Study On The Correlation Between White Matter Hyperintensity And Carotid Atherosclerosis

Objective: To study the relationship between the severity of white matter hyperintensity(WMH)and carotid atherosclerosis,and to seek the mechanism of WMH,and offer the evidence for the prevention about the occurrence and its progression of WMH.Methods: A total of 441 patients who had WMH in cranial magnetic resonance imaging(MRI),improved cervical vascular color Doppler ultrasound and complete clinical data were collected in the Second Hospital of Lanzhou University from December 2018 to January 2020.The patients fell into three groups: simple WMH group,lacunar infarction with WMH group and large atherosclerotic cerebral infarction with WMH group according to whether or not the patients were complicated with large atherosclerotic cerebral infarction or lacunar infarction.The severity of WMH was classified into grades 1,2 and 3 according to the Fazekas grading scale.On the basis of the above three groups,the study was seperated into three parts to research into the relationship between the severity of WMH and carotid atherosclerosis and other clinical risk factors respectively.SPSS22.0 software was used for statistical analysis,and Microsoft Word and SPSS22.0 software were for mapping.Results: Part I: 1.Contained 53 patients with simple WMH totally.Statistical differences were seen in age and hypertension among different WMH groups(P<0.05);2.The result of age and hypertension is different from CIMT(Carotid Intima Media Thickness),Carotid artery plaques and Carotid artery stenosis(P>0.05);3.Spearman correlation analysis revealed that the severity of WMH correlated positively with the right CIMT classification(P<0.05).Part II: 1.Included 137 patients who had lacunar infarction with WMH.There were statistical differences in age,hypertension,mean platelet volume,high density lipoprotein and homocysteine among the three WMH groups(P<0.05);2.The severity of WMH was statistically different in the total number of bilateral carotid mixed-echo plaques,the number and the degree of carotid artery stenosis(P<0.05);3.Ordinal process demonstrated that age,hypertension,mean platelet volume,high density lipoprotein,and homocysteine had statistically significant effects on the severity of WMH(OR=1.056,95%CI1.010-1.105,P<0.05;OR=2.700,95%CI 1.090-6.689,P<0.05;OR=1.479,95%CI1.086-2.014,P<0.05;OR=0.080,95%CI 0.025-0.257,P=0.000;OR=1.051,95%CI1.021-1.082,P=0.001),compared with no carotid artery stenosis,one carotid artery stenosis had a statistically significant effect on the severity of WMH(OR=3.701,95%CI 1.027-13.333,P<0.05);4.In Spearman correlation analysis,WMH severity was related positively of the total number of bilateral carotid mixed-echo plaques,the number and the degree of carotid artery stenosis(P=0.001,P=0.000,P=0.000).Part III: 1.Include 251 patients with large atherosclerotic cerebral infarction and WMH,and there were statistically significant differences in age,hypertension,history of stroke,mean platelet volume,high density lipoprotein,total cholesterol and triglyceride among the three WMH groups(P<0.05);2.WMH severity is statistically significant in terms of left CIMT classification,total number of bilateral carotid artery mixed-echo plaques,number and degree of carotid artery stenosis(P<0.05);3.Ordinal process displayed that age,hypertension,history of ischemic stroke,mean platelet volume,high density lipoprotein,total cholesterol and triglyceride had statistically significant effects on the severity of WMH(OR=1.057,95%CI 1.027-1.088,P=0.000;OR=2.020,95%CI 1.046-3.901,P<0.05;OR=2.259,95%CI 1.233-4.140,P<0.05;OR=1.448,95%CI 1.189-1.763,P=0.000;OR=0.025,95%CI 0.008-0.079,P=0.000;OR=1.425,95%CI 1.051-1.934,P<0.05;OR=0.627,95%CI 0.437-0.898,P<0.05),compared with non mixed-echo plaque in bilateral carotid arteries,one mixed-echo plaque in bilateral carotid arteries had a statistically significant effect on the severity of WMH(OR=3.709,95%CI 1.738-7.913,P=0.001);4.Spearman analysis displayed that the severity of WMH was positively correlated with left CIMT value,left CIMT classification,total number of mixed-echo plaques in bilateral carotid arteries,number and degree of carotid artery stenosis(P<0.05,P<0.05,P=0.000,P=0.000,P=0.000).Conclusion: Age and hypertension are significant contributing factors for WMH.The severity of WMH is positively related to some indicators of carotid atherosclerosis.In patients who have lacunar infarction with WMH and large atherosclerotic cerebral infarction with WMH,it could be found that the numbers of carotid artery stenosis and the total numbers of carotid mixed-echo plaques have an effect on the severity of WMH separately,but more studies are still necessary in the future.