I-321/321L i-stainless steel capillary tube Association of white matter hyperintensity nge-coronary artery calcification kubantu abanempilo: ucwaningo oluhlukanisayo

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I-White matter hyperintensity (WWH) iwukutholakala okuvamile ku-magnetic resonance imaging (MRI) yobuchopho futhi kwaziwa ngokubonisa isifo semikhumbi emincane ebuchosheni.Inhloso yocwaningo lwethu kwakuwukuphenya ukuhlotshaniswa kwe-coronary artery calcium (CCA) ne-WMH kanye nokucacisa ubudlelwano phakathi kwe-WMH nezici eziyingozi ze-atherosclerosis kubantu abaningi abanempilo.Lolu cwaningo lokubuyisela emuva luhlanganisa abantu abangu-1337 abathola i-MRI yobuchopho kanye ne-computed tomography nokuhlolwa kwe-CAC esikhungweni sezokwelapha sasesibhedlela esiphakeme.I-GVM yobuchopho yachazwa njengamaphuzu e-Fazekas angaphezu kwamaphoyinti angu-2 ku-MRI yobuchopho.I-Intracranial arterial stenosis (ICAS) nayo yahlolwa futhi yaqinisekiswa lapho i-angiography ibonisa ngaphezu kuka-50% stenosis.Izinhlangano zezici eziyingozi, izikolo ze-CAC kanye ne-ICAS ezinobuchopho be-HBG zahlolwa kusetshenziswa ukuhlaziywa kokuhlehla kokunye.Ekuhlaziyweni kwe-multivariate, izigaba ezinezibalo eziphezulu ze-CAC zibonise ukuhlangana okukhulayo ne-periventricular kanye ne-hypertension ejulile ngendlela encike kumthamo.Ukuba khona kwe-ICAS nakho kwakuhlotshaniswa kakhulu ne-HBH yobuchopho, futhi phakathi kokuguquguquka kwemitholampilo, ubudala kanye nomfutho wegazi ophezulu kwakuyizici ezizimele zengozi.Sengiphetha, kubantu abanempilo, i-CAC yayihlotshaniswa kakhulu nobuchopho be-WMH, obungase bunikeze ubufakazi bokukhomba abantu abasengozini ye-WMH yobuchopho ngokubhekisela kumaphuzu we-CAC.

I-Stainless Steel 321 Coil Tube Chemical Composition

Ukwakhiwa kwamakhemikhali we-321 stainless steel coil tubing imi kanje:
- Ikhabhoni: 0.08% ubuningi
I-Manganese: 2.00% ubuningi
I-Nickel: 9.00% min

321/321L insimbi engagqwali 8 * 0.2 tube capillary

I-Stainless Steel 321 I-Coil Tube Mechanical Properties

321/321L insimbi engagqwali 8 * 0.2 tube capillary

NgokoMkhiqizi we-Stainless Steel 321 Coil Tube, izakhiwo zemishini yeshubhu yekhoyili yensimbi engagqwali engu-321 zidwetshwe ngezansi: Amandla Aqinile (psi) Amandla Okukhiqiza (psi) Ukwelulwa (%)

321/321L insimbi engagqwali 8 * 0.2 tube capillary

I-White matter hyperintensity (WWH) iwukutholakala okuvamile ku-T2-weighted and fluid-attenuated magnetic resonance imaging (MRI) inversion recovery recovery (FLAIR) ukulandelana kobuchopho1,2.Nakuba indlela eqondile ye-HHH ye-pathophysiological ingaziwa, iboniswe ukuthi ihlotshaniswa nezici eziyingozi ze-atherosclerosis ezifana nokuguga, umfutho wegazi ophakeme, isifo sikashukela, ukubhema, nokukhuluphala, okuphakamisa umnikelo wezinqubo ze-vascular ekuthuthukiseni i-HHH3,4,5 ,6.,7,8,9,10.Ucwaningo lwe-pathological luye lwabonisa nokuthi i-HHH ibangelwa ubuqotho be-vascular ekhubazekile, ngaleyo ndlela iqinisekisa ukuthi i-HHH iwukubonakaliswa kwesifo semikhumbi emincane ebuchosheni11.Ukwengeza, i-SHG ibalulekile emtholampilo njengoba iboniswe ukuthi ithinta izehlakalo kanye nokubikezelwa kwezifo ezihlukahlukene zezinzwa, okuhlanganisa ukwehla komqondo, ukuwohloka komqondo, ukucindezeleka, ukuphazamiseka kokuhamba, kanye ne-stroke12,13,14,15,16,17,18, 19 , 20, 21, 22, 23.
Ukuhlolwa kwe-Coronary calcium assessment (CAC) kuthathwa njengesilinganiso esikahle nesithembekile sokungenwa okuqongelelekayo komuntu ku-atherosclerosis futhi kuboniswe ukuthi kuhlotshaniswa ne-ischemic stroke kanye ne-cranial artery stenosis, kanye nesifo senhliziyo24,25.Isifo semikhumbi emincane yobuchopho sihambisana kalula ne-atherosclerosis yemithambo emikhulu ye-intracranial ngoba imikhumbi emincane ebhoboza ehambisa udaba olumhlophe isuka emthanjeni omkhulu we-basilar.Ucwaningo oluningi lukhombe ukuhlobana phakathi kwe-SHH nezici eziyingozi ze-atherosclerosis noma i-carotid atherosclerosis, nokho, izifundo ezimbalwa kuphela ezigxile ebudlelwaneni obuphakathi komthwalo we-SAS kanye ne-SHH, futhi lezi zifundo zenziwe kuphela kubantu abadala asebekhulile noma amadoda angama-29, 30, 31 .32.
Ngokutholakala okwandayo kwe-neuroimaging eminyakeni yamuva, ukusabalala okuphezulu kanye nokubaluleka komtholampilo kwe-HHH kuya ngokuya kuqashelwa njengesibikezelo sokuncipha kwengqondo kanye nomphumela we-stroke19,20,21,22,23.Isisusa salolu cwaningo sasiwukuthi uma amaphuzu e-CAC angasetshenziswa emisebenzini yomtholampilo ukubikezela ingozi ye-SHH, isibikezelo sezinkinga ezihlukahlukene zemizwa, kungaba ithuluzi elilula neliwusizo lokunquma inzuzo engaba khona yezinye izifundo zabantu, ezifana njenge-MRI yobuchopho19,20,21,22,23.Sacabanga ukuthi i-HHH ihlobene eduze nomthwalo we-CCA, inkomba ye-atherosclerosis, ngenani elikhulu labantu abanempilo emphakathini uwonke.Ngaphezu kwalokho, siye sazama ukusiza ukuqonda izindlela eziyisisekelo zokuthuthukiswa kwe-HHH ngokuhlonza izici zengozi yomtholampilo ezifanele.Ngakho, umgomo oyinhloko walolu cwaningo kwakuwukuphenya ukuhlangana kwe-CAC ne-WMH kubantu abanempilo.Okwesibili, inhloso yalolu cwaningo kwakuwukucacisa ubudlelwano phakathi kwe-SHG nezici eziyingozi ze-atherosclerosis.
Lolu cwaningo luwucwaningo lwe-retrospective lwezigaba ezihlukene olususelwe kubantu abajwayelekile.Siseshe imininingo egciniwe ye-elekthronikhi yabahlanganyeli abahlolelwe udokotela, okuhlanganisa i-MRI yobuchopho kanye ne-magnetic resonance angiography (MRA), e-Gangbuk Samsung General Medical Centers Hospital e-Seoul nase-Suwon phakathi kukaJanuwari 2016 no-December 2019. Isibalo sabantu sasihlanganisa izifundo ezithole i-CAC computed tomography ( CT) kanye nesithombe sobuchopho njengengxenye yokuhlolwa okuphelele komzimba, okuyindlela evamile yokuhlola impilo e-Korea.Ukuze uthole ireferensi, umthetho wase-Korea udinga ukuthi zonke izisebenzi zihlolwe njalo ngonyaka noma ngemva kweminyaka emibili, ngakho abaningi ababambiqhaza bangabasebenzi noma amalungu omndeni ezisebenzi zezinkampani ezihlukahlukene noma izinhlangano zikahulumeni wendawo.
Kubantu abangama-3983, abangama-2646 abafakwanga ngenxa yalezi zizathu ezilandelayo: a) ukungavumelani nokusetshenziswa kolwazi lwezokwelapha kunoma yiziphi izinjongo zocwaningo kuhlu lwemibuzo oluzilawulele lona ngaphambi kokuhlolwa (n = 376);uma ukuhlolwa okuphindaphindiwe kwenziwa phakathi nenkathi (n = 43), abantu abanokuhlolwa okuphindaphindiwe babengabandakanywa, futhi i-CT ne-imaging yobuchopho ngokuhlolwa kwe-CAC okwenziwa ngosuku olufanayo noma ngesikhathi sokuphumula sakamuva kakhulu kukhethiwe ocwaningweni;(c) ukuwohloka komqondo okwaziwayo, isifo sika-Parkinson.umlando, i-hydrocephalus, ukuhlinzwa kobuchopho kwangaphambilini, isimila sobuchopho, isifo se-moyamoya, isifo sohlangothi noma ukopha (n = 47);(d) abantu abanezilonda eziphawulekayo zobuchopho ezitholwe ngokuhlaziywa kwesithombe, isibonelo, ngenxa ye-encephalomalacia yangaphambili ngenxa ye-stroke (isilinganiso esikhulu sobubanzi obukhulu kuno-15 mm) noma ukopha okudabukisayo okudala, ukukhubazeka kwe-arteriovenous, noma i-neoplastic lesion (n = 46);(e) abantu abane-MRI noma i-MRA yekhwalithi enganele yokuhlaziywa kwesithombe (n = 2);(f) abantu abangazange benze i-CT esikalini se-CAC (n = 1796);(g) abantu abangenalo idatha yezinombolo edingekayo ukuze kuhlaziywe, okuhlanganisa inkomba yesisindo somzimba (BMI) kanye namazinga e-homocysteine ​​​​(n = 336).I-flowchart yokuqasha ababambiqhaza bocwaningo ikhonjisiwe kuMfanekiso 1.
Faka ne-flowchart yabahlanganyeli.I-MRI magnetic resonance imaging, i-MRA magnetic resonance angiography, i-periventricular white matter hyperintensity PVWMH, i-hyperintensity yento emhlophe ejulile i-DMH.
Ngakho, izifundo ze-1337 (iminyaka yobudala engu-51.63 ± 9.20, ububanzi beminyaka engu-20-89, i-1157 [86.54%] iziguli zesilisa) zifakwe kulolu cwaningo.Bonke ababambiqhaza bahlolwe ngokuphindaphindiwe ukuze bathole okutholakele emitholampilo kanye ne-radiographic.Lolu cwaningo lwenziwe ngokuhambisana nemigomo yeSimemezelo sase-Helsinki futhi lwavunyelwa Ibhodi Lokubuyekeza Isikhungo (IRB) le-Gangbuk Samsung Hospital (IRB No. 2020-12-036-006).I-IRB eSibhedlela i-Kangbuk Samsung iyeka imfuneko yemvume enolwazi ngenxa yokusetshenziswa kwedatha engahlonziwe kanye nomklamo wocwaningo obonisa imuva.Zonke izindlela zocwaningo zenziwa ngokuhambisana neziqondiso nemithethonqubo efanele.
Siqoqe idatha yomtholampilo ngayinye ehlanganisa ubulili, ubudala, i-BMI, i-systolic ne-diastolic blood pressure, umlando wokubhema, umsebenzi womzimba, ukuxilonga nokwelashwa komfutho wegazi ophezulu, isifo sikashukela, i-hyperlipidemia, nesifo senhliziyo.Kusukela kuhlu lwemibuzo olujwayelekile lokuzilawula, siqoqe idatha yomlando wezokwelapha womuntu ngamunye kanye nomlando wokubhema, kanye nokuthi ingabe ujwayele ukwenza umsebenzi onamandla ngaphezu kwamaminithi angu-10 okungenani izikhathi ezingu-3 ngeviki.
Ngenxa yokuthi bonke ababambiqhaza kwakuhlelwe ukuthi bahlolwe e-Ganbuk Samsung Hospital General Medical Center, ukuhlolwa kwaselabhorethri kwenziwa ngosuku olufanayo ne-MRI yobuchopho ne-MRA ngemva kokuzila ukudla kwamahora angu-12, futhi idatha yayihlanganisa i-glucose, i-glycated hemoglobin (HbA1c), amazinga. i-cholesterol ephelele, i-LDL cholesterol, i-HDL cholesterol, i-triglycerides ne-homocysteine.
I-Arterial hypertension yachazwa njengokuthatha kwamanje kwezidakamizwa ze-antihypertensive, umfutho wegazi we-systolic ≥ 140 mmHg.noma umfutho wegazi we-diastolic ≥ 90 mmHg33.Isifo sikashukela sachazwa njengokusetshenziswa kwezidakamizwa zamanje ze-antidiabetic, ushukela wegazi osheshayo ≥ 126 mg/dL, noma i-HbA1c ≥ 6.5%.I-Dyslipidaemia yachazwa njengokusetshenziswa kwamanje kwezidakamizwa zokwehlisa i-lipid, i-cholesterol ephelele ≥240 mg/dl, i-cholesterol ephansi-density lipoprotein ≥160 mg/dl, i-high-density lipoprotein cholesterol <40 mg/dl, noma i-triglycerides ≥200 mg/dl35.
Bonke ababambiqhaza bathole i-MRI yobuchopho kanye ne-MRA ngekhoyili yekhanda lamashaneli ayisishiyagalombili besebenzisa isithwebuli se-1.5 T MRI (i-Optima MR360, i-GE Healthcare, i-Milwaukee, i-Wisconsin noma i-Signa HDxt, i-GE Healthcare, i-Milwaukee, i-Wisconsin).Iphrothokholi yokucabanga yayinezithombe ezinesisindo se-axial T1 (isikhathi sokuphindaphinda [TR]/isikhathi se-echo [TE] = 417–450/9 ms noma 400–450/10 ms), izithombe ezinesisindo se-T2 (TR/TE = 4343–4694 )./100-110 ms noma 4084-4494/95-104 ms), izithombe ze-FLAIR (TR/TE = 11000/127-138 ms noma 8800/128-130 ms) kanye nezithombe ze-3D zesikhathi sokundiza (TOF) (TR /TE = 28/7 ms noma 27/3 ms, ukujiya kocezu = 1.2 mm).Ugqinsi locezu lwalungu-5 mm kuwo wonke amaphrothokholi ezithombe ngaphandle kwe-TOF MRA.
Izinga le-WMH le-periventricular kanye ne-deep lihlolwe ngokuhlukana ngokuvumelana ne-Fazekas scale1 yesifundo ngasinye, njengoba kukhonjisiwe Emfanekisweni Owengeziwe 1 ku-inthanethi.I-PVWMH itholwe ngendlela elandelayo: 0=ayikho, 1=ikepisi noma ulayini omncane, 2=i-halo ebushelelezi, 3=i-periventricular hyperintensity engavamile edlulela kundaba emhlophe ejulile.I-DMH ihlukaniswa kanje: 0 = engekho, 1 = punctate, 2 = izilonda ziqala ukuhlangana, 3 = izindawo ezinkulu zokuhlangana.Ngenxa yokuthi ibanga lesi-2 le-HBH lobuchopho noma ngaphezulu laziwa njengelibalulekile ngokomtholampilo ngoba lithambekele ekubeni nezimpawu nokuqhubekela phambili, sihlukanise iziguli ezinamaphuzu e-Fazekas angu-2 no-3 sibe yi-PVBVH ne-DGBV36,37.
Ukuhlaziywa kwe-TOF MRA, okusekelwe endleleni ye-warfarin-aspirin symptomatic intracranial disease (WASID), kuchaza i-intracranial artery stenosis (ICAS) njenge-intracranial artery stenosis engaphezu kuka-50%38.Izitsha ezifakwe ekuhlaziyweni kwakuyi-artery yangaphakathi ye-carotid kusukela engxenyeni ye-cavernous kuya engxenyeni ye-M2 ye-artery ye-cerebral ephakathi, ingxenye ye-A2 ye-anterior cerebral artery, ingxenye ye-P2 ye-posterior cerebral artery, i-basilar artery, kanye ne-intracranial. umthambo wegazi.ingxenye ye-vertebral artery.
Konke ukuhlolwa kwe-radiological kwenziwa i-neuroradiologist (JYK), ebingazi ngayo yonke idatha yomtholampilo neyelabhorethri.Ukuthembeka kwesikali esibonakalayo phakathi kwezibukeli kwahlolwa i-radiographer yesibili eqeqeshiwe (JYC) ezifundweni ezikhethwe ngokungahleliwe ezingama-700 futhi phakathi nesikhawu sezinyanga ezingu-2 ngemva kokufundwa kokuqala.Hlola ukwethembeka ngaphakathi kwesibukeli.Ukuhlola okubukwayo kwe-PVWMH, i-DWMH, kanye ne-ICAS kubonise uchwepheshe ophakathi okuhle (i-kappa enesisindo sika-Cohen: 0.7, 0.81, kanye no-0.67, ngokulandelana; n = 700) kanye nochwepheshe bangaphakathi (i-kappa enesisindo sika-Cohen: 0.92, 0.88, kanye no-0 . 65, ngokulandelana; n = 1339) umthetho olandelwayo.
Isikolo se-CAC sihlolwe kubantu abenze i-CT ukuze bahlole i-CAC phakathi neminyaka engu-5 ye-MRI yobuchopho ne-MRA39.Kubantu abayi-1,337, abangama-686 bahlolwa ubuchopho ngosuku olufanayo nabangu-651 ngolunye usuku phakathi neminyaka emi-5.
Izikhungo zase-Seoul ne-Suwon zisebenzisa i-mAc (310 mA × 0.4 s) ishubhu yamanje ekujikeni okungu-2.5 mm, isikhathi sokuzungezisa esingu-400 ms, i-voltage yeshubhu engu-120 kV, kanye nokushintshwa kwethamo okuncike ku-124 ECG.Ngokuka-Agatston et al.40, i-CAC ibalwa kusukela emithanjeni engu-4 emikhulu ye-epicardial coronary arteries (okuyinhloko kwesokunxele, ukwehla okungaphambili kwesobunxele, i-circumflex kwesokunxele, kanye nemithambo ye-coronary yesokudla).Uchwepheshe we-CT uphuphuthekiswe yinoma yiluphi ulwazi mayelana nesihloko futhi isikolo se-CAC sanqunywa ngokuzenzakalela kusetshenziswa isofthiwe ye-HEARTBEAT-CS (Philips, Cleveland, OH, USA).Izikolo ze-CAC zihlukaniswe ngamaqembu amathathu: 0, 1-100, kanye > ne-100.
Izici eziyisisekelo ziqhathaniswe phakathi kwezifundo ezine-WMH yobuchopho nezingenayo kusetshenziswa ukuhlolwa kwe-χ2 kokuguquguquka kwezigaba kanye nokuhlolwa kwe-t koMfundi noma ukuhlolwa kwe-Mann-Whitney kokuguquguquka okuqhubekayo, njengoba kufanele.Okuguquguqukayo okusatshalaliswa ngokuvamile kuvezwa njengokuchezuka okushiwo ± okujwayelekile, kuyilapho okuguquguqukayo okungasatshalaliswanga ngokuvamile kuvezwa njengobubanzi be-median ne-interquartile.Okuguquguqukayo kwe-Dummy kwethulwe ngamavelu angekho wokuguquguquka kwezigaba.
Ukuhlaziywa kokuhlehla kwezinto eziningi kwenziwa ukuze kubalwe izilinganiso ze-odds (ORs) kanye nezikhawu zokuzethemba ezingu-95% (CIs) ukuze kuhlolwe ubudlelwano phakathi kwezikolo ze-WMH zobuchopho kanye ne-CAC nezici zengozi ze-atherosclerosis.Njengoba ukusabalala kwe-HHH kukhula ngokuya ngeminyaka futhi kuhluka ngokobulili, konke ukuhlaziya okuhlukahlukene okwenziwa ukuze kuhlolwe ukuhlobana phakathi kokunye okuguquguqukayo kanye ne-HHH18 elungiselwe ubudala nobulili.Enye imodeli ye-multivariate ye-logistic regression yasetshenziselwa ukuhlola ukuthi ingabe isikolo se-CAC sinokuhlangana okuzimele ne-SHG yobuchopho, ngisho nangemva kokulungiswa kwezici zengozi ye-atherosclerosis kanye ne-ICAS njengezici ezididayo okuye kwabikwa ukuthi zihlotshaniswa ne-SHH emibikweni yangaphambilini10, 26, 27, 41 . Imodeli 1 yalungiselelwa ubudala nobulili, Imodeli 2 yalungiselelwa ubudala, ubulili, nezici eziyingozi ze-atherosclerosis (BMI, umfutho wegazi ophezulu, isifo sikashukela, i-dyslipidaemia, umuntu obhemayo okwamanje noma owayekade ebhema, ukuvivinya umzimba njalo, umlando wesifo senhliziyo wesifo senhliziyo namazinga e-cystine ).kulungisiwe;Imodeli 3 yalungiselelwa ubudala, ubulili, izici eziyingozi ze-atherosclerosis, kanye nokuba khona kwe-ICAS.Ukuba khona kobuchopho be-WMH kwahlolwa ngokwezigaba zamaphuzu e-CAC kusetshenziswa amaphuzu we-CAC 0 njengebhentshimakhi.
Ukuhlaziywa kwezibalo kwenziwe kusetshenziswa inguqulo ye-Stata 16.1 (StataCorp, College Station, Texas, USA) kanye nenguqulo ye-studio engu-R engu-3.6.3 (RStudio, Boston, Massachusetts, USA).Amanani we-p anemisila emibili <0.05 athathwe njengebalulekile ngokwezibalo.
Izici eziyisisekelo zabantu abangu-1337 ziboniswa kuThebula 1. Isilinganiso seminyaka yabahlanganyeli, esilinganiselwa kusukela ngesikhathi se-MRI yobuchopho, sasiyiminyaka engu-51.63 ± 9.20, kanti i-86.54% yabantu bocwaningo yayingamadoda.Izici eziyinhloko zengozi ye-atherosclerosis kuleli qembu kwakungukubhema kwamanje noma okwedlule (57.82%), kulandelwa i-dyslipidemia (51.76%) kanye nomfutho wegazi ophezulu (28.65%).Ngokuphathelene nokuguquguquka kwe-radiological, iziguli ezingu-158 (11.82%) zine-PVWMH, ezingu-148 (11.07%) zine-DMH, kanti ezingu-21 (1.57%) zine-ICAS.Ngokwamaphuzu e-CAC, izifundo ezingama-849 (63.5%) zibe namaphuzu e-CAC angu-0, 332 (24.83%) abe namaphuzu aphakathi kuka-0 no-100, kanti angu-156 (11.67%) abe namaphuzu angaphezu kuka-100.
Ekuhlaziyweni okungaguquki, ubudala, ubulili, kanye nezici eziyingozi kakhulu ze-atherosclerosis, ngaphandle kwe-BMI, i-dyslipidemia, nokubhema kwamanje noma okwedlule, kwakuhlotshaniswa kakhulu nokuba khona kobuchopho be-HHH (p <0.05) (Ithebula 2).Abantu abane-PVWMH ne-DMH babebadala futhi benomthwalo omkhulu we-hypertension, isifo sikashukela, umlando we-coronary artery disease, i-CAC, ne-ICAS kunabantu abangenayo i-PVWMH ne-DMH.Ekuhlaziyeni okungaguquki, ingxenye ephezulu yabesifazane nezihloko eqenjini le-WMH babike ukuthi bazivocavoca njalo.I-median (ububanzi be-interquartile; IQR) i-CAC yayingama-62 (IQR 0-269.5) eqenjini le-PVWMH kanye no-46.5 (IQR 0-192) eqenjini le-DMH.Ukusatshalaliswa kwezigaba ze-CAC ngokuba khona kwe-PVWMH ne-DWMH kuboniswa kufig.2. Ingxenye yezigaba ezinezikolo eziphezulu ze-CAC ikhuphuke ngezinga le-comorbid WMH.
Amaphesenti ezigaba zamaphuzu e-CAC asuselwe ekubeni ne-PVMWH (a), i-DWMH (b), ne-PVWMH noma i-DMH (c).Ukubalwa kwemithambo yenhliziyo ye-SAS, i-white matter hyperintensity SHG, i-periventricular white matter hyperintensity HVBV, i-deep white matter hyperintensity SHVH.
Ukuhlaziywa kokuhlehla kwe-multivariate okulungiselwe iminyaka yobudala (NOMA 1.13; 95% CI 1.10-1.16; NOMA 1.11; 95% CI 1.08-1.14) kanye nomfutho wegazi ophezulu (OR 2.29; 95% CI 1.50–3.50, NOMA 1.20–1.98% .ngokulandelana) i-PVWMH ngemuva kokulungiswa kweminyaka, ubulili, izici eziyingozi ze-atherosclerosis (BMI, umfutho wegazi ophakeme, isifo sikashukela, i-dyslipidemia, umuntu obhemayo wamanje noma wangaphambili, ukuzivocavoca, umlando we-coronary artery disease, kanye namazinga e-homocysteine ​​​​) kanye nezibikezelo ezizimele ezibalulekile zomtholampilo ze-DMH kanye I-ICAS (konke p <0.05) (Ithebula 3).Kwakungekho ukuhlangana okubalulekile phakathi kwe-WMH elungisiwe kanye nobulili, i-BMI, isifo sikashukela noma i-dyslipidemia, umlando wokubhema, noma ukuvivinya umzimba okuvamile.
Ngisho nangemva kokulungiswa kwezici ezididayo, izigaba ezinezikolo eziphakeme ze-CAC zibonise ukuhlobana okukhuphukile ne-GMI yobuchopho ngendlela encike kumthamo uma kuqhathaniswa nezigaba zereferensi ezinesikolo se-CAC esingu-0. Ku-PVWMH ne-DMH, izigaba ezinesikolo se-CAC esikhulu kune-100 ( NOMA 5.45; 95 % CI 3.11–9.54 noma 3.66; 95% CI 2.10–6.38) ibonise ukuhlangana okukhulu kunezigaba ezinezikolo ze-CAC ze-0 kuya ku-100 (NOMA 2.22; 95% CI).1.36–3.61, NOMA 1.59;95% CI 0.98–2.58).Lapho kuqhathaniswa ukuhlotshaniswa ne-CAC phakathi kwamaqembu e-PVWMH ne-DWMH, womathathu amamodeli okuhlaziya ama-multivariate abonise ukuhlobana okuphezulu ne-PVWMH kuzo zombili izigaba zamaphuzu ze-CAC.Ukuba khona kwe-ICAS kuphinde kwabonisa ukuhlobana okubalulekile ne-PVWMH (OR 3.97, 95% CI 1.31-12.06) kanye ne-DMH (OR 7.11, 95% CI 2.33-21.77).
Ukwehluka kwe-inflation coefficients abalwe kuwo wonke amamodeli wokuhlehla ukuze kuhlolwe i-multicollinearity engaba khona, futhi akukho multicollinearity eyinkinga etholakele (Ithebula Lokwengeza 1 ku-inthanethi).
Kulolu cwaningo, ubungozi be-SHH yobuchopho bukhuphuke ngokwanda kwamaphuzu e-CAC ngendlela encike kumthamo, futhi imiphumela yayibaluleke ngokwezibalo ngemva kokulungiswa kwezici zengcuphe ye-comorbid ye-atherosclerosis.Imiphumela yethu ihambisana nezifundo zangaphambilini ezibonisa ukuhlobana phakathi kwe-CAC kanye nokungajwayelekile kwe-MRI yobuchopho, ngokuqhubekayo nokusekela ukuhlotshaniswa kwe-CAC ne-cerebral isitsha esincane se-atherosclerosis kanye ne-atherosclerosis yomkhumbi omkhulu29,30,31,32.
Kuyathakazelisa ukuthi kuwo womathathu amamodeli wokuhlaziya ama-multivariate, ama-OR wezikolo ze-CAC abephezulu kancane eqenjini le-PVWMH kunaseqenjini le-DWM.Lo mehluko ungaba ngenxa yokuthi umehluko wezinqubo ze-pathophysiological kanye nezici zengozi zicatshangwa phakathi kwe-PVWMH ne-DMH11,42,43.Ama-PVWMH avame ukuba khona ngokulinganayo kuwo womabili ama-cerebral hemispheres, okuphakamisa ukuphazamiseka kwe-perfusion okusabalalisa, kuyilapho ama-DWMH evame ukuba nokusabalalisa okulinganayo, okuphakamisa ukuthi abangelwa ukuphazamiseka kwe-perfusion okugxile.Njengoba isifunda se-periventricular sinikezwa imithambo ye-terminal ye-medulla ende kanye namagatsha e-perforating [45], isengozini ikakhulukazi lapho izindlela zokulawula ukugcinwa kwe-cerebral perfusion ziphazanyiswa yi-arteriosclerosis noma i-lipoid hyalinosis [46, 47, 48, 49].I-Hypoperfusion kanye ne-ischemia iyakhula.Ikakhulukazi, ucwaningo oluningi luye lwabonisa ukuthi ukubonakaliswa kwe-systemic atherosclerosis, njenge-hypertension, isifo sikashukela, kanye nokuba khona kwe-aortic atherosclerosis, kuhlotshaniswa kakhulu ne-PVWMH50,51,52,53, esekela okutholakele kwethu ukuthi amaphuzu we-CAC, ubudala, kanye ne-arterial. umfutho wegazi ophezulu ube nama-OR aphezulu e-PVWMH kunawe-DMH kuwo wonke amamodeli.
Kulolu cwaningo, ukuba khona kwe-ICAS kwakuhlotshaniswa kakhulu nobuchopho be-HHH, umphumela ongachazwa ukuthi i-stenosis ebalulekile yemithambo emikhulu ye-intracranial inciphisa ukugcwala kobuchopho kwendawo noma yesifunda, futhi lokhu ku-hypoperfusion okungapheli kunomthelela ku-fatty hyalinosis, okuyi- izindlela eziyisisekelo.ukuthuthukiswa kwe-WMH 26.54.
Ngokuvumelana nezifundo eziningi zangaphambilini3, i-27, i-28, i-55 eyenziwa ngezizwe ezihlukahlukene, ucwaningo lwethu luphinde lwabonisa ukuthi ubudala nomfutho wegazi ophezulu wawuzimele futhi uhlotshaniswa kakhulu nobuchopho be-HBG ekuhlaziyweni okuhlukahlukene.Nokho, ukuhlobana phakathi kwe-HHH nezinye izici eziyingozi ze-atherosclerosis kubonise imiphumela exubile emibikweni yangaphambili27,28,37,56.Izizathu zale miphumela ehlukene zingase zibangelwe ukuhluka kwabantu bocwaningo, indlela yokunquma izici eziyingozi, noma izindlela ezisetshenziselwa ukuhlaziya i-WMH, ezidinga ukucwaninga okwengeziwe.
Kufanele kuqashelwe imikhawulo eminingana yalolu cwaningo.Okokuqala, lolu ucwaningo olwenziwayo lwenani labantu base-Asia esikhungweni sezokwelapha se-monobrand.Kungase kube nengozi yokukhetha ukukhetha njengoba inani elikhulu labahlanganyeli beminyaka yokusebenza, futhi abangaphezu kwesigamu kubo kwakungamadoda, ngenxa yezici eziyingqayizivele zaseNingizimu Korea, okudinga ukuthi izinkampani zihlole abasebenzi bazo njalo.Ukuze kuncishiswe ukuchema ezifundweni zeqoqo, izifundo zesikhathi eside, zobude, kanye nezizokwenzeka ezifana ne-Rotterdam Study57 noma i-Framingham Study58 kufanele zenziwe.Ngaphambilini, kube nemibiko eminingi esebenzisa Ucwaningo lwe-Rotterdam ukuze kugxilwe ebudlelwaneni phakathi kwe-SHG yobuchopho kanye nezici ezihlukahlukene zengozi ye-atherosclerosis Association phakathi kwamaqoqo kanye nezifundo ze-Framingham 4, 59, 60, 61, 62, 63. Nokho, njengoba kungekho izifundo zigxile ekuhlobaneni phakathi kwe-GIBD ne-CCA kubantu abavamile, imiphumela yethu ihlobene nomtholampilo.Okwesibili, njengoba ukuhlaziywa kwe-MRI kwenziwa ngokubonwa yizazi ze-radiologists, ukucabangela kungase kunganele.Kodwa-ke, sizame ukunqoba lo mkhawulo ngokufaka inani elikhulu labahlanganyeli nokuchaza izifundo okungenani ezine-WMH emaphakathi noma ephakeme njengeqembu elihle.Ukwengeza, senze ukuhlolwa kokuthembeka kwe-inter-observer kanye ne-intra-observer, futhi imiphumela yabonisa ukuvumelana okuhle.Kuphinde kwabikwa ngaphambilini ukuthi kunokuhlobana okuphezulu phakathi kwezindlela zokuhlola okubukwayo kusetshenziswa isikali se-Fazekas nokuhlaziywa kwevolumu esetshenziselwa ukuhlola izinga le-WMH64,65.Okwesithathu, abantu abanezilonda ebuchosheni bavalelwa ngaphandle kusetshenziswa uhlu lwemibuzo oluzilawulayo oluhlanganisa umlando wezokwelapha wangaphambilini nokuhlaziywa kwezithombe zabantu abanesifo esibi kakhulu futhi kungenzeka bangabahlungi abantu abanezifo ezingaphansi.Ngaphezu kwalokho, uhlelo lwe-MRI yobuchopho lokuhlolwa kwezempilo esibhedlela sethu alubandakanyi izithombe ezithuthukisiwe, ngakho-ke kukhona ithuba lokulahlekelwa ukuxilongwa kokuthuthukiswa kobuchopho be-pathological, okungabonakali ezithombeni ezinesisindo se-T1, i-T2-weighted kanye ne-FLAIR, kanye ukunemba akuphakeme.Uma kuqhathaniswa nokuthuthukiswa kwe-MRA, ukuba khona kwe-ICAS kukalwe njengokuphansi uma kuqhathaniswa.Okwesine, njengoba iningi labahlanganyeli kulolu cwaningo bebevela kubantu abanempilo futhi abaningi babengenaso isifo, ingxenye yezifundo ezihlushwa i-ICAS yayincane kakhulu.
Kodwa-ke, lolu cwaningo lwaluhlanganisa abantu abaningi abanempilo kunezifundo ezedlule ezibheka ukuhlobana phakathi kwe-SHG ne-SAS, futhi ngokwazi kwethu, lolu ucwaningo lokuqala olufaka abantu abadala abanempilo ngaphandle kokucacisa ubulili noma iminyaka.Imikhawulo yocwaningo 31,32.
Ukubaluleka kobuchopho be-WMH kanye nokuphazamiseka okuhlukahlukene kwemizwa okuhlobene okufana nokuwohloka komqondo nokushaywa unhlangothi kugqanyiswa ngenxa yokwanda okumangalisayo kokutholakala kwezithombe zobuchopho neminyaka yokuphila, kodwa lezi zifo zihlala zinganqotshwa.Ukuba khona kwezilonda ze-HHH ebuchosheni kuhlotshaniswa nokwehla okukhulu kwengqondo, ukuwohloka komqondo, ukucindezeleka, nokushaywa unhlangothi, futhi kunobufakazi obukhulayo bokuthi ukulawula izici ezithile eziyingozi ze-atherosclerosis kungavimbela i-HHH12, 13, 14, 15, 16, 17, 18 , 19, 20, 21, 22, 23, 66, 67, 68, 69. Ngakho, imiphumela yethu ingase inikeze ubufakazi bokuhlola abantu abasengozini yobuchopho be-HHH, isici esibalulekile esiyingozi kanye nesibikezelo sezifo ezihlukahlukene zezinzwa, ngokubhekisela amaphuzu e-CAC, ngaleyo ndlela kuhlonzwe iziguli ezingazuza ekungeneleleni kokuxilonga nokwelapha okunolaka.kungakhathaliseki ukuthi i-CAC idlala indima ebalulekile futhi ezimele ekuthuthukisweni kwe-WMH ezifundweni zesikhathi eside nezizayo ezivela ezifundeni ezahlukene, amaqembu eminyaka yobudala kanye namaqembu ezizwe, kanye nezinye izimpawu ze-MRI zesifo somkhumbi omncane we-cerebral kufanele futhi zifakwe ukuze kuqondwe kabanzi.
Sengiphetha, amaphuzu e-CAC kanye nobudala nomfutho wegazi ophakeme kwakuhlotshaniswa kakhulu nobuchopho be-WMH kubantu abaningi abanempilo.Isikolo se-CAC siyinkomba yomthwalo we-atherosclerotic futhi sinendima engaba khona ekubikezeleni ubungozi be-HHH yobuchopho emisebenzini yomtholampilo.
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