脑小血管病研究新理念
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摘要
脑小血管病的提出已经历了一个多世纪。近年随着人口老龄化日益突出,好发于老年人群的脑小血管病越来越受到关注,对其研究也成为当前之热点。在现代诊疗技术的推动下,脑小血管病研究中的许多概念被不断更新,为临床诊疗提供了有价值的启示。
Cerebral small vessel disease(cSVD)has been reported for more than a century.Owing to the aging of population becoming more and more prominent,cSVD,which tends to occur in the elderly,is becoming the focus of both basic and clinical research.With the development of modern technologies,many concepts of cSVD are renewed,which provides inspiration to the diagnosis and treatment of cSVD.
Cerebral small vessel disease(cSVD)has been reported for more than a century.Owing to the aging of population becoming more and more prominent,cSVD,which tends to occur in the elderly,is becoming the focus of both basic and clinical research.With the development of modern technologies,many concepts of cSVD are renewed,which provides inspiration to the diagnosis and treatment of cSVD.
引文
[1]Pantoni L.Cerebral small vessel disease:from pathogenesis and clinical charac.teristics to therapeutic challenges[J].Lancet Neurol,2010,9:689-701.
[2]Chinese Medical Association,Chinese Society of Neurology,Cerebrovascular Disease Study Group.Chinese consensus on diagnosis and treatment of c:erebral small vessel disease[J].Zhonghua Shen Jing Ke Za Zhi,2015,48:838-844.[中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑小血管病诊治共识[J].中华神经科杂志,2015,48:838-844.]
[3]S?ndergaard CB,Nielsen JE,Hansen CK,Christensen H.Hereditary cerebral small vessel disease and stroke[J].Clin Neurol Neurosurg,2017,155:45-57.
[4]Chinese Medical Association,Chinese Society of Geriatrics,Geriatric Neurology Study Group; Expert Writing Group of Chinese Guidelines for Diagnosis and Treatment of Cerebral Small Vessel Disease Related Cognitive Impairment.Chinese guidelines for diagnosis and treatment of cerebral small vessel disease related cognitive impairment(2019)[J].Zhonghua Lao Nian Yi Xue Za Zhi,2019,38:345-354.[中华医学会老年医学分会老年神经病学组,脑小血管病认知功能障碍诊疗指南中国撰写专家组.脑小血管病相关认知功能障碍中国诊疗指南(2019)[J].中华老年医学杂志,2019,38:345-354.]
[5]Wardlaw JM,Smith EE,Biessels GJ,Cordonnier C,Fazekas F,Frayne R,Lindley RI,O'Brien JT,Barkhof F,Benavente OR,Black SE,Brayne C,Breteler M,Chabriat H,Decarli C,de Leeuw FE,Doubal F,Duering M,Fox NC,Greenberg S,Hachinski V,Kilimann I,Mok V,Oostenbrugge R,Pantoni L,Speck O,Stephan BC,Teipel S,Viswanathan A,Werring D,Chen C,Smith C,van Buchem M,Norrving B,Gorelick PB,Dichgans M; STandards for Reporting Vascular changes on nEuroimaging(STRIVE v1).Neuroimaging standards for research into small vessel disease and its contribution to ageingand neurodegeneration[J].Lancet Neurol,2013,12:822-838.
[6]Moran C,Phan TG,Srikanth VK.Cerebral small vessel disease:a review of clinical,radiological,and histopathological phenotypes[J].Int J Stroke,2015,7:36-46.
[7]Poels MM,Ikram MA,van der Lugt A,Hofman A,Krestin GP,Breteler MM,Vernooij MW.Incidence of cerebral microbleeds in the general population:the Rotterdam Scan Study[J].Stroke,2011,42:656-661.
[8]Wu B, Lin S,Hao Z, Yang J, Xu Y,Wu L, Zhang S,Liu M.Proportion,risk factors and outcome of lacunar infarction:a hospital-based study in a Chinese population[J]. Cerebrovasc Dis,2010,29:181-187.
[9]Song MR,Wang QS.A development history of cerebral small vessel disease[J].Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2016,16:736-740.[宋明睿,王乔树.脑小血管病发展史[J].中国现代神经疾病杂志,2016,16:736-740.]
[10]Hachinski V.World Stroke Day 2008:"little strokes,big trouble"[J].Stroke,2008,39:2407-2420.
[11]Cummings JL.Frontal-subcortical circuits and human behavior[J].J Psychosom Res,1998,44:627-628.
[12]Vasquez BP,Zakzanis KK.The neuropsychological profile of vascular cognitive impairment not demented:a meta-analysis[J].J Neuropsychol,2015,9:1 09-136.
[13]Ter Telgte A, van Leijsen EM,Wiegertjes K,Klijn CJ.,Tuladhar AM,de Leeuw FE.Cerebral small vessel disease:from a focal to a global perspective[J].Nat Rev Neurol,2018,14:387-398.
[14]Maniega SM,Valdes Hernandez MC,Clayden JD,Royle NA,Murray C,Morris Z,Aribisala BS,Gow AJ,Starr JM,Bastin ME,Deary IJ,Wardlaw JM.White matter hyperintensities and normal-appearing white matter integrity in the aging brain[J].Neurobiol Aging,2015,36:909-918.
[15]Maillard P,Fletcher E,Harvey D,Carmichael 0,Reed B,Mungas D,DeCarli C.White malter hyperintensity penumbra[J].Stroke,2011,42:1917-1922.
[16]Tuladhar AM,Reid AT,Shumskaya E,de Laat KF,van Norden AG,van Dijk EJ,Norris DG,de Leeuw FE.Relationship between white matter hyperintensities,cortical thickness,and cognition[J].Stroke,2015,46:425-432.
[17]Tuladhar AM,van Dijk E,Zwiers MP,van Norden AG,de Laat KF,Shumskaya E,Norris DG,de Leeuw FE.Structural network connectivity and cognition in cerebral small vessel disease[J].Hum Brain Mapp,2016,37:300-310.
[18]Lawrence AJ,Chung AW,Morris RG,Markus HS,Barrick TR.Structural network efficiency is associated with cognitive impairment in small-vessel disease[J].Neurology,2014,83:304-311.
[19]Fornito A,Zalesky A,Breakspear M.The connectomics of brain disorders[J].Nat Rev Neurosci,2015,16:159-172.
[20]Nekovarova T,Fajnerova I,Horacek J,Spaniel F.Bridging disparate symptoms of schizophrenia:a triple network dysfunction theory[J].Front Behav Neurosci,2014,8:171.
[21]Dey AK,Stamenova V,Turner G,Black SE,Levine B.Pathoconnectomics of cognitive impairment in small vessel disease:a systematic review[J].Alzheimers Dement,2016, 12:831-845.
[22]Stern Y.Cognitive reserve[J].Neuropsychologia,2009,47:2015-2028.
[23]Gouw AA,van der Flier WM,Fazekas F,van Straaten EC,Pantoni L,Poggesi A,Inzitari D,Erkinjuntti T,Wahlund LO,Waldemar G,Schmidt R,Scheltens P,Barkhof F; LADIS Study Group.Progression of white matter hyperintensities and incidence of new lacunes over a 3-year period:the Leukoaraiosis and Disability study[J].Stroke,2008,39:1414-1420.
[24]Nitkunan A,Lanfranconi S,Charlton RA,Barrick TR,Markus HS.Brain atrophy and cerebral small vessel disease:a prospective follow-up study[J].Stroke,2011,42:133-138.
[25]van Leijsen EC,de Leeuw FE,Tuladhar AM.Disease progression and regression in sporadic small vessel disease:insights from neuroimaging[J].Clin Sci(Lond),2017,131:1191-1206.
[26]Schmidt R,Enzinger C,Ropele S,Schmidt H,Fazekas F;Austrian Stroke Prevention Study.Progression of cerebral white matter lesions:6-year results of the Austrian Stroke Prevention Study[J].Lancet,2003,361:2046-2048.
[27]Cho A,Kim HR,Kim W,Yang DW.White matter hyperintensity in ischemic stroke patients:it may regress over time[J].J Stroke,2015,17:60-66.
[28]Lee SH,Lee ST,Kim BJ, Park HK,Kim CK,Jung KH,Roh JK.Dynamic temporal change of cerebral microbleeds:longterm follow-up MRI study[J].PLoS One,201 1,6:E25930.
[29]van Leijsen EMC,van Uden IWM,Ghafoorian M,Lohner V,Kooijmans E,van der Holst HM,Arntz A,Tuladhar A,Norris D,van Dijk EJ,Klijn K,Platel B,de Leeuw FE.The rise and fall of cerebral small vessel disease:the RUN DMC study[J].Eur Stroke J,2016,1(Suppl):744-745.
[30]Charidimou A,Pantoni L,Love S.The concept of sporadic cerebral small vessel disease:a road map on key definitions and current concepts[J].Int J Stroke,201 6,11:6-18.
[31]?stergaard L,Engedal TS,Moreton F,Hansen MB,Wardlaw JM,Dalkara T,Markus HS,Muir KW.Cerebral small vessel disease:capillary pathways to stroke and cognitive decline[J].J Cereb Blood Flow Metab,2015,36:302-325.
[32]Zhu YC.Important problems in the clinical study of cerebral small vessel disease[J].Zhongguo Zu Zhong Za Zhi,2015,10:996-999.[朱以诚.脑小血管病临床研究中的重要问题[J].中国卒中杂志,2015,10:996-999.]
[33]Fazekas F,Kleinert R,Offenbacher H,Payer F,Schmidt R,Kleinert G,Radner H,Lechner H.The morphologic correlate of incidental punctate white matter hyperintensities on MR images[J].AJNR Am J Neuroradiol,1990,12:915-921.
[34]O'Rourke MF,Hashimoto J.Mechanical factors in arterial aging:a clinical perspective[J].J Am Coll Cardiol,2007,50:1-13.
[35]Zarrinkoob L,Ambarki K,Wahlin A,Birgander R,Carlberg B,Eklund A,Malm J.Aging alters the dampening of pulsatile blood flow in cerebral arteries[J].J Cereb Blood Flow Metab,2016,36:1519-1527.
[36]Moody DM,Brown WR,Challa VR,Anderson RL.Periventricular venous collagenosis:association with leukoaraiosis[J].Radiology,1995,194:469-476.
[37]Yan S,Wan J,Zhang X,Tong L,Zhao S,Sun J,Lin Y,Shen C,Lou M.Increased visibility of deep medullary veins in leukoaraiosis:a 3-T MRI study[J].Front Aging Neurosci,2014,6:144.
[38]Blanco PJ,Muller LO,Spence JD.Blood pressure gradients in cerebral arteries:a clue to pathogenesis of cerebral small vessel disease[J].Stroke Vase Neurol,2017,2:108-1 17.
[39]Spenc:e JD.Blood pressure gradients in the brain:their importance to understanding pathogenesis of cerebral small vessel disease[J].Brain Sci,2019,9:E21.
[2]Chinese Medical Association,Chinese Society of Neurology,Cerebrovascular Disease Study Group.Chinese consensus on diagnosis and treatment of c:erebral small vessel disease[J].Zhonghua Shen Jing Ke Za Zhi,2015,48:838-844.[中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑小血管病诊治共识[J].中华神经科杂志,2015,48:838-844.]
[3]S?ndergaard CB,Nielsen JE,Hansen CK,Christensen H.Hereditary cerebral small vessel disease and stroke[J].Clin Neurol Neurosurg,2017,155:45-57.
[4]Chinese Medical Association,Chinese Society of Geriatrics,Geriatric Neurology Study Group; Expert Writing Group of Chinese Guidelines for Diagnosis and Treatment of Cerebral Small Vessel Disease Related Cognitive Impairment.Chinese guidelines for diagnosis and treatment of cerebral small vessel disease related cognitive impairment(2019)[J].Zhonghua Lao Nian Yi Xue Za Zhi,2019,38:345-354.[中华医学会老年医学分会老年神经病学组,脑小血管病认知功能障碍诊疗指南中国撰写专家组.脑小血管病相关认知功能障碍中国诊疗指南(2019)[J].中华老年医学杂志,2019,38:345-354.]
[5]Wardlaw JM,Smith EE,Biessels GJ,Cordonnier C,Fazekas F,Frayne R,Lindley RI,O'Brien JT,Barkhof F,Benavente OR,Black SE,Brayne C,Breteler M,Chabriat H,Decarli C,de Leeuw FE,Doubal F,Duering M,Fox NC,Greenberg S,Hachinski V,Kilimann I,Mok V,Oostenbrugge R,Pantoni L,Speck O,Stephan BC,Teipel S,Viswanathan A,Werring D,Chen C,Smith C,van Buchem M,Norrving B,Gorelick PB,Dichgans M; STandards for Reporting Vascular changes on nEuroimaging(STRIVE v1).Neuroimaging standards for research into small vessel disease and its contribution to ageingand neurodegeneration[J].Lancet Neurol,2013,12:822-838.
[6]Moran C,Phan TG,Srikanth VK.Cerebral small vessel disease:a review of clinical,radiological,and histopathological phenotypes[J].Int J Stroke,2015,7:36-46.
[7]Poels MM,Ikram MA,van der Lugt A,Hofman A,Krestin GP,Breteler MM,Vernooij MW.Incidence of cerebral microbleeds in the general population:the Rotterdam Scan Study[J].Stroke,2011,42:656-661.
[8]Wu B, Lin S,Hao Z, Yang J, Xu Y,Wu L, Zhang S,Liu M.Proportion,risk factors and outcome of lacunar infarction:a hospital-based study in a Chinese population[J]. Cerebrovasc Dis,2010,29:181-187.
[9]Song MR,Wang QS.A development history of cerebral small vessel disease[J].Zhongguo Xian Dai Shen Jing Ji Bing Za Zhi,2016,16:736-740.[宋明睿,王乔树.脑小血管病发展史[J].中国现代神经疾病杂志,2016,16:736-740.]
[10]Hachinski V.World Stroke Day 2008:"little strokes,big trouble"[J].Stroke,2008,39:2407-2420.
[11]Cummings JL.Frontal-subcortical circuits and human behavior[J].J Psychosom Res,1998,44:627-628.
[12]Vasquez BP,Zakzanis KK.The neuropsychological profile of vascular cognitive impairment not demented:a meta-analysis[J].J Neuropsychol,2015,9:1 09-136.
[13]Ter Telgte A, van Leijsen EM,Wiegertjes K,Klijn CJ.,Tuladhar AM,de Leeuw FE.Cerebral small vessel disease:from a focal to a global perspective[J].Nat Rev Neurol,2018,14:387-398.
[14]Maniega SM,Valdes Hernandez MC,Clayden JD,Royle NA,Murray C,Morris Z,Aribisala BS,Gow AJ,Starr JM,Bastin ME,Deary IJ,Wardlaw JM.White matter hyperintensities and normal-appearing white matter integrity in the aging brain[J].Neurobiol Aging,2015,36:909-918.
[15]Maillard P,Fletcher E,Harvey D,Carmichael 0,Reed B,Mungas D,DeCarli C.White malter hyperintensity penumbra[J].Stroke,2011,42:1917-1922.
[16]Tuladhar AM,Reid AT,Shumskaya E,de Laat KF,van Norden AG,van Dijk EJ,Norris DG,de Leeuw FE.Relationship between white matter hyperintensities,cortical thickness,and cognition[J].Stroke,2015,46:425-432.
[17]Tuladhar AM,van Dijk E,Zwiers MP,van Norden AG,de Laat KF,Shumskaya E,Norris DG,de Leeuw FE.Structural network connectivity and cognition in cerebral small vessel disease[J].Hum Brain Mapp,2016,37:300-310.
[18]Lawrence AJ,Chung AW,Morris RG,Markus HS,Barrick TR.Structural network efficiency is associated with cognitive impairment in small-vessel disease[J].Neurology,2014,83:304-311.
[19]Fornito A,Zalesky A,Breakspear M.The connectomics of brain disorders[J].Nat Rev Neurosci,2015,16:159-172.
[20]Nekovarova T,Fajnerova I,Horacek J,Spaniel F.Bridging disparate symptoms of schizophrenia:a triple network dysfunction theory[J].Front Behav Neurosci,2014,8:171.
[21]Dey AK,Stamenova V,Turner G,Black SE,Levine B.Pathoconnectomics of cognitive impairment in small vessel disease:a systematic review[J].Alzheimers Dement,2016, 12:831-845.
[22]Stern Y.Cognitive reserve[J].Neuropsychologia,2009,47:2015-2028.
[23]Gouw AA,van der Flier WM,Fazekas F,van Straaten EC,Pantoni L,Poggesi A,Inzitari D,Erkinjuntti T,Wahlund LO,Waldemar G,Schmidt R,Scheltens P,Barkhof F; LADIS Study Group.Progression of white matter hyperintensities and incidence of new lacunes over a 3-year period:the Leukoaraiosis and Disability study[J].Stroke,2008,39:1414-1420.
[24]Nitkunan A,Lanfranconi S,Charlton RA,Barrick TR,Markus HS.Brain atrophy and cerebral small vessel disease:a prospective follow-up study[J].Stroke,2011,42:133-138.
[25]van Leijsen EC,de Leeuw FE,Tuladhar AM.Disease progression and regression in sporadic small vessel disease:insights from neuroimaging[J].Clin Sci(Lond),2017,131:1191-1206.
[26]Schmidt R,Enzinger C,Ropele S,Schmidt H,Fazekas F;Austrian Stroke Prevention Study.Progression of cerebral white matter lesions:6-year results of the Austrian Stroke Prevention Study[J].Lancet,2003,361:2046-2048.
[27]Cho A,Kim HR,Kim W,Yang DW.White matter hyperintensity in ischemic stroke patients:it may regress over time[J].J Stroke,2015,17:60-66.
[28]Lee SH,Lee ST,Kim BJ, Park HK,Kim CK,Jung KH,Roh JK.Dynamic temporal change of cerebral microbleeds:longterm follow-up MRI study[J].PLoS One,201 1,6:E25930.
[29]van Leijsen EMC,van Uden IWM,Ghafoorian M,Lohner V,Kooijmans E,van der Holst HM,Arntz A,Tuladhar A,Norris D,van Dijk EJ,Klijn K,Platel B,de Leeuw FE.The rise and fall of cerebral small vessel disease:the RUN DMC study[J].Eur Stroke J,2016,1(Suppl):744-745.
[30]Charidimou A,Pantoni L,Love S.The concept of sporadic cerebral small vessel disease:a road map on key definitions and current concepts[J].Int J Stroke,201 6,11:6-18.
[31]?stergaard L,Engedal TS,Moreton F,Hansen MB,Wardlaw JM,Dalkara T,Markus HS,Muir KW.Cerebral small vessel disease:capillary pathways to stroke and cognitive decline[J].J Cereb Blood Flow Metab,2015,36:302-325.
[32]Zhu YC.Important problems in the clinical study of cerebral small vessel disease[J].Zhongguo Zu Zhong Za Zhi,2015,10:996-999.[朱以诚.脑小血管病临床研究中的重要问题[J].中国卒中杂志,2015,10:996-999.]
[33]Fazekas F,Kleinert R,Offenbacher H,Payer F,Schmidt R,Kleinert G,Radner H,Lechner H.The morphologic correlate of incidental punctate white matter hyperintensities on MR images[J].AJNR Am J Neuroradiol,1990,12:915-921.
[34]O'Rourke MF,Hashimoto J.Mechanical factors in arterial aging:a clinical perspective[J].J Am Coll Cardiol,2007,50:1-13.
[35]Zarrinkoob L,Ambarki K,Wahlin A,Birgander R,Carlberg B,Eklund A,Malm J.Aging alters the dampening of pulsatile blood flow in cerebral arteries[J].J Cereb Blood Flow Metab,2016,36:1519-1527.
[36]Moody DM,Brown WR,Challa VR,Anderson RL.Periventricular venous collagenosis:association with leukoaraiosis[J].Radiology,1995,194:469-476.
[37]Yan S,Wan J,Zhang X,Tong L,Zhao S,Sun J,Lin Y,Shen C,Lou M.Increased visibility of deep medullary veins in leukoaraiosis:a 3-T MRI study[J].Front Aging Neurosci,2014,6:144.
[38]Blanco PJ,Muller LO,Spence JD.Blood pressure gradients in cerebral arteries:a clue to pathogenesis of cerebral small vessel disease[J].Stroke Vase Neurol,2017,2:108-1 17.
[39]Spenc:e JD.Blood pressure gradients in the brain:their importance to understanding pathogenesis of cerebral small vessel disease[J].Brain Sci,2019,9:E21.