaa lagu qeexay isticmaalka daawada macaanka ee hadda jirta, gulukoosta dhiigga ee soonka ≥ 126 mg/dL, ama HbA1c ≥ 6.5%.Dyslipidemia waxaa lagu qeexay isticmaalka hadda ee daawooyinka dufan-yareeya, wadarta kolestaroolka ≥240 mg/dl, kolestaroolka lipoprotein-cufnaanta hoose ≥160 mg/dl, kolestaroolka lipoprotein-cufnaanta sare <40 mg/dl, ama triglycerides ≥200 mg/dl35.
Dhammaan ka qaybgalayaasha waxa lagu maray MRI maskaxda iyo MRA oo leh xadhig madax siddeed kanaal ah iyadoo la adeegsanayo iskaanka 1.5 T MRI (Optima MR360, GE Healthcare, Milwaukee, Wisconsin ama Signa HDxt, GE Healthcare, Milwaukee, Wisconsin).Nidaamka sawirku wuxuu ka kooban yahay sawirro axial T1 ah (waqtiga ku celcelinta [TR]/waqtiga echo [TE] = 417-450/9 ms ama 400-450/10 ms), sawirada T2-miisaanka leh (TR/TE = 4343-4694). ) ./ 100-110 ms ama 4084-4494/95-104 ms), sawirada FLAIR (TR/TE = 11000/127-138 ms ama 8800/128-130 ms) iyo 3D wakhtiga duulimaadka (TOF) /TE = 28/7 ms ama 27/3 ms, dhumucdiisuna tahay 1.2 mm).Dhumucdiisuna waxay ahayd 5 mm dhammaan borotokoollada sawirka marka laga reebo TOF MRA.
Heerarka WMH-wareegga iyo qoto-dheer ayaa si gooni ah loo qiimeeyay iyadoo loo eegayo cabbirka Fazekas ee maaddo kasta, sida lagu muujiyey Jaantuska Dheeraadka 1 ee khadka.PVWMH waxa loo dhaliyay sidan soo socota: 0= midna, 1= koofiyad ama dahaar dhuuban, 2=halo siman, 3= dhiig-karnidu aan joogto ahayn oo ku fidsan walxo cad oo qoto dheer.DWMH waxa loo kala saaraa sidan soo socota: 0 = maqane, 1 = punctate, 2 = nabaradu waxay bilaabaan inay is urursadaanSababtoo ah maskaxda HBH fasalka 2 ama ka sareeya waxaa loo yaqaanaa inay kiliinikada muhiim tahay sababtoo ah waxay u nugul tahay calaamadaha iyo horumarka, waxaanu u qaybinay bukaanada Fazekas dhibcaha 2 iyo 3 PVBVH iyo DGBV36,37.
Falanqaynta TOF MRA, oo ku salaysan habka warfarin-aspirin calaamadaha cudurka intracranial (WASID), waxay qeexaysaa intracranial artery stenosis (ICAS) sida stenosis intracranial artery stenosis oo ka weyn 50%38.Maraakiibta lagu daray falanqaynta waxay ahaayeen halbowlaha carotid gudaha ee qaybta godka ilaa qaybta M2 ee halbowlaha dhexe ee maskaxda, qaybta A2 ee halbowlaha hore ee maskaxda, qaybta P2 ee halbowlaha maskaxda ee dambe, xididka basilar, iyo intracranial. halbowleyaasha.qaybta halbowlaha vertebral.
Dhammaan qiimeynta shucaaca waxaa sameeyay dhakhtarka neerfaha (JYK), kaas oo aan ka warqabin dhammaan xogta bukaan-socodka iyo shaybaarka.Kalsoonida miisaanka aragga ee u dhexeeya goobjoogayaasha waxaa lagu qiimeeyay raadiyaha labaad ee tababbaran (JYC) 700 maadooyin si aan kala sooc lahayn loo doortay iyo 2-bilood gudahood ka dib akhrinta koowaad.Qiimee isku halaynta gudaha kormeeraha.Qiimaynta muuqaalka ee PVWMH, DWMH, iyo ICAS waxay muujisay khabiiro wanaagsan (Cohen-miisaan kappa: 0.7, 0.81, iyo 0.67, siday u kala horreeyaan; n = 700) iyo gudaha-khabiirka (Cohen-miisaanka kappa: 0.92, 0.88, iyo 0. 65, siday u kala horreeyaan; n = 1339) borotokoolka.
Dhibcaha CAC waxaa lagu qiimeeyay shakhsiyaadka maray CT si loo qiimeeyo CAC gudaha 5 sano ee maskaxda MRI iyo MRA39.1,337 qof, 686 ka mid ah ayaa laga qaaday skaanka maskaxda isla maalintaas iyo 651 maalin kale 5 sano gudahood.
Xarumaha Seoul iyo Suwon waxay adeegsadeen mAc (310 mA × 0.4 s) tuubada hadda jirta ee dhumucda 2.5 mm, 400 ms wakhtiga wareeg, 120 kV tuubada korantada, iyo 124 qiyaasta qiyaasta ECG ku tiirsan.Sida laga soo xigtay Agatston et al.40, CAC waxaa laga soo xisaabiyay 4 halbowlayaasha wadnaha ee waaweyn (bidix bidix, hore ee bidix ee soo degaya, wareegga bidix, iyo halbowlayaasha wadnaha ee midig).Farsamoyaqaanka CT-ga ayaa la indho-tiray macluumaad kasta oo ku saabsan mawduuca iyo dhibcaha CAC si toos ah ayaa loo go'aamiyay iyada oo la adeegsanayo software-ka HEARTBEAT-CS (Philips, Cleveland, OH, USA).Dhibcaha CAC waxa loo qaybiyaa saddex kooxood: 0, 1-100, iyo>100.
Sifooyinka asaasiga ah ayaa la barbardhigay maaddooyinka leh iyo kuwa aan lahayn maskaxda WMH iyadoo la adeegsanayo χ2 imtixaan doorsoomayaal iyo imtixaanka t-tijaabka ama imtixaanka Mann-Whitney ee doorsoomayaasha joogtada ah, sida ku habboon.Doorsoomayaasha sida caadiga ah loo qaybiyo waxaa loo soo bandhigaa celcelis ahaan ± weecasho caadi ah, halka doorsoomayaasha aan sida caadiga ah loo qaybin loo soo bandhigo dhex dhexaad iyo kala duwanaansho.Doorsoomayaasha dummy waxaa loo soo bandhigay qiimayaasha maqan ee doorsoomayaasha kala duwan.
Falanqaynta dib-u-celinta saadka ee kala duwan ayaa la sameeyay si loo xisaabiyo saamiga is-khilaafsan (ORs) iyo 95% isku-kalsoonida (CIs) si loo qiimeeyo xidhiidhka ka dhexeeya dhibcaha WMH iyo CAC maskaxda iyo arrimaha khatarta ah ee atherosclerosis.Maadaama faafitaanka HHH uu sii kordhayo da'da oo ay ku kala duwan tahay jinsiga, dhammaan falanqaynta kala duwan ee la sameeyay si loo qiimeeyo ururada ka dhexeeya doorsoomayaasha kale iyo HHH18 ee lagu hagaajiyay da'da iyo jinsiga.Qaab kale oo kala duwanaansho saadka ah ayaa loo adeegsaday si loo qiimeeyo in dhibcaha CAC ay leedahay xiriir madax-bannaan oo maskaxda SHG ah, xitaa ka dib marka la isku hagaajiyo arrimaha khatarta ah ee atherosclerosis iyo ICAS sida arrimo jahawareer ah oo lagu soo warramey inay xiriir la leeyihiin SHH warbixinadii hore10, 26, 27, 41 Model 1 waxaa lagu hagaajiyay da'da iyo jinsiga, Moodelka 2 waxaa lagu hagaajiyay da'da, jinsiga, iyo khatarta khatarta ah ee atherosclerosis ).la hagaajiyay;Habka 3 waxaa lagu hagaajiyay da'da, jinsiga, arrimaha khatarta ah ee atherosclerosis, iyo joogitaanka ICAS.Jiritaanka maskaxda WMH waxaa lagu qiimeeyay iyadoo loo eegayo qaybaha dhibcaha CAC iyadoo la isticmaalayo dhibcaha CAC 0 sidii halbeeg.
Falanqaynta tirakoobka ayaa la sameeyay iyadoo la adeegsanayo nooca Stata 16.1 (StataCorp, College Station, Texas, USA) iyo nooca R studio 3.6.3 (RStudio, Boston, Massachusetts, USA).Qiimaha p-laba-dabo <0.05 ayaa loo tixgeliyey inay muhiim tahay.
Astaamaha asaasiga ah ee shakhsiyaadka 1337 ayaa lagu muujiyay shaxda 1. Celceliska da'da ka qaybgalayaasha, oo lagu qiyaasay wakhtiga MRI ee maskaxda, waxay ahayd 51.63 ± 9.20 sano, iyo 86.54% dadka daraasadda waxay ahaayeen rag.Sababaha ugu muhiimsan ee khatarta ah ee atherosclerosis ee kooxdan waxay ahaayeen sigaar cabbitaan hadda ama hore (57.82%), oo ay ku xigto dyslipidemia (51.76%) iyo hypertension (28.65%).Marka la eego doorsoomayaasha shucaaca, 158 bukaan (11.82%) waxay lahaayeen PVWMH, 148 (11.07%) waxay lahaayeen DWMH, iyo 21 (1.57%) waxay lahaayeen ICAS.Marka la eego dhibcaha CAC, 849 maado (63.5%) waxay lahaayeen dhibcaha CAC ee 0, 332 (24.83%) waxay heleen dhibco u dhexeeya 0 iyo 100, iyo 156 (11.67%) waxay heleen dhibco ka wayn 100.
Falanqaynta kala-duwanaanshaha, da'da, jinsiga, iyo waxyaabaha ugu badan ee halista u ah atherosclerosis, marka laga reebo BMI, dyslipidemia, iyo sigaar cabbista hadda ama hore, ayaa si weyn loola xiriiriyay joogitaanka maskaxda HHH (p <0.05) (Shaxda 2).Shakhsiyaadka qaba PVWMH iyo DWMH way da'weynaayeen oo waxay lahaayeen culays weyn oo ah hypertension, sonkorowga, taariikhda cudurka halbowlaha wadnaha, CAC, iyo ICAS marka loo eego shakhsiyaadka aan lahayn PVWMH iyo DWMH.Falanqaynta univariate, qayb sare oo ka mid ah haweenka iyo maadooyinka kooxda WMH ayaa sheegay inay si joogto ah u jimicsadaan.Dhexdhexaadka (kala duwanaanshaha afar-geesoodka ah; IQR) CAC wuxuu ahaa 62 (IQR 0-269.5) kooxda PVWMH iyo 46.5 (IQR 0-192) ee kooxda DWMH.Qaybinta qaybaha CAC ee joogitaanka PVWMH iyo DWMH waxa lagu muujiyay fig.2. Saamiga qaybaha leh buundooyinka CAC sare ayaa kordhay iyadoo la raacayo heerka WMH.
Boqolkiiba qaybaha dhibcaha CAC ee ku salaysan haysashada PVMWH (a), DWMH (b), iyo PVWMH ama DWMH (c).Xisaabinta halbowlayaasha halbawlaha ah ee SAS, dhiig-karka sheyga cad ee SHG, hyperintensity arrinta cad ee periventricular HVBV, cadaadiska qoto dheer ee cadaanka SHVH.
Falanqaynta dib-u-celinta kala duwan ee lagu hagaajiyay da'da (OR 1.13; 95% CI 1.10-1.16; OR 1.11; 95% CI 1.08-1.14) iyo dhiig-karka (OR 2.29; 95% CI 1.50-3.50, OR 9.2-3) .siday u kala horreeyaan) waa PVWMH ka dib marka la isku hagaajiyo da'da, jinsiga, arrimaha khatarta ah ee atherosclerosis (BMI, hypertension, diabetes, dyslipidemia, sigaarka hadda ama hore, jimicsiga, taariikhda cudurka halbowlaha halbowlaha, iyo heerarka homocysteine ​​​​) iyo saadaasha caafimaad ee madax-bannaan ee DWMH iyo ICAS (dhammaan p <0.05) (Shaxda 3).Ma jirin xidhiidh muhiim ah oo u dhexeeya WMH la hagaajiyay iyo jinsiga, BMI, sonkorowga ama dyslipidemia, taariikhda sigaarka, ama jimicsiga caadiga ah.
Xitaa ka dib marka la isku hagaajiyo arrimo jahawareer leh, qaybaha leh buundooyinka CAC sare waxay muujiyeen xiriirka korodhay ee GMI maskaxda qaab ku-tiirsanaan ah marka loo eego qaybaha tixraaca ee dhibcaha CAC ee 0. PVWMH iyo DWMH, qaybaha leh dhibcaha CAC ee ka weyn 100 ( AMA 5.45; 95% CI 3.11-9.54 ama 3.66; 95% CI 2.10-6.38) waxay muujisay urur ka weyn qaybaha leh buundooyinka CAC ee 0 ilaa 100 (OR 2.22; 95% CI).1.36–3.61, AMA 1.59;95% CI 0.98-2.58).Marka la barbardhigo xiriirka CAC ee u dhexeeya kooxaha PVWMH iyo DWMH, dhammaan saddexda nooc ee falanqaynta kala duwan waxay muujiyeen ururo sare oo leh PVWMH labada qaybood ee dhibcaha CAC.Joogitaanka ICAS waxay sidoo kale muujisay xiriir la taaban karo oo leh PVWMH (OR 3.97, 95% CI 1.31-12.06) iyo DWMH (OR 7.11, 95% CI 2.33-21.77).
Isku-duwayaasha sicir-bararka kala duwanaanshiyaha ayaa loo xisaabiyay dhammaan moodooyinka dib-u-celinta si loo qiimeeyo suurtogalka ah multicollinearity, mana jirin wax dhib ah oo multicollinearity ah oo la helay (Shaxda Dheeraadka ah 1 online).
Daraasaddan, khatarta SHH-da maskaxda ayaa kor u kacday iyadoo la kordhinayo dhibcaha CAC ee habka qiyaasta ku-tiirsanaanta, natiijadu waxay ahaayeen kuwo aad u muhiim ah ka dib markii la isku hagaajiyo arrimaha khatarta ah ee khatarta ah ee atherosclerosis.Natiijooyinkayagu waxay la socdaan daraasado hore oo muujinaya xiriirka ka dhexeeya CAC iyo maskaxda MRI aan caadi ahayn, oo sii xoojinaya xiriirka CAC ee leh xididdada yaryar ee maskaxda ee atherosclerosis iyo sidoo kale maraakiibta waaweyn ee atherosclerosis29,30,31,32.
Waxa xiisaha lihi leh, dhammaan saddexda nooc ee falanqaynta kala duwan, OR-yada buundooyinka CAC waxay waxyar ka sarreeyaan kooxda PVWMH marka loo eego kooxda DWMH.Farqigani waxa laga yaabaa inuu sabab u yahay xaqiiqda ah in kala duwanaanshiyaha hababka pathophysiological iyo arrimaha khatarta ah loo maleeyo inta u dhaxaysa PVWMH iyo DWMH11,42,43.PVWMH-yadu waxay inta badan si isku mid ah ugu sugan yihiin labada hemispheres ee maskaxda, iyagoo soo jeedinaya khalkhalka fidsan ee fidsan, halka DWMHs ay inta badan leeyihiin qaybin asymmetric ah, taasoo soo jeedinaysa inay sababto khalkhal fir-fircooni.Maaddaama gobolka periventricular ay bixiso halbowlayaasha terminal ee medulla dheer iyo laamo dalool [45], waxay si gaar ah u nugul tahay marka hababka iswada ee lagu ilaalinayo fayraska maskaxda ee joogtada ah ay wiiqaan arteriosclerosis ama lipoid hyalinosis [46, 47, 48, 49].Dhiig-karka iyo ischemia ayaa soo baxa.Gaar ahaan, cilmi-baarisyo dhowr ah ayaa muujiyay in muujinta atherosclerosis ee nidaamka, sida hypertension, diabetes mellitus, iyo joogitaanka atherosclerosis aortic, ay inta badan la xiriiraan PVWMH50,51,52,53, taageeraya natiijooyinkayaga in dhibcaha CAC, da'da, iyo halbowlayaasha. dhiigkarka ayaa lahaa ORs ka sareeya PVWMH marka loo eego DWMH dhammaan noocyada.
Daraasaddan, joogitaanka ICAS waxay si dhow ula xiriirtay maskaxda HHH, natiijadu waxay noqon kartaa mid lagu sharxi karo xaqiiqda ah in stenosis weyn ee halbowlayaasha intracranial ay yareeyaan qallafsanaanta maskaxda ee degaanka ama gobolka, iyo hypoperfusion dabadheeraad ah waxay gacan ka geysataa hyalinosis dufanka leh, kuwaas oo ah hababka hoose.horumarinta WMH 26.54 .
Iyadoo la raacayo daraasado badan oo hore3, 27, 28, 55 lagu sameeyay kooxo qowmiyadeed oo kala duwan, daraasaddeenu waxay sidoo kale muujisay in da'da iyo dhiig-karka ay si madax-bannaan u yihiin oo si weyn ula xiriiraan maskaxda HBG ee falanqaynta kala duwan.Si kastaba ha ahaatee, xiriirka ka dhexeeya HHH iyo arrimaha kale ee khatarta ah ee atherosclerosis ayaa muujiyay natiijooyin isku dhafan warbixinadii hore27,28,37,56.Sababaha natiijooyinkan kala duwan waxaa laga yaabaa inay sabab u tahay kala duwanaanshaha dadyowga daraasadda, shuruudaha lagu go'aamiyo arrimaha khatarta ah, ama hababka loo isticmaalo in lagu falanqeeyo WMH, kuwaas oo u baahan daraasad dheeraad ah.
Dhowr xaddidood oo daraasaddan ah waa in la xuso.Marka hore, tani waa daraasad dib-u-eegis ah oo lagu sameeyay dadka Aasiyaanka ah ee ku jira xarun caafimaad oo monobrand ah.Waxaa laga yaabaa in ay jirto khatar ah in la doorto eexda maaddaama tiro badan oo ka mid ah ka qaybgalayaasha daraasadda ay ahaayeen da'da shaqada, in ka badan kala badhna waxay ahaayeen rag, sababtoo ah sifooyinka gaarka ah ee Kuuriyada Koonfureed, taas oo u baahan shirkadaha inay si joogto ah u baaraan shaqaalahooda.Si loo dhimo eexda ee daraasadaha kooxda, muddada dheer, dheer, iyo daraasadaha mustaqbalka sida Rotterdam Study57 ama Framingham Study58 waa in la qabtaa.Markii hore, waxaa jiray warbixino badan oo isticmaalaya Daraasadda Rotterdam si ay diiradda u saaraan xiriirka ka dhexeeya maskaxda SHG iyo arrimo kala duwan oo khatar ah oo loogu talagalay atherosclerosis Association ee u dhexeeya kooxaha iyo daraasadaha Framingham 4, 59, 60, 61, 62, 63. Si kastaba ha ahaatee, tan iyo mid ka mid ah kuwa hadda jira ma jiro. Daraasaduhu waxay diiradda saareen xiriirka ka dhexeeya GIBD iyo CCA ee dadka caadiga ah, natiijooyinkayagu waa kuwo khuseeya kiliinikada.Marka labaad, maadaama falanqaynta MRI ay si muuqata u sameeyaan dhakhaatiirta shucaaca, ujeedadu kuma filna.Si kastaba ha ahaatee, waxaan isku daynay inaan ka gudubno xaddidan annagoo ku darayna tiro badan oo ka mid ah ka qaybgalayaasha iyo qeexidda maaddooyinka leh ugu yaraan dhexdhexaad ah ama ka sarreeya WMH sida koox togan.Intaa waxaa dheer, waxaanu samaynay imtixaanada isku-kalsoonida ee isku-kalsoonida iyo kormeerayaasha, natiijaduna waxay muujisay heshiis wanaagsan.Waxa kale oo hore loo soo sheegay in xidhiidh sare ka dhexeeyo hababka qiimaynta muuqaalka iyadoo la isticmaalayo cabbirka Fazekas iyo falanqaynta mugga ee loo adeegsaday qiimaynta darajada WMH64,65.Saddexaad, shakhsiyaadka qaba dhaawacyada maskaxda ayaa laga saaray iyadoo la adeegsanayo su'aalo-is-waydaarsi iskood isu maamulay oo ay ku jiraan taariikh caafimaad oo hore iyo falanqaynta sawirka shakhsiyaadka qaba cudurro cad oo laga yaabo inaysan sifeynin shakhsiyaadka qaba cudurrada hoose.Intaa waxaa dheer, barnaamijka MRI ee maskaxda ee baaritaanka caafimaadka ee isbitaalkeena kuma jiraan sawirro la xoojiyay, sidaas darteed waxaa suurtagal ah in la waayo ogaanshaha horumarinta maskaxda ee cudurada, taas oo aan caddayn T1-miisaanka, T2-miisaanka iyo sawirada FLAIR, iyo saxnimadu maaha mid sare.Marka la barbar dhigo kobcinta MRA, joogitaanka ICAS waxaa lagu qiimeeyay mid aad u hooseeya.Afar, maadaama inta badan ka qaybgalayaasha daraasaddan ay ka yimaadeen dad caafimaad qaba oo intooda badan aysan qabin wax cudur ah, saamiga maaddooyinka la ildaran ICAS waxay ahaayeen kuwo yar.
Si kastaba ha ahaatee, daraasaddan waxaa ku jiray dad ka caafimaad badan daraasadihii hore ee lagu eegayay xiriirka ka dhexeeya SHG iyo SAS, iyo aqoontayada, tani waa daraasaddii ugu horreysay ee lagu daro dadka waaweyn ee caafimaadka qaba iyada oo aan la sheegin jinsiga iyo da'da.Xaddidaadda daraasadda 31,32.
Muhiimadda maskaxda WMH iyo xanuunada dareemayaasha ee kala duwan ee la xidhiidha sida waallida iyo istaroogga ayaa la muujiyey sababtoo ah korodhka weyn ee helitaanka sawirka maskaxda iyo rajada nolosha, laakiin cudurradani waa kuwo aan laga adkaan.Joogitaanka nabarrada HHH ee maskaxda waxay la xiriirtaa hoos u dhac garasho oo aad u daran, waallida, niyad-jabka, iyo istaroogga, waxaana jira caddayn isa soo taraya oo sheegaya in la xakameeyo arrimaha khatarta ah ee khatarta ah ee atherosclerosis ay ka hortagi karto HHH12, 13, 14, 15, 16, 17, 18 . buundada CAC, si markaas loo aqoonsado bukaanada ka faa'iidaysan kara waxqabadyada ogaanshaha iyo daaweynta gardarrada ah.haddii CAC ay door muhiim ah oo madaxbannaan ka qaadato horumarinta WMH ee daraasadaha dheer iyo kuwa la filayo ee laga kala keenay gobollo kala duwan, kooxaha da'da iyo kooxaha qowmiyadaha, iyo calaamadaha kale ee MRI ee cudurrada maraakiibta yaryar ee maskaxda waa in sidoo kale lagu daro faham dhamaystiran.
Gabagabadii, dhibcaha CAC iyo sidoo kale da'da iyo dhiig-karka ayaa si weyn loola xiriiriyay maskaxda WMH ee dad badan oo caafimaad qaba.Dhibcaha CAC waa tusaha culayska atherosclerotic waxayna leedahay door suurtagal ah oo lagu saadaaliyo khatarta HHH ee maskaxda ee waxqabadka kiliinikada.
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