脑小血管病相关轻度认知功能障碍患者海马代谢水平及相关因素研究

目的 探讨脑小血管病(Cerebral small vessel disease,CSVD)相关认知功能障碍碍(Mild cognitive impairment,MCI)患者的海马代谢水平与临床危险因素。方法 连续入组的CSVD患者按照蒙特利尔认知评估表(Montreal cognitive assessment,MoCA)评分分为CSVD-MCI组和CSVD组,对所有患者海马进行氢质子磁共振波谱成像(Hydrogen proton Magnetic resonance spectroscopy,¹H-MRS)扫描,收集相关临床资料和生化指标水平,采用Logistic回归分析CSVD-MCI的危险因素。结果 共入组97例患者,CSVD-MCI组42例,CSVD组55例; 2组患者在命名、语言、抽象思维、延迟记忆等方面有显著性差异(P<0.01),CSVD-MCI组两侧海马的代谢产物[肌醇(Myo-Inositol,MI)/肌酸(Creatine,Cr)、MI/N-乙酰天门冬氨酸(N-acetyl aspartate acid,NAA)]高于CSVD组(P<0.01),右侧海马NAA/Cr较CSVD组偏低(P<0.01)。Logistic回归分析显示年龄≥65岁、合并冠心病史、高血压病史、左侧大脑半球病变和超敏C反应蛋白(Hypersensitive-c-reactive-protein,hs-CRP)水平是脑小血管病相关认知功能障碍的危险因素(P<0.01)。结论 脑小血管相关认知功能障碍在命名、语言、抽象思维和延迟记忆方面均受到影响,可能与海马的代谢产物分泌不均相关; 其高龄、冠心病史、高血压病史、左侧大脑病变是其危险因素,超敏C反应蛋白的水平升高也是导致脑小血管相关认知功能障碍的一项危险因素。     

血清肾脏功能指标、炎症指标及凝血-纤溶指标与脑小血管病的关系

目的探讨血清肾脏功能指标、炎症指标及凝血-纤溶指标与脑小血管病(CSVD)的关系。方法收集68例CSVD患者及30例头颅MRI和神经系统查体均正常者的临床资料,并检测相关血液指标。入院后行头颅MRI检查,根据MRI结果将CSVD患者分为急性亚组和慢性亚组。结果对照组与CSVD组年龄、高血压病比率、胱抑素C、尿酸、肾小球滤过率、纤维蛋白原、D-二聚体、超敏C反应蛋白(hs-CRP)水平差异有统计学意义(均P<0.05)。CSVD组急性亚组及慢性亚组血肌酐水平、白细胞计数差异有统计学意义(均P<0.05)。调整混杂因素后,年龄、高血压病、胱抑素C、尿酸、hs-CRP及D-二聚体为CSVD的独立危险因素(均P<0.05);慢性CSVD的独立危险因素与CSVD相同(均P<0.05),而急性CSVD的独立危险因素为年龄、高血压病、胱抑素C、尿酸和D-二聚体(均P<0.05)。结论年龄、高血压病、胱抑素C、尿酸、CRP及D-二聚体是CSVD及慢性CSVD的独立危险因素,年龄、高血压病、胱抑素C、尿酸和D-二聚体是急性CSVD的独立危险因素。     

脑小血管病患者血清Klotho,FGF23表达水平变化与疾病进展及认知功能障碍的相关性分析

目的 探讨脑小血管病(Cerebral small vascular disease,CSVD)患者血清Klotho蛋白、成纤维细胞生长因子23(Fibroblast growth factor 23,FGF23)表达水平变化与疾病进展及认知功能障碍的相关性。方法 选取2017年2月-2020年2月本院收治的CSVD患者80例为研究对象,同期选取40例体检健康人群为对照组,根据CSVD患者脑动脉搏动指数(Pulsatility index,PI)将其分为轻度组23例(PI<1.0)、中度组36例(1.0≤PI<1.5)和重度组21例(PI≥1.5); 根据蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)评分将其分为伴认知功能障碍组32例(MoCA评分<26分)和无认知功能障碍组48例(MoCA评分≥26分); 采用酶联免疫吸附法(Enzyme-linked immunosorbent assay,ELISA)检测血清Klotho,FGF23蛋白水平; 利用Pearson法分析CSVD患者血清Klotho,FGF23水平与MoCA评分的相关性; 利用多因素Logistic分析影响CSVD患者发生认知功能障碍的危险因素。结果 研究组患者MoCA评分、Klotho水平明显低于对照组(P=0.000),FGF23水平明显高于对照组(P=0.000)。随CSVD患者病情严重程度加重,轻度组、中度组、重度组血清Klotho[(491.23±116.34)、(417.51±107.57)、(332.87±92.36)pg/mL]水平逐渐降低(P均<0.05),FGF23[(447.83±97.42)、(512.74±119.67)、(627.32±127.43)pg/mL]水平逐渐升高(P均<0.05)。与无认知功能障碍组患者比较,伴认知功能障碍组CSVD患者血清Klotho水平[(347.62±95.24)比(462.50±107.06)pg/mL]明显降低,FGF23水平[(580.29±120.54)比(492.68±107.34)pg/mL]明显升高(P<0.05)。Pearson法分析显示,CSVD患者血清Klotho水平与MoCA评分呈正相关(r=0.611,P=0.000),FGF23水平与MoCA评分呈负相关(r=-0.607,P=0.000)。多因素Logistic回归分析显示,Klotho水平、FGF23水平是CSVD患者发生认知功能障碍的独立影响因素(P均<0.01)。结论 随CSVD患者病情加重,血清Klotho水平逐渐降低,FGF23水平逐渐升高,且与患者认知功能障碍密切相关。     

血清胱抑素C与脑小血管病认知功能相关性研究

目的 探讨血清胱抑素C与隐袭起病的脑小血管病(CSVD)患者认知功能之间的相互作用.方法 首先选取了符合CSVD诊断标准的病例64例,并依据患者MoCA评分的分析结果,将同期CSVD的病例分别归类为认知功能障碍组(39例)及认知功能正常组(25例),与此同时选取了同期32例具有脑血管危险因素及卒中样症状(如头晕、头痛、...     

脑小血管病患者血液氨基酸谱和脂肪酸谱变化

目的 探讨脑小血管病(CSVD)患者血液氨基酸谱和脂肪酸谱的变化。方法 采用病例对照设计方法,选择2017年1月-2019年3月本院神经内科住院的165例CSVD患者为观察组,同期住院的66例非脑血管病患者作为对照组,采用串联质谱法(MS)测定入组患者血液氨基酸谱和脂肪酸谱。结果(1)2组Ala,Cys,Gly,C12,C16:1-OH,Gly/Ala,C2/C0,C3/C0,C3/C16,C6DC水平有显著性差异(P<0.05);(2)对上述代谢物进行Logistic回归分析显示Ala,Gly,Gly/Ala是CSVD发病的相关危险因素(P<0.05),C3/C0是CSVD的独立危险因素。结论 Ala,Cys,Gly,C12,C16:1-OH,Gly/Ala,C2/C0,C3/C0,C3/C16,C6DC是CSVD的潜在代谢物; Ala,Gly,Gly/Ala,C3/C0对CSVD可能具有辅助诊断价值。     

ERP联合DTI对脑小血管病相关认知功能障碍的初步研究

目的 探讨事件相关诱发电位(Event-related potential,ERP)联合弥散张量成像(Diffusion tensor imaging,DTI)在脑小血管病(Cerebral small vessel disease,CSVD)相关认知功能障碍评估中的应用价值。方法 选取2020年1月-2021年1月本院收治的CSVD患者100例,采用蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)对患者的认知功能进行评估,根据MoCA评分将患者分为认知功能障碍组(MoCA<26分,n=50)和对照组(MoCA≥26分,n=50); 所有患者均接受ERP和DTI检查,比较2组患者的一般资料、实验室指标水平、ERP和DTI相关参数水平的差异,评估ERP,DTI及其联合检测对CSVD相关认知功能障碍的诊断价值。结果 认知功能障碍组的高血压病的发生率明显高于对照组,MoCA、简易精神状态量表(Mini-mental state examination,MMSE)评分明显低于对照组,血清碱性磷酸酶(Alkaline phosphatase,ALP)、同型半胱氨酸水平明显高于对照组(P<0.05)。认知功能障碍组患者的P300潜伏期明显长于对照组,P300波幅明显小于对照组(P<0.05); 认知功能障碍组双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的各向异性分数(Fractional anisotropy,FA)值均明显小于对照组(P<0.05),双侧半卵圆中心、双侧额叶的平均弥散率(Mean diffusivity,MD)值明显大于对照组(P<0.05); 患者P300潜伏期、双侧半卵圆中心、双侧额叶、胼胝体膝部和胼胝体压部的FA值与MoCA,MMSE评分呈正相关(r≥0.203,P<0.05); P300波幅、双侧半卵圆中心、双侧额叶的MD值与MoCA,MMSE评分呈负相关(r≤-0.038,P<0.05); 患者双侧额叶FA值与P300潜伏期呈负相关(r=-0.274、-0.318,P<0.05),与P300波幅呈正相关(r=0.248、0.256,P<0.05); 双侧额叶MD值与P300潜伏期呈正相关(r=0.213、0.207,P<0.05),与P300波幅呈负相关(r=-0.327、-0.318,P<0.05)。结论 CSVD患者认知功能障碍的发生与脑微结构病变及电生理改变有关,ERP联合DTI检查或可作为CSVD相关认知功能障碍早期诊断的定量评估指标。     

胱抑素C与脑小血管病患者24h动态血压的相关性研究

目的探讨胱抑素C(Cystatin C,CysC)与脑小血管病(cerebral small vessel disease,CSVD)患者24 h动态血压之间的相关性。方法选取经3.0T MRI确诊的CSVD患者40例作为CSVD组,同期选取头部MRI未见异常的轻度头痛、头晕患者40例作为对照组。测定所有受试者血清CysC水平,并对CSVD组受试者行24 h动态血压监测。结果 (1)CSVD组年龄、高血压比例、同型半胱氨酸(Hcy)水平、CysC水平均高于对照组(P0.05)。Logistic回归分析显示年龄、高血压、Hcy和CysC均是CSVD的独立危险因素(P0.05)。(2)血清CysC水平与24 h收缩压(24 h SBP)、24 h舒张压(24 h DBP);日间收缩压(d SBP)、夜间收缩压(nSBP)、夜间舒张压(nDBP);24 h收缩压标准差(24 h SSD)、24 h舒张压标准差(24 h DSD);日间收缩压标准差(dSSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)呈正相关(P0.05)。结论 (1)CysC是CSVD的独立危险因素;(2)血清CysC水平与24 h动态血压之间具有相关性,CysC可望成为血压变异性的间接监测指标,为CSVD的二级预防提供新的理论依据。     

脑小血管病认知障碍与影像特征分析

目的观察分析脑小血管病(CSVD)认知障碍与磁共振影像特征,为早期发现及治疗依据。方法选取脑小血管病患者86例,另选取80例健康志愿者为对照组。应用MMSE、临床记忆量表、WAIS-RC对86例脑小血管病患者进行认知评估,并分析其磁共振影像特征。结果脑小血管病患者MMSE评分、记忆商数MQ、语言智商VIQ、作业智商PIQ、总智商FIQ与对照组比较下降明显(P0.05);LI组无意义图形再认、人像特点回忆、算术、数字广度、木块图、数字符号的等值量表分下降更显著(P0.01);WML组数字广度、算术、图画填充、木块图、数字符号、图形拼凑、图片排列测试的等值量表分下降更显著(P0.01);CMB组在图像自由回忆、无意义图形再认、数字广度、图画填充、木块图、图片排列测试的等值量表分下降更显著(P0.01);LI、CMB、WML共存组各项测试分值均显著下降(P0.01)。结论脑小血管病存在认知障碍,且磁共振特征可以提示其认知障碍特点,早期发现其磁共振异常表现可以早期进行CSVD防治,延缓及改善CSVD认知障碍。     

血清胱抑素C与缺血性卒中患者脑血管造影下脑动脉狭窄的关系

目的探讨缺血性卒中患者胱抑素C(cystatin C,Cys C)与脑动脉粥样硬化性狭窄的关系。方法应用荷兰Philips公司生产的FD-20 C型臂血管造影系统,对299例缺血性卒中患者进行全脑血管造影及血浆Cys C检测,根据Cys C检测水平,分为对照组(Cys C正常)139例患者与异常组(Cys C异常)160例患者,比较其全脑血管造影。结果正常组(对照组)与异常组(病例组)脑动脉狭窄程度差异有统计学意义(χ2=16.94,P0.05);异常组中颅内外动脉中重度狭窄和闭塞的比率显著升高,且以无侧支循环代偿(73.13%)及弥漫性病变(65.63%)为主;随着Cys C的升高,脑动脉狭窄程度逐渐加重。结论 Cys C是缺血性脑卒中患者脑动脉粥样硬化性狭窄的一种危险因素,脑血管狭窄与Cys C升高有关,Cys C在一定程度上反映脑血管狭窄程度。     

急性脑梗死患者脑微出血与胱抑素C的相关性研究

目的探讨急性期脑梗死患者脑微出血与胱抑素C(cystatin C,Cys C)的关系。方法收集于我院2018年～2019年住院的75例急性期脑梗死患者的资料。通过核磁SWI序列检测到32例脑微出血,43例无脑微出血。所有均测定血清Cys C的水平。结果与无脑微出血组对比,脑微出血组血清Cys C水平显着升高,高于无脑微出血组,且差异具有统计学意义(P <0. 05)。结论急性脑梗死患者中年龄、高血压、Cys C水平是脑微出血的危险因素,且Cys C是急性脑梗死患者脑微出血的独立危险因素。     

尿液神经丝蛋白水平与脑小血管病的关系

目的 探讨尿液神经丝蛋白轻链(Neurofilament light chain,NFL)水平与脑小血管病(Small cerebral vessel disease,SVD)的关系。方法 本研究共纳入了122例SVD患者和62例健康对照者,检测尿液NFL水平并进行磁共振(MRI)检查,记录白质高信号(WMH)相对体积、大脑相对容积、微出血灶计数和平均弥散率,同时进行NIHSS量表的测定,验证NFL水平与各指标之间的相关性。结果 SVD组患者的尿液NFL水平要显著高于健康对照组(P<0.001),健康对照组人群的NFL水平集中在20 pg/mL左右,而SVD组患者集中在40～70 pg/mL左右,NFL对于区分SVD患者和健康对照者的ROC曲线下面积为0.779; 多因素线性回归分析显示平均弥散率(P=0.019)和WMH(P=0.033)与NFL水平显著相关; 多因素有序Logistics回归分析显示平均弥散率(OR=3.27,P=0.018)和尿液NFL水平(OR=1.51,P=0.024)与NIHSS显著相关。结论 尿液NFL水平在排除其他病变后可以作为核磁共振检查的替代来判定脑小血管病的发生。     

同型半胱氨酸与脑小血管病的相关性研究

目的探讨血浆同型半胱氨酸(Hcy)水平与脑小血管病(SVD)的相关性。方法回顾性分析218例脑SVD患者的临床资料,并根据诊断将其分为无症状脑梗死组(SBI,56例),脑白质疏松组(LA,143例),颅外段动脉硬化组(EC,28例),颅内段动脉硬化组(IC,31例)。测定所有患者的血浆Hcy水平,分析其对脑SVD发病的影响。结果脑SVD患者以老年女性居多,高血压、糖尿病比例高,且尿酸、Hcy、CRP水平也普遍升高。单因素logistic分析显示,血浆Hcy均是SBI、LA、EC、IC发生的危险因素,而多因素logistic回归分析显示,血浆Hcy是SBI(OR:3.47,95%CI:1.76⁴.65)、LA(OR:2.98,95%CI:1.484.65)、LA(OR:2.98,95%CI:1.48⁵.64)的独立危险因素(P<0.05),而血浆Hcy与EC、IC无明显相关性(P>0.05)。LA患者中随着Fazekas分级的增加,血浆Hcy水平依次升高(P<0.05)。结论血浆Hcy与脑SVD,尤其是SBI、LA具有相关性,是脑SVD发病的独立危险因素,但与脑大血管病变(EC、IC)之间的关系不明显。     

Lipids in ischemic stroke subtypes

In secondary prevention, reduction of the risk of recurrent ischemic stroke might be expected with statins if a correlation can be established between hyperlipidemia and ischemic stroke or some specific ischemic stroke/TIA subtypes. However, such correlation remains controversial, and more particularly with the etiologic stroke/TIA subtypes. Few studies have evaluated the plasma lipid profile in different ischemic stroke subtypes, and notably in lacunar infarctions and cardioembolic strokes. The objectives of this case-control study was to determine (1) which cholesterol fractions is associated with large vessel disease (LVD), small vessel disease (SVD), and cardioembolic disease (CED); (2) whether hypertriglyceridemia is related more to any particular stroke subtype; and (3) whether the lipid profile is different between LVD and SVD which are both responsible for atherothrombotic cerebral ischemia. From a cohort of 485 patients, were selected 240 consecutive cases with ischemic stroke (n = 182) or transient ischemic attack (n = 58) due to a single etiology. The levels of total cholesterol (total-C), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), and triglycerides (TG) were measured in 61 patients with LVD, in 65 with SVD, and in 114 with CED, and compared with age- and sex-matched control subjects. Additional analysis was performed to compare the lipid profile between LVD and SVD after adjustment for other risk factors. Compared to controls, the total-C level was significantly higher in patients with SVD (p = 0.005) and LVD (p = 0.018). A significant increase in the LDL-C level (p < 0.004) and a significant decrease in the HDL-C level (p = 0.001) were only observed in the LVD patients. The three stroke subtypes showed higher TG levels than the controls (CED, p = 0.037; SVD, p < 0.001; LVD, p = 0.014). The plasma lipid profile was similar in the SVD and LVD subtypes except for HDL-C, which was significantly lower in LVD than in SVD (p = 0.047). Logistic regression adjusted for confounders showed that decreased HDL-C (p = 0.020), and smoking (p = 0.019) were significant discriminative factors for LVD vs. SVD. In conclusion, this controlled study shows that hypertriglyceridemia is commonly found in patients with ischemic cerebrovascular disease whatever the etiologic subtype, whereas hypercholesterolemia is related more to SVD and LVD. In addition to hypertension and diabetes, hypercholesterolemia may also be involved in the etiology of SVD and differs from LVD by a lower decrease in HDL-C.     

Cystatin C as an index of cerebral small vessel disease: results of a cross‐sectional study in community‐based Japanese elderly

Background and purpose: Recent studies have shown that kidney dysfunction is associated with cerebral small vessel disease (SVD). Although creatinine‐based estimating equations have been used as the standard measure for the evaluation of kidney function, the accuracy of these is limited in the elderly because of muscle mass decrease with aging. Cystatin C is a more useful measurement than creatinine‐based estimating equations for evaluating kidney function, however, the relationship amongst cystatin C, cognitive dysfunction, and cerebral SVD has not been fully examined in community‐based elderly. Methods: We performed a cross‐sectional study using MRI to determine the relationship amongst cystatin C, cognitive function, and cerebral SVD in a total of 604 community‐based Japanese elderly. Results: In this study, subjects with higher cystatin C levels tended to have more lacunas and higher grades of white matter lesions. Although a decline of the Mini‐Mental State Examination (MMSE) scores was associated with SVD‐related lesions, the relationship between the tertiles of cystatin C and mean MMSE scores was not statistically significant. In the logistic regression analysis, the association between cystatin C and SVD‐related lesions was statistically significant, even after adjustment for conventional risk factors and high‐sensitivity C‐reactive protein. Furthermore, subjects with higher cystatin C levels accompanied with albuminuria had a greater risk for the presence of subclinical cerebral SVD than those with lower cystatin C levels without albuminuria. Conclusions: The present study suggests that there is a close relationship between cystatin C and subclinical cerebral SVD, independently of conventional risk factors, in community‐based elderly.     

急性腔隙性脑梗死患者血清胱抑素C与认知功能的相关性研究

目的探讨急性腔隙性脑梗死患者血清胱抑素C(cystatin C,CysC)水平与认知功能的相关性。方法123例住院治疗的小血管病变所致急性腔隙性脑梗死患者根据CysC水平被分为低、中、高三组(各组均为n=41例)。根据认知功能评测分为认知功能正常组(n=64),血管性轻度认知功能障碍(vascular mild cognitive impairment,VaMCI)组(n=36)及血管性痴呆(vascular dementia,VaD)组(n=23)。比较组间血清CysC、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清肌酐(serum creatinine,Scr)、血脂、空腹血糖、糖化血红蛋白A1C、血压、美国国立卫生研究院卒中量表(NIHSS)评分、简易精神状态量表(MMSE)、阿尔兹海默病评定量表认知分量表(ADAS-cog)、汉密尔顿抑郁量表(HAMD)得分的差异。采用Logistic回归方法分析CysC与认知功能障碍的相关性。结果高水平血清CysC组较中、低水平血清CysC组的MMSE得分更低(21.98±6.08 vs.25.02±4.69 vs.25.10±3.95),ADAS-cog得分更高(17.73±14.23 vs.12.51±10.39 vs.10.67±7.53),差异有统计学意义(P0.05)。随着血清CysC升高,SCr逐渐升高,e GFR逐渐减低(P0.05)。CysC(0.93±0.21 vs.1.10±0.45 vs.1.34±0.58)、MMSE、ADAS-cog在认知正常组、VaMCI组和VaD三组间两两比较差异均具有统计学意义(P0.05),认知损害越重,CysC越高。多元Logistic回归分析显示CysC的回归系数为7.06(P0.05)。结论血清CysC升高是小血管病变所致急性腔隙性脑梗死患者认知功能障碍的危险因素之一,且与认知障碍的严重程度相关。     

Comparison of plasma concentrations of fibrinogen in patients with ischemic stroke due to large vessel disease and small vessel disease

BACKGROUND AND PURPOSE: Hyperfibrinogenemia is a known cardiovascular risk factor, but its role as a risk factor for ischemic stroke remains controversial. Most studies on this topic did not consider the different etiologies of ischemic stroke. We designed this study to compare plasma fibrinogen concentrations in patients with acute ischemic stroke due to large vessel disease (LVD) or small vessel disease (SVD). MATERIAL AND METHODS: We studied 203 patients with acute ischemic stroke, including 107 patients with SVD and 96 subjects with LVD. Etiology of stroke was established according to the TOAST criteria, using computed tomography, ultrasonography of the carotid and vertebral arteries as well as echocardiography. The plasma concentration of fibrinogen was measured in venous blood samples drawn within 48 hours from the onset of stroke. RESULTS: Patients with LVD were more likely to be men and more likely to have ischemic heart disease. The median plasma concentration of fibrinogen was higher in patients with LVD [3.7 g/l (2.9-4.9 g/l)] than in patients with SVD [3.2 g/l (2.6-3.8 g/l); p=0.0001]. Hyperfibrinogenemia (i.e. plasma fibrinogen concentration >3.5 g/l) occurred more frequently in patients with LVD (54.2%) than in patients with SVD (35.5%; p=0.008). CONCLUSIONS: Patients with ischemic stroke due to LVD have a higher concentration of plasma fibrinogen than patients with SVD, they also present more frequently with hyperfibrinogenemia. Further studies of risk factors for stroke should take into account various etiologies of ischemic stroke.     

脑小血管病与眼底血管网络参数的相关性研究

目的利用计算机辅助的全自动眼底照相分析技术,研究脑小血管病与眼底血管网络参数的相关性。方法连续性纳入能坐位行眼底照相的脑小血管病患者80例,大动脉粥样硬化性脑梗死患者41例,比较两组患者的一般临床资料和眼底血管网络参数。同时行logistic回归分析脑小血管病患者的危险因素。结果脑小血管病组在男性比例、吸烟史发生率、血尿酸水平方面均低于大动脉粥样硬化性脑梗死组[(55%vs.75.6%);(20%vs.39%);(308.33±85.30 vs.367.79±113.60)],差异均有统计学意义(P0.05)。脑小血管病组小静脉分支系数和不对称性指数均小于大动脉粥样硬化性脑梗死组,[(1.37±0.04 vs.1.39±0.05);(0.80±0.02 vs.0.81±0.02)],差异均有统计学意义(P0.05)。Logistic回归分析显示,调整血管危险因素后,减小的小静脉不对称性指数与脑小血管病相关,是其危险因素(OR值=1.16,95%CI:1.05-1.38,P0.05)。结论减小的小静脉不对称性指数与脑小血管病相关,是其危险因素,可作为其早期诊断指标。     

Microalbuminuria is a risk factor for cerebral small vessel disease in community-based elderly subjects

Microalbuminuria (MA) is known as a marker for generalized vascular dysfunction. It occurs most commonly in the setting of diabetes and hypertension; however, its association with cerebral small vessel disease (SVD) in community-based elderly remains to be clarified. In this cross-sectional analysis, we evaluated the association between MA and cerebral SVD in total 651 community-based elderly subjects. We assessed cardiovascular risk factors by interviews and physical examinations, including an evaluation of urinary albumin creatinine ratio (UACR). All subjects underwent brain magnetic resonance imaging (MRI) and carotid ultrasonography. As endothelial markers, the serum levels of thrombomodulin (TM) and a tissue-type plasminogen activator/ plasminogen activator inhibitor-1 complex were also studied. The mean TM and UACR were higher in subjects with lacunar infarcts or with moderate white matter hyperintensities (mWMH) on MRI than in those without them. Additionally, the prevalence of lacunar infarcts or mWMH was higher in the highest tertile of UACR level than in the lowest or middle tertile. Furthermore, in logistic regression analysis, the elevation of logarithmically transformed UACR (log UACR) was associated with the higher likelihood for total lacunar infarcts (odds ratio [OR], 1.85 per one log UACR increase), multiple lacunar infarcts (OR, 1.89 per one log UACR increase), and mWMH (OR, 2.15 per one log UACR increase). The present study revealed that levels of urinary albumin are associated with cerebral SVD, independently of traditional cerebrovascular risk factors, in community-based elderly.     

Neuroimaging biomarkers of small vessel disease in cerebral amyloid angiopathy-related intracerebral hemorrhage

Aims

The significance of the correlation of computed tomography (CT)–based cerebral small vessel disease (SVD) markers with the clinical outcomes in patients with cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) remains uncertain. Thus, this study aimed to explore the relationship between SVD markers and short-term outcomes of CAA-ICH.

Methods

A total of 183 patients with CAA-ICH admitted to the Xuanwu Hospital, and Beijing Fengtai You'anmen Hospital, from 2014 to 2021 were included. The multivariate logistic regression analysis was performed to identify the correlation between SVD markers based on CT and clinical outcomes at 7-day and 90-day.

Results

Of the 183 included patients, 66 (36%) were identified with severe SVD burden. The multivariate analysis showed that the total SVD burden, white matter lesion (WML) grade, and brain atrophy indicator were independent risk factors for unfavorable outcomes at 90-day. The brain atrophy indicator was independently associated with mortality at 90-day. Severe cortical atrophy was significantly associated with early neurological deterioration.

Conclusions

The neuroimaging profiles of SVD based on CT in patients with CAA-ICH might predict the short-term outcome more effectively. Further studies are required to validate these findings and identify modifiable factors for preventing CAA-ICH development.