321/321L bakin karfe capillary tube Ƙungiyar farin al'amari hyperintensity tare da jijiyoyin jini calcification a cikin lafiya mutane: wani giciye-section binciken

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Halin hawan jini (WWH) wani bincike ne na yau da kullun akan hoton maganadisu na maganadisu (MRI) na kwakwalwa kuma an san shi yana nuna ƙananan cututtukan jirgin ruwa a cikin kwakwalwa.Manufar bincikenmu shine don bincika haɗin haɗin calcium na jijiyoyin jini (CCA) tare da WMH kuma don bayyana dangantakar dake tsakanin WMH da abubuwan haɗari ga atherosclerosis a cikin yawan jama'a masu lafiya.Wannan binciken na baya-bayan nan ya haɗa da mutanen 1337 waɗanda suka yi amfani da MRI na kwakwalwa da kuma ƙididdige ƙididdiga tare da kima na CAC a cibiyar kiwon lafiya na asibiti.An bayyana GVM na kwakwalwa azaman Fazekas maki fiye da maki 2 akan MRI na kwakwalwa.Har ila yau, an yi nazari na intracranial arterial stenosis (ICAS) kuma an tabbatar da shi lokacin da angiography ya nuna fiye da 50% stenosis.Ƙungiyoyin abubuwan haɗari, ƙimar CAC da ICAS tare da HBG na kwakwalwa an ƙididdige su ta amfani da bincike mai yawa.A cikin ƙididdiga masu yawa, nau'ikan da ke da ƙimar CAC mafi girma sun nuna haɓakar haɗin gwiwa tare da hauhawar jini mai zurfi da zurfi ta hanyar dogaro da kashi.Kasancewar ICAS kuma yana da alaƙa da alaƙa da kwakwalwa HBH, kuma a tsakanin masu canji na asibiti, shekaru da hauhawar jini sune abubuwan haɗari masu zaman kansu.A ƙarshe, a cikin jama'a masu lafiya, CAC yana da alaƙa da mahimmanci da WMH na kwakwalwa, wanda zai iya ba da shaida don gano mutane da ke cikin haɗari ga kwakwalwar WMH tare da ma'aunin CAC.

Bakin Karfe 321 Coil Tube Chemical Composition

Abubuwan sinadaran na 321 bakin karfe nada tubing kamar haka:
Carbon: 0.08% max
Manganese: 2.00% max
- nickel: 9.00% min

321/321L bakin karfe 8 * 0.2 capillary tube

Bakin Karfe 321 Coil Tube Mechanical Properties

321/321L bakin karfe 8 * 0.2 capillary tube

Dangane da Bakin Karfe 321 Coil Tube Manufacturer, kayan aikin injiniya na bakin karfe 321 na bututun nada an tsara su a ƙasa: Ƙarfin Ƙarfin (psi) Ƙarfin Haɓaka (psi) Tsawaita (%)

321/321L bakin karfe 8 * 0.2 capillary tube

Halin hawan jini (WWH) wani bincike ne na kowa a cikin T2-nau'i da kuma ruwa-attenuated magnetic resonance imaging (MRI) inversion dawo da (FLAIR) jerin kwakwalwa1,2.Kodayake ba a san ainihin tsarin ilimin pathophysiological na HHH ba, an nuna cewa yana da alaƙa da abubuwan haɗari ga atherosclerosis kamar tsufa, hauhawar jini, ciwon sukari, shan taba, da kiba, yana ba da gudummawar hanyoyin hanyoyin jijiyoyin jini don haɓaka HHH3,4,5. ,6.,7,8,9,10.Har ila yau, nazarin ilimin cututtuka ya nuna cewa HHH yana haifar da rashin daidaituwa na jijiyoyi, don haka yana tabbatar da cewa HHH yana nuna alamun ƙananan cututtuka a cikin kwakwalwa11.Bugu da ƙari, SHG yana da mahimmancin asibiti kamar yadda aka nuna ya shafi abubuwan da suka faru da kuma tsinkaye na cututtuka daban-daban na jijiyoyi, ciki har da raguwar fahimi, lalata, damuwa, tashin hankali, da bugun jini12,13,14,15,16,17,18, 19, 20, 21, 22, 23.
Ana ɗaukar kimantawar calcium na coronary (CAC) a matsayin ma'auni mai dacewa kuma abin dogaro na tarawar mutum ga atherosclerosis kuma an nuna yana da alaƙa da bugun jini na ischemic da bugun jini na cranial artery stenosis, da cututtukan zuciya na zuciya24,25.Kananan cututtukan tasoshin kwakwalwa suna kasancewa tare da atherosclerosis na manyan arteries na intracranial saboda ƙananan tasoshin da ke ba da fararen kwayoyin halitta sun samo asali daga babban jijiyar basilar.Yawancin karatu sun gano wata ƙungiya tsakanin SHH da abubuwan haɗari don atherosclerosis ko carotid atherosclerosis, duk da haka, kawai 'yan binciken sun mayar da hankali kan dangantakar dake tsakanin nauyin SAS da SHH, kuma an gudanar da waɗannan binciken ne kawai a cikin tsofaffi ko maza 29, 30, 31 .32.
Tare da haɓakar haɓakar neuroimaging a cikin 'yan shekarun nan, haɓakar haɓakawa da mahimmancin asibiti na HHH yana ƙara fahimtar ƙimar fahimi da sakamakon bugun jini19,20,21,22,23.Dalilin wannan binciken shine cewa idan za'a iya amfani da ma'aunin CAC a cikin aikin asibiti don tsinkayar haɗarin SHH, mai hangen nesa na cututtuka daban-daban, zai iya zama kayan aiki mai dacewa da amfani don sanin yiwuwar amfanin sauran nazarin ɗan adam, irin wannan. kamar yadda MRI na kwakwalwa19,20,21,22,23.Mun yi tsammanin cewa HHH yana da alaƙa da alaƙa da nauyin CCA, mai nuna alamar atherosclerosis, a cikin adadi mai yawa na mutane masu lafiya a cikin yawan jama'a.Bugu da ƙari, mun nemi taimako don fahimtar hanyoyin da ke haifar da ci gaban HHH ta hanyar gano abubuwan haɗari na asibiti masu dacewa.Don haka, babban burin wannan binciken shine bincika haɗin CAC tare da WMH a cikin mutane masu lafiya.Abu na biyu, manufar wannan binciken shine don bayyana dangantakar dake tsakanin SHG da abubuwan haɗari ga atherosclerosis.
Wannan binciken bincike ne na baya-bayan nan bisa ga yawan jama'a.Mun bincika bayanan lantarki na mahalarta waɗanda suka yi gwajin likita, gami da MRI na kwakwalwa da Magnetic resonance angiography (MRA), a Gangbuk Babban Cibiyoyin Kiwon Lafiya na Asibitin Samsung da ke Seoul da Suwon tsakanin Janairu 2016 da Disamba 2019. Yawan jama'a sun haɗa da batutuwan da suka sami CAC da aka lissafta tomography ( CT) da kuma hoton kwakwalwa a matsayin wani ɓangare na ingantattun gwaje-gwajen jiki, waɗanda hanyoyin tantance lafiyar kowa ne a Koriya.Don tunani, dokar Koriya ta buƙaci duk ma'aikata su yi gwajin likita na yau da kullun na shekara-shekara ko na shekara-shekara, don haka yawancin mahalarta ma'aikata ne ko dangin ma'aikatan kamfanoni ko ƙungiyoyin ƙaramar hukuma.
Daga cikin mutane 3983, an cire 2646 saboda dalilai masu zuwa: a) rashin jituwa tare da yin amfani da bayanan likita don kowane dalilai na bincike a cikin tambayoyin da aka gudanar da kansu kafin jarrabawar (n = 376);idan an sake gwada gwaje-gwaje a lokacin (n = 43), an cire mutanen da ke da gwaje-gwajen maimaitawa, kuma CT da kuma kwakwalwar kwakwalwa tare da kima na CAC da aka yi a rana ɗaya ko kuma a kwanan nan kwanan nan an zaba don binciken;(c) Sanin ciwon hauka, cutar Parkinson.tarihi, hydrocephalus, tiyata na baya na kwakwalwa, ciwon kwakwalwa, cutar moyamoya, bugun jini ko zubar jini (n = 47);(d) mutanen da ke da manyan raunuka na kwakwalwa da aka gano ta hanyar nazarin hoto, alal misali, saboda kafin encephalomalacia saboda bugun jini (ma'aunin diamita mafi girma fiye da 15 mm) ko tsohuwar zubar da jini mai rauni, rashin lafiya na arteriovenous, ko ciwon neoplastic (n = 46);(e) mutanen da ke da MRI ko MRA na rashin isasshen inganci don nazarin hoto (n = 2);(f) mutanen da ba su sha CT akan sikelin CAC (n = 1796);(g) Mutanen da ba su da bayanan lambobi da ake buƙata don bincike, gami da ma'aunin jiki (BMI) da matakan homocysteine ​​​​(n = 336).An nuna tsarin tafiyar da aikin daukar mahalarta binciken a hoto na 1.
Haɗa jadawalin tafiyar mahalarta.MRI Magnetic resonance Hoto, MRA Magnetic resonance angiography, periventricular farin al'amarin hyperintensity PVWMH, zurfin farin abu hauhawar jini DWMH.
Don haka, batutuwa na 1337 (ma'anar shekaru 51.63 ± 9.20 shekaru, shekarun shekaru 20-89, 1157 [86.54%) maza marasa lafiya) an haɗa su a cikin wannan binciken.Dukkan mahalarta an sake tantance su don binciken asibiti da na rediyo.An gudanar da wannan binciken ne bisa ka'idodin Sanarwa na Helsinki kuma an amince da shi daga Hukumar Binciken Cibiyoyi (IRB) na Asibitin Gangbuk Samsung (IRB No. 2020-12-036-006).IRB a Asibitin Kangbuk Samsung ta yi watsi da bayanin yarda da ake bukata saboda amfani da bayanan da ba a tantance ba da kuma zanen nazari na baya.Dukkan hanyoyin bincike an yi su daidai da ƙa'idodi da ƙa'idodi masu dacewa.
Mun tattara bayanan asibiti na mutum wanda ya haɗa da jinsi, shekaru, BMI, systolic da hawan jini na diastolic, tarihin shan taba, aikin jiki, da ganewar asali da kuma kula da hauhawar jini, ciwon sukari, hyperlipidemia, da cututtukan zuciya.Daga daidaitattun tambayoyin tambayoyin da aka gudanar da kansu, mun tattara bayanai kan tarihin likitancin kowane mutum da tarihin shan taba, da kuma ko suna yin aikin motsa jiki akai-akai na fiye da mintuna 10 aƙalla sau 3 a mako.
Domin duk mahalarta an shirya za a duba su a asibitin Ganbuk Samsung General Medical Center, an gudanar da gwaje-gwajen dakin gwaje-gwaje a rana guda da MRI na kwakwalwa da MRA bayan azumi na sa'o'i 12, kuma bayanan sun hada da glucose, glycated haemoglobin (HbA1c), matakan. na jimlar cholesterol, LDL cholesterol, HDL cholesterol, triglycerides da homocysteine ​​​​.
An bayyana hauhawar hauhawar jini a matsayin shan magungunan antihypertensive na yanzu, hawan jini na systolic ≥ 140 mmHg.ko hawan jini na diastolic ≥ 90 mmHg33.An bayyana ciwon sukari azaman amfani da magungunan rigakafin ciwon sukari na yanzu, glucose na jini mai azumi ≥ 126 mg/dL, ko HbA1c ≥ 6.5%.Dyslipidemia an bayyana shi azaman amfani na yanzu na magunguna masu rage lipid, jimlar cholesterol ≥240 mg/dl, cholesterol low-density lipoprotein ≥160 mg/dl, high-density lipoprotein cholesterol <40 mg/dl, ko triglycerides ≥200 mg/dl35.
Duk mahalarta sunyi MRI na kwakwalwa da MRA tare da tashar tashar tashar tashar takwas ta amfani da na'urar daukar hoto na 1.5 T MRI (Optima MR360, GE Healthcare, Milwaukee, Wisconsin ko Signa HDxt, GE Healthcare, Milwaukee, Wisconsin).Ka'idar hoto ta ƙunshi hotuna masu nauyin axial T1 (lokacin maimaitawa [TR] / lokacin amsawa [TE] = 417-450 / 9 ms ko 400-450 / 10 ms), hotuna masu nauyi T2 (TR / TE = 4343-4694). ) ./ 100-110 ms ko 4084-4494/95-104 ms), Hotunan FLAIR (TR/TE = 11000/127-138 ms ko 8800/128-130 ms) da 3D lokacin jirgin sama (TOF) hotuna (TR /TE = 28/7 ms ko 27/3 ms, yanki kauri = 1.2 mm).Kaurin yanki ya kasance mm 5 don duk ka'idojin hoto ban da TOF MRA.
An tantance matakin WMH na gefe da zurfi daban-daban bisa ga ma'aunin Fazekas na kowane jigo, kamar yadda aka nuna a Ƙarin Hoto 1 akan layi.An saka PVWMH kamar haka: 0=babu, 1= hula ko siriri, 2=taushi mai laushi, 3=hawan hawan jini mara ka'ida ba bisa ka'ida ba wanda ya shimfida zuwa fararen fata mai zurfi.An rarraba DWMH kamar haka: 0 = babu, 1 = punctate, 2 = raunuka sun fara haɗuwa, 3 = manyan wuraren haɗuwa.Saboda an san matakin HBH na 2 ko sama da cewa yana da mahimmanci a asibiti saboda yana da saurin bayyanar cututtuka da ci gaba, mun raba marasa lafiya da Fazekas maki na 2 da 3 zuwa PVBVH da DGBV36,37.
Binciken TOF MRA, dangane da tsarin warfarin-aspirin alamar cututtuka na intracranial (WASID), ya bayyana intracranial artery stenosis (ICAS) a matsayin intracranial artery stenosis fiye da 50% 38.Tasoshin da aka haɗa a cikin bincike sune ƙwayar carotid na ciki daga ɓangaren cavernous zuwa sashin M2 na tsakiya na tsakiya na tsakiya, sashin A2 na kwakwalwar kwakwalwa na baya, sashin P2 na kwakwalwa na baya, da basilar artery, da intracranial. jijiya.sashi na vertebral artery.
An yi duk kimantawar rediyo ta hanyar likitan neuroradiologist (JYK), wanda bai san duk bayanan asibiti da na dakin gwaje-gwaje ba.An kimanta amincin ma'aunin gani tsakanin masu kallo ta hanyar mai horar da rediyo na biyu (JYC) akan batutuwa 700 da aka zaɓa ba da gangan ba kuma a cikin tazara na watanni 2 bayan karatun farko.Yi la'akari da amincin cikin mai kallo.Ƙimar gani na PVWMH, DWMH, da ICAS sun nuna ƙwararrun ƙwararru (Cohen-weighted kappa: 0.7, 0.81, da 0.67, bi da bi; n = 700) da kuma cikin gwani (Cohen-weighted kappa: 0.92, 0.88, da 0. 65, bi da bi; n = 1339) yarjejeniya.
An kiyasta maki CAC a cikin mutanen da suka yi CT don tantance CAC a cikin shekaru 5 na kwakwalwa MRI da MRA39.Daga cikin mutane 1,337, 686 sun yi gwajin kwakwalwa a rana guda kuma 651 a wata rana a cikin shekaru 5.
Cibiyoyin Seoul da Suwon sun yi amfani da mAc (310 mA × 0.4 s) bututu na yanzu a kauri 2.5 mm, lokacin juyi 400 ms, ƙarfin bututun kV 120, da 124-dogaran kashi na ECG.A cewar Agatston et al.40, an ƙididdige CAC daga manyan jijiya na 4 na epicardial (hagu na hagu, hagu na hagu na hagu, da'irar hagu, da jijiyoyin jini na dama).Duk wani bayani game da batun ya makantar da masanin fasahar CT kuma an ƙaddara makin CAC ta atomatik ta amfani da software na HEARTBEAT-CS (Philips, Cleveland, OH, Amurka).An raba maki CAC zuwa rukuni uku: 0, 1-100, da>100.
An kwatanta halaye na asali tsakanin batutuwa tare da kuma ba tare da WMH na kwakwalwa ta amfani da gwajin χ2 don nau'ikan mabambanta da gwajin t-test na Student ko Mann-Whitney don ci gaba da masu canji, kamar yadda ya dace.Ana gabatar da ma'auni na yau da kullum a matsayin ma'anar ± daidaitaccen ma'auni, yayin da ba a saba rarrabawa ba ana gabatar da su azaman tsaka-tsaki da tsaka-tsaki.An gabatar da masu canji na dummmy don rashin ƙima na ma'auni.
An gudanar da bincike na sake fasalin dabaru da yawa don ƙididdige ma'auni (ORs) da 95% tazarar amincewa (CIs) don tantance alakar da ke tsakanin kwakwalwar WMH da maki CAC da abubuwan haɗari ga atherosclerosis.Tun da yawancin HHH yana ƙaruwa tare da shekaru kuma ya bambanta ta hanyar jima'i, duk nazarin da yawa da aka yi don tantance ƙungiyoyi tsakanin wasu masu canji da HHH18 da aka daidaita don shekaru da jima'i.An yi amfani da wani nau'in nau'i na nau'i na nau'i mai yawa don tantance ko CAC ci yana da haɗin kai mai zaman kanta tare da kwakwalwa SHG, ko da bayan daidaitawa ga abubuwan haɗari na atherosclerosis da ICAS a matsayin abubuwan da ke da ban sha'awa waɗanda aka ruwaito suna da alaƙa da SHH a cikin rahotannin da suka gabata10, 26, 27, 41. An daidaita samfurin 1 don shekaru da jinsi, Model 2 an daidaita shi don shekaru, jinsi, da abubuwan haɗari ga atherosclerosis (BMI, hauhawar jini, ciwon sukari, dyslipidemia, na yanzu ko tsohon shan taba, motsa jiki na yau da kullum, tarihin cututtuka na cututtukan zuciya na cututtukan zuciya da matakan cystine). ).gyara;An daidaita samfurin 3 don shekaru, jinsi, abubuwan haɗari don atherosclerosis, da kasancewar ICAS.An tantance kasancewar kwakwalwar WMH bisa ga nau'ikan maki CAC ta amfani da maki CAC 0 a matsayin ma'auni.
An yi nazarin ƙididdiga ta amfani da sigar Stata 16.1 (StataCorp, Kwalejin Kwalejin, Texas, Amurka) da R studio version 3.6.3 (RStudio, Boston, Massachusetts, Amurka).p-darajar masu wutsiya biyu <0.05 an yi la'akari da mahimmancin ƙididdiga.
An nuna alamun asali na mutane 1337 a cikin Table 1. Matsakaicin shekarun mahalarta, wanda aka kiyasta daga lokacin MRI na kwakwalwa, shine 51.63 ± 9.20 shekaru, kuma 86.54% na yawan binciken maza ne.Babban abubuwan haɗari ga atherosclerosis a cikin wannan rukunin sune shan taba na yanzu ko baya (57.82%), sannan dyslipidemia (51.76%) da hauhawar jini (28.65%).Dangane da masu canjin rediyo, marasa lafiya 158 (11.82%) suna da PVWMH, 148 (11.07%) suna da DWMH, kuma 21 (1.57%) suna da ICAS.Dangane da maki CAC, batutuwa 849 (63.5%) suna da maki CAC na 0, 332 (24.83%) suna da maki tsakanin 0 da 100, kuma 156 (11.67%) suna da maki fiye da 100.
A cikin bincike na univariate, shekaru, jinsi, da kuma mafi yawan abubuwan haɗari ga atherosclerosis, sai dai BMI, dyslipidemia, da kuma na yanzu ko shan taba, sun kasance da alaka da kasancewar kwakwalwar HHH (p <0.05) (Table 2).Mutanen da ke da PVWMH da DWMH sun tsufa kuma suna da nauyi mai girma na hauhawar jini, ciwon sukari, tarihin cututtukan jijiyoyin jini, CAC, da ICAS fiye da daidaikun mutane ba tare da PVWMH da DWMH ba.A cikin bincike na bai-daya, yawancin mata da batutuwa a cikin ƙungiyar WMH sun ba da rahoton cewa suna motsa jiki akai-akai.Matsakaici (kewayon tsaka-tsaki; IQR) CAC ya kasance 62 (IQR 0-269.5) a cikin ƙungiyar PVWMH da 46.5 (IQR 0-192) a cikin ƙungiyar DWMH.Ana nuna rarraba nau'ikan CAC ta kasancewar PVWMH da DWMH a cikin fig.2. Matsakaicin nau'ikan da ke da makin CAC mafi girma ya ƙaru tare da ƙimar WMH mai cutarwa.
Kashi na nau'ikan maki CAC dangane da samun PVMWH (a), DWMH (b), da PVWMH ko DWMH (c).Calcification na arteries na jijiyoyin jini na SAS, farin al'amari hyperintensity SHG, periventricular farin kwayoyin halitta hyperintensity HVBV, zurfin farin al'amari hyperintensity SHVH.
Ƙididdigar ƙididdiga masu yawa da aka gyara don shekaru (OR 1.13; 95% CI 1.10-1.16; OR 1.11; 95% CI 1.08-1.14) da hauhawar jini (OR 2.29; 95% CI 1.50-3.50, OR 1.02-3, CI) .bi da bi) shine PVWMH bayan daidaitawa don shekaru, jima'i, abubuwan haɗari na atherosclerosis (BMI, hauhawar jini, ciwon sukari, dyslipidemia, na yanzu ko tsohon mai shan taba, motsa jiki, tarihin cututtukan jijiyoyin jini, da matakan homocysteine ​​​​) da kuma masu tsinkayar asibiti masu zaman kansu na DWMH da ICAS (duk p <0.05) (Table 3).Babu wata muhimmiyar ƙungiya tsakanin daidaitawar WMH da jima'i, BMI, ciwon sukari ko dyslipidemia, tarihin shan taba, ko motsa jiki na yau da kullum.
Ko da bayan daidaitawa don dalilai masu banƙyama, nau'o'in da ke da mafi girma CAC maki sun nuna karuwar haɗin gwiwa tare da GMI na kwakwalwa a cikin hanyar da aka dogara da kashi idan aka kwatanta da nau'o'in tunani tare da ƙimar CAC na 0. Don PVWMH da DWMH, nau'i tare da CAC mafi girma fiye da 100 ( OR 5.45; 95% CI 3.11-9.54 ko 3.66; 95% CI 2.10-6.38) ya nuna ƙungiya mafi girma fiye da nau'i tare da maki CAC na 0 zuwa 100 (OR 2.22; 95% CI).1.36–3.61, KO 1.59;95% CI 0.98-2.58).Lokacin kwatanta haɗin gwiwa tare da CAC tsakanin ƙungiyoyin PVWMH da DWMH, duk nau'ikan bincike iri-iri guda uku sun nuna ƙungiyoyi masu girma tare da PVWMH a duka nau'ikan maki CAC.Kasancewar ICAS kuma ya nuna muhimmiyar ƙungiya tare da PVWMH (OR 3.97, 95% CI 1.31-12.06) da DWMH (OR 7.11, 95% CI 2.33-21.77).
An ƙididdige ƙididdige ƙididdige ƙididdige ƙididdiga na ƙididdige ƙididdiga don duk samfuran koma baya don tantance yuwuwar multicollinearity, kuma ba a sami matsala ta multicollinearity (Ƙarin Teburin 1 akan layi).
A cikin wannan binciken, haɗarin SHH na cerebral ya karu tare da karuwar CAC a cikin nau'i-nau'i mai dogara, kuma sakamakon ya kasance mai mahimmanci bayan daidaitawa don abubuwan haɗari masu haɗari ga atherosclerosis.Sakamakonmu ya yi daidai da binciken da aka yi a baya yana nuna haɗin gwiwa tsakanin CAC da kwakwalwa na MRI marasa kyau, suna kara tallafawa ƙungiyar CAC tare da ƙananan ƙananan ƙwayar cuta da kuma babban jirgin ruwa atherosclerosis29,30,31,32.
Abin sha'awa, a cikin duka nau'ikan bincike iri-iri guda uku, ORs don maki CAC sun ɗan fi girma a cikin ƙungiyar PVWMH fiye da na ƙungiyar DWMH.Wannan bambance-bambance na iya zama saboda gaskiyar cewa bambance-bambance a cikin matakai na pathophysiological da abubuwan haɗari ana ɗauka tsakanin PVWMH da DWMH11,42,43.PVWMHs galibi suna kasancewa da daidaituwa a cikin sassan kwakwalwan kwakwalwa biyu, suna ba da shawarar cutarwar rikice-rikice, yayin da DWMHs galibi suna da rarrabawar asymmetric, suna nuna cewa cutarwar ɓarna ce ta haifar da su.Tunda ana ba da yanki na yanki ta tasoshin jijiyoyin jijiyoyi na dogon medulla da rassa masu raɗaɗi [45], yana da rauni musamman lokacin da hanyoyin sarrafa kai don ci gaba da ɓarna cerebral suna lalacewa ta hanyar arteriosclerosis ko lipoid hyalinosis [46, 47, 48, 49].Hypoperfusion da ischemia suna tasowa.Musamman, yawancin bincike sun nuna cewa bayyanar cututtuka na tsarin jijiyoyin jini, irin su hauhawar jini, ciwon sukari mellitus, da kasancewar atherosclerosis na aortic, galibi suna da alaƙa da PVWMH50,51,52,53, suna tallafawa bincikenmu cewa maki CAC, shekaru, da arterial. hauhawar jini yana da mafi girma ORs don PVWMH fiye da na DWMH a duk samfura.
A cikin wannan binciken, kasancewar ICAS yana da alaƙa da haɗin gwiwa tare da HHH na kwakwalwa, sakamakon da za'a iya bayyana shi ta hanyar gaskiyar cewa babban stenosis na manyan arteries na intracranial yana rage zubar da jini na gida ko na yanki, kuma wannan hypoperfusion na kullum yana ba da gudummawa ga m hyalinosis, wanda shine hanyoyin da ke ƙasa.Ci gaban WMH 26.54 .
Daidai da yawancin binciken da aka yi a baya3, 27, 28, 55 da aka gudanar a cikin kabilu daban-daban, bincikenmu kuma ya nuna cewa shekaru da hauhawar jini sun kasance masu zaman kansu kuma suna da alaƙa da kwakwalwa HBG a cikin bincike mai yawa.Duk da haka, haɗin kai tsakanin HHH da sauran abubuwan haɗari don atherosclerosis ya nuna sakamakon gauraye a cikin rahotannin da suka gabata27,28,37,56.Dalilan waɗannan sakamakon daban-daban na iya zama saboda bambance-bambance a cikin yawan binciken, ma'auni don ƙayyade abubuwan haɗari, ko hanyoyin da ake amfani da su don nazarin WMH, wanda ke buƙatar ƙarin bincike.
Ya kamata a lura da iyakoki da yawa na wannan binciken.Na farko, wannan nazari ne na baya-bayan nan na al'ummar Asiya a cikin cibiyar kiwon lafiya ta monobrand.Ana iya samun haɗari na zaɓin zaɓi kamar yadda yawancin mahalarta nazarin sun kasance shekarun aiki, kuma fiye da rabin su maza ne, saboda halaye na musamman na Koriya ta Kudu, wanda ke buƙatar kamfanoni su duba ma'aikatan su akai-akai.Don rage son zuciya a cikin karatun ƙungiyar, ya kamata a gudanar da dogon lokaci, na dogon lokaci, da kuma na gaba karatu kamar Nazarin Rotterdam57 ko Nazarin Framingham58.A baya can, an sami rahotanni da yawa ta yin amfani da Nazarin Rotterdam don mayar da hankali kan dangantakar dake tsakanin kwakwalwa SHG da kuma abubuwan haɗari daban-daban na atherosclerosis Association tsakanin ƙungiyoyi da nazarin Framingham 4, 59, 60, 61, 62, 63. Duk da haka, tun da babu wani daga cikin data kasance. Nazarin ya mayar da hankali kan haɗin gwiwa tsakanin GIBD da CCA a cikin al'umma na al'ada, sakamakonmu yana da mahimmanci na asibiti.Na biyu, tun da ana yin nazarin MRI ta gani ta hanyar masu aikin rediyo, ƙila ƙila ƙila isa.Duk da haka, mun yi ƙoƙarin shawo kan wannan iyakancewa ta haɗa da yawan mahalarta da ma'anar batutuwa tare da aƙalla matsakaici ko mafi girma WMH a matsayin ƙungiya mai kyau.Bugu da kari, mun yi gwaje-gwajen amincin masu lura da tsaka-tsaki da intra-observer, kuma sakamakon ya nuna kyakkyawar yarjejeniya.An kuma bayar da rahoton cewa akwai babban alaƙa tsakanin hanyoyin tantance gani ta hanyar amfani da ma'aunin Fazekas da ƙididdigar ƙima da aka yi amfani da shi don tantance darajar WMH64,65.Na uku, an cire mutanen da ke da raunin kwakwalwa ta hanyar amfani da takardar tambayoyin da aka gudanar da kansu wanda ya haɗa da tarihin likita na baya da kuma nazarin hoto na mutanen da ke fama da cutar da kuma mai yiwuwa ba za su iya tace mutanen da ke fama da cutar ba.Bugu da ƙari, shirin MRI na kwakwalwa don nazarin lafiyar lafiya a asibitinmu ba ya haɗa da ingantattun hotuna, don haka akwai yiwuwar rasa ganewar ganewar ƙwaƙwalwar ƙwayar cuta, wanda ba a bayyane ba a kan T1-weighted, T2-weighted da FLAIR hotuna, da kuma daidaito ba shi da yawa.Idan aka kwatanta da haɓakawa na MRA, kasancewar ICAS an ƙididdige shi a matsayin ɗan ƙaramin ƙarfi.Na hudu, tun da yawancin masu halartar wannan binciken sun fito ne daga mutane masu lafiya kuma mafi yawan basu da wata cuta, yawancin batutuwa da ke fama da ICAS sun kasance kadan.
Duk da haka, wannan binciken ya ƙunshi mutane masu lafiya fiye da binciken da suka gabata suna kallon haɗin gwiwa tsakanin SHG da SAS, kuma ga iliminmu, wannan shine binciken farko da ya haɗa da manya masu lafiya ba tare da ƙayyade jinsi ko shekaru ba.Iyakan binciken 31,32.
Muhimmancin WMH na kwakwalwa da cututtuka daban-daban da ke da alaƙa irin su ciwon hauka da bugun jini an bayyana shi ne saboda karuwa mai ban mamaki na samuwa na hoton kwakwalwa da kuma tsawon rayuwa, amma waɗannan cututtuka sun kasance marasa nasara.Kasancewar raunin HHH a cikin kwakwalwa yana da alaƙa da raguwar fahimi mai tsanani, rashin ƙarfi, damuwa, da bugun jini, kuma akwai alamun girma da ke nuna cewa sarrafa wasu abubuwan haɗari ga atherosclerosis na iya hana HHH12, 13, 14, 15, 16, 17, 18. , 19, 20, 21, 22, 23, 66, 67, 68, 69. Don haka, sakamakonmu na iya ba da shaida don tantance mutane da ke cikin haɗari ga kwakwalwa HHH, wani muhimmin mahimmancin haɗari da tsinkaya ga cututtuka daban-daban na neurological, tare da tunani game da maki CAC, ta haka ne ke gano marasa lafiya waɗanda za su iya amfana daga tsangwama mai tsauri da hanyoyin warkewa.ko CAC tana taka muhimmiyar rawa kuma mai zaman kanta a cikin ci gaban WMH a cikin dogon lokaci da bincike mai zuwa daga yankuna daban-daban, kungiyoyi masu shekaru da kabilanci, da sauran alamomin MRI na ƙananan ƙananan ƙwayar cuta ya kamata a haɗa su don cikakkiyar fahimta.
A ƙarshe, ƙimar CAC da shekaru da hauhawar jini suna da alaƙa da mahimmanci tare da WMH na kwakwalwa a cikin yawan jama'a masu lafiya.Makin CAC alama ce ta nauyin atherosclerotic kuma yana da yuwuwar rawa wajen tsinkayar haɗarin HHH na cerebral a cikin aikin asibiti.
Saitin bayanan da aka bincika a cikin wannan binciken ba ya samuwa ga jama'a saboda ya ƙunshi mahimman bayanan sirri na mutane.Ana samun waɗannan bayanan daga Jimlar Cibiyar Kiwon Lafiya ta Asibitin Kangbuk bisa buƙata ta dace daga ƙwararrun masu binciken ɗan adam.Kwamitin Binciken Cibiyoyin Asibitin Gangbuk Samsung zai duba kowace buƙata kuma masu bincike za su sami damar samun damar bayanan daidai da sharuɗɗan amincewa.
Fazekas, F. et al.Alamar fararen al'ada mara kyau a cikin mutane masu lafiya: daidaitawa tare da duban dan tayi na carotid, ma'aunin kwararar jini na cerebral, da abubuwan haɗari na cerebrovascular.Alkalami 19, 1285-1288.doi.org/10.1161/01.str.19.10.1285 (1988).
Wardlow, JM et al.Daidaitaccen neuroimaging don nazarin ƙananan cututtuka na jirgin ruwa da tasirin su akan tsufa da neurodegeneration.lanceolate jijiya.12, 822-838.doi.org/10.1016/s1474-4422(13)70124-8 (2013).
Liao, D. et al.Kasancewa da tsanani, magani da kula da cututtukan fararen fata da hauhawar jini.Haɗarin Atherosclerosis a cikin binciken al'umma na ARIC.Bugawa 27, 2262-2270.doi.org/10.1161/01.str.27.12.2262 (1996).
Jeracatil, T. et al.Bayanin haɗarin bugun jini yana tsinkayar ƙarar hauhawar hauhawar jini: Nazarin Framingham.Bugawa 35, 1857-1861 https://doi.org/10.1161/01.Str.0000135226.53499.85 (2004).
Murray, AD et al.Halin farin jini mai tsanani: mahimmancin mahimmancin abubuwan haɗari na jijiyoyin jini a cikin tsofaffi ba tare da lalata ba.Radiology 237, 251-257.doi.org/10.1148/radiol.2371041496 (2005).
Park, K. et al.Muhimmiyar alaƙa tsakanin leukoaraiosis da ciwo na rayuwa a cikin mutane masu lafiya.Kwayoyin cuta 69, 974-978.doi.org/10.1212/01.wnl.0000266562.54684.bf (2007).
DeCarly, K. et al.Namiji Tsarin Morphology na Namiji a cikin karatun NhLBI tagwaye.Bugawa 30, 529-536.doi.org/10.1161/01.str.30.3.529 (1999).
Longstreth, WT Jr. et al.Abubuwan da suka dace na asibiti na bayyanar fararen kwayoyin halitta na kwakwalwa akan hoton maganadisu a cikin 3301 tsofaffi.Bincike cikin cututtukan zuciya.Bugawa 27, 1274-1282 https://doi.org/10.1161/01.str.27.8.1274 (1996).
de Leeuw, FE et al.Binciken bin diddigin cutar hawan jini da raunukan fararen fata.shigar.Neurons.46, 827-833.https://doi.org/10.1002/1531-8249(199912)46:6%3c827::aid-ana4%3e3.3.co;2-8 (1999).
Lampe, L. et al.Kiba na visceral yana da alaƙa da kumburin ƙwayar cuta mai zurfi mai zurfi.shigar.Neurons.85, 194-203.doi.org/10.1002/ana.25396 (2019).
Matasa, WG, Holliday, GM da Creel, JJ Neuropathological yana daidaita yawan hauhawar jini.Neurology 71, 804-811.doi.org/10.1212/01.wnl.0000319691.50117.54 (2008).
Prins, ND & Scheltens, P. Farin al'amarin hawan jini, rashin hankali da rashin hankali: sabuntawa.National Neural Priest.11, 157-165.doi.org/10.1038/nrneurol.2015.10 (2015).
Garde E., Mortensen EL, Crabbe C., Rostrup E., da Larsson HB Association tsakanin shekarun da suka shafi tunanin tunani da hauhawar jini a cikin masu ilimin octogenar masu lafiya: nazari na dogon lokaci.Lancet 356, 628-634.doi.org/10.1016/s0140-6736(00)02604-0 (2000).
Bezner, H. et al.Ƙungiyar gait da rashin daidaituwa tare da canje-canje masu alaka da shekaru a cikin fararen fata: nazarin LADIS.Kwayoyin cuta 70, 935-942.doi.org/10.1212/01.wnl.0000305959.46197.e6 (2008).