Endothelial Function, Inflammation, Thrombosis, and Basal Ganglia Perivascular Spaces in Patients with Stroke

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• 作者：Xin Wang ; PhD^* ; Francesca M. Chappell ; PhD^* ; Maria Valdes Hernandez ; PhD^* ; Gordon Lowe ; MD^&dagger ; ; Ann Rumley ; PhD^&dagger ; ; Kirsten Shuler ; BSc^* ; Fergus Doubal ; MBChB ; PhD^* ; ^&Dagger ; ; Joanna M. Wardlaw ; FRCR ; FRCP ; MD ; FMedSci^* ; ^{joanna.wardlaw@ed.ac.uk}
• 关键词：Endothelial function ; stroke ; small vessel disease ; perivascular spaces
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：25
• 期：12
• 页码：2925-2931
• 全文大小：124 K
• 卷排序：25

文摘

Recent studies suggest perivascular spaces are a marker of small vessel disease, blood–brain barrier permeability, and inflammation, but little is known about their risk factors and associations with peripheral blood markers.Materials and MethodsIn prospectively recruited patients with recent minor ischemic stroke, we investigated the influence of age, sex, hypertension, diabetes, and smoking on the severity of perivascular spaces in the basal ganglia seen on T2-weighted magnetic resonance imaging. We assessed plasma markers of endothelial function (von Willebrand factor, intracellular adhesion molecule-1), inflammation (interleukin-6, tumor necrosis factor-alpha, C-reactive protein), and thrombosis (fibrinogen, prothrombin fragments 1 + 2, thrombin–antithrombin complex, tissue plasminogen activator, D-dimer). We used a validated semi-automated method to measure basal ganglia perivascular spaces count and volume. We tested uni- and multivariable associations between blood markers and basal ganglia perivascular spaces count and volume.FindingsIn 100 patients (median age: 67 years, range: 37-92), on adjusted analysis, basal ganglia perivascular spaces count was associated with age (r = .117, P = .003) and hypertension (r = 2.225, P = .013). On multivariable linear regression, adjusted for age, sex, hypertension, smoking and diabetes, reduced von Willebrand factor was associated with increased basal ganglia perivascular spaces count (r = −.025, P = .032).ConclusionThe association of increased basal ganglia perivascular spaces count with reduced von Willebrand factor is novel. As von Willebrand factor may promote cerebral endothelial integrity, insufficient von Willebrand factor is consistent with dysfunctional cerebral endothelium and increased basal ganglia perivascular spaces in cerebral small vessel disease. Quantitative perivascular spaces measurement may increase sensitivity to detect cerebral endothelial dysfunction.