脑小血管病与认知功能障碍

随着人口老龄化的加剧,各种原因所致的痴呆患者人数逐年增加,而血管性痴呆作为继阿尔茨海默病的第2常见痴呆类型逐渐受到人们的重视。流行病学调查发现,血管性痴呆在65岁以上的人群中占10%~15%,其患病率每增长5.3岁即增加1倍,是血管性认知功能损害最严重的形式[1]。脑小血管病相关认知功能障碍是血管性认知功能障碍的重要亚型,约50%的血管性认知功能障碍因小血管病所致[2],是其首要病因,多项研究表明脑小血管     

脑小血管病与认知功能障碍的研究进展

脑小血管病目前已成为血管性痴呆的最常见病因。脑小血管病可导致认知功能、情绪及运动的障碍。近年来,脑小血管病受到越来越多的重视,本文将从脑小血管病的定义、常见分类、病理学、影像学及认知损害等研究现状进行综述。     

高血压脑小血管病老年患者血管性认知功能障碍程度与IL-18、CCL-2等细胞因子的相关性

目的探讨高血压脑小血管病(CSVD)患者血管性认知功能障碍(VCI)程度与血清炎症因子的相关性。方法 60例高血压CSVD患者,根据其认知功能障碍程度分为无VCI(WVCI)组(30例)和非痴呆性VCI(VCIND)组(30例),收集两组一般资料,采用简易精神状态量表(MMSE)进行认知功能评价,比较2组生化指标〔血清高敏C反应蛋白(hs-CRP)、同型半胱氨酸(HCY)、总胆固醇、低密度脂蛋白、三酰甘油、尿酸〕及血清炎症因子〔CCL-2、白细胞介素(IL)-18、肿瘤坏死因子(TNF)-α、组织生长因子(TGF)-β〕水平,并分析VCIND组血清炎症因子水平与MMSE评分的相关性。结果 VCIND组MMSE评分显著低于WVCI组〔(17. 92±3. 61)分vs (29. 30±3. 31)分,t=12. 799,P<0. 05〕,VCIND组hs-CRP、HCY、CCL-2、IL-18及TNF-α水平均显著高于WVCI组,而TGF-β水平显著低于WVCI组(P <0. 05)。IL-18水平与MMSE评分呈负相关性。结论高血压CSVD并伴有VCIND患者血清IL-18水平越高,MMSE评分越高,提示血清IL-18水平可能反映高血压CSVD患者认知障碍的严重程度。     

脑小血管病的轻度认知损害与同型半胱氨酸的相关性研究

目的探讨脑小血管病（SVD）患者的血浆同型半胱氨酸（Hcy）与血管性轻度认知功能损害（VMCI）的关系。方法选取SVD患者151例,按照蒙特利尔认知评估量表（MoCA）的评分结果分为VMCI组（80例）和非VM-CI组（71例）。所有研究对象均测定血浆Hcy及叶酸、VitB12水平。结果 VMCI组Hcy水平高于非VMCI组,叶酸、VitB12水平低于非VMCI组（P〈0.01）。SVD患者Hcy水平与年龄呈正相关（r=0.176,P〈0.05）,与MoCA评分的总分及视空间与执行功能、注意与计算力、语言、延迟回忆各亚项的评分呈明显负相关（P均〈0.01）。结论高Hcy可能是SVD患者VMCI的独立危险因素,叶酸、VitB12缺乏是间接引起Hcy增高而导致VMCI的重要营养因素。     

脑小血管病与认知功能障碍

脑小血管病是指颅内小动脉和做动脉病变引起脑的缺血或出血损害,是血管性认知功能障碍的重要亚型。其主要的影像学表现为腔隙性脑梗死、脑白质疏松和脑做出血。脑小血管病的临床分类主要包括腔隙综合征、Binswanger脑病、脑淀粉样血管病、伴有皮质下腑梗死和白质肭痫的常染色体显性遗传性脑动脉病、伴有皮质下脑梗死和白质脑病的常染色体隐性遗传性脑动脉病及其它较少见的小血管病。其临床表现则丰要为静灶腑血管病（静灶腔隙性脑梗化、脑微出血和部分白质疏松）、各类腔隙综合征和血管性认知功能障碍。     

血清3-硝基酪氨酸水平与脑小血管病患者并发认知功能障碍的关系

目的 探讨血清3-硝基酪氨酸(3-NT)水平与脑小血管病(CSVD)患者并发认知功能障碍(CI)的关系.方法 选取144例CSVD患者,根据是否并发CI分为CSVD-CI组、CSVD-NCI组,另选取52例体检健康者为对照组.测定三组血清3-NT,根据简易智力状态检查量表(MMSE)将CSVD-CI组分为重度CI组、中...     

高血压病合并不同类型脑小血管病与认知功能障碍的关系

目的:探讨高血压病合并不同类型脑小血管病(CSVD)与认知功能障碍的关系,及其可能机制。方法:收集168例高血压病合并CSVD住院患者的临床资料,CSVD分为腔隙性脑梗死、脑白质变性和脑微出血3种类型。根据其(VCI)程度将患者分为无VCI(NVCI)组(99例)和非痴呆性VCI(VCIND)组(69例),比较2组病例简易精神状态量表(MMSE)评分的差异,并检测2组患者血清白介素1(IL-1)、IL-6、IL-10及高迁移率族蛋白(HMGB1)的水平,研究其发病机制。结果:VCIND组MMSE评分明显低于NVCI组[(16. 20±3. 35)分vs (29. 40±5. 74)分,t=13. 650,P 0. 05)];而各组内3种不同类型CSVD MMSE评分比较,差异无统计学意义(均P 0. 05)。与NVCI组比较,VCIND组血清IL-1、IL-6、HMGB1水平显著升高(均P 0. 05),而IL-10水平比较差异无统计学意义(P0. 05)。结论:高血压病合并不同类型CSVD人群发生VCIND可能与高细胞炎症反应相关。     

血C肽水平与老年脑小血管病轻度认知功能障碍的相关性研究

目的分析血C肽水平与老年脑小血管病(CSVD)病人血管性轻度认知功能障碍(VMCI)的相关性。方法选取2016年1月至2018年1月我院收治的CSVD老年病人100例,根据MoCA评分将其分为VMCI组(n=50)和非VMCI组(n=50)。比较2组病人的一般资料,FPG、血脂、空腹血C肽及口服葡萄糖50 g后30 min、60 min、90 min及120 min血C肽水平,MoCA总分和各亚型得分;将血C肽水平与病人的认知程度进行相关性分析。结果 VMCI组年龄、FPG水平、空腹血C肽及口服葡萄糖50 g后30 min、60 min、90 min及120 min血C肽水平均高于非VMCI组,血C肽水平与MoCA总分、视空间和执行能力、抽象力、注意力、计算力语言、记忆和命名得分呈负相关(P<0.05)。结论血C肽水平与CSVD老年病人VMCI存在相关性。     

总胆红素水平与老年脑小血管病患者认知功能障碍的相关性研究

目的 探讨总胆红素(TBil)水平与老年脑小血管病(CSVD)患者认知功能障碍的关系.方法 纳入社区老年CSVD患者277例,采用简易精神状态检查量表(MMSE)对其进行神经心理学评价,根据MMSE评分将其分为认知功能障碍组88例和认知功能正常组189例.比较两组患者的流行病学特征、TBil水平及血脂等临床资料,并采用...     

Increased risk of cognitive impairment and more severe brain lesions in hypertensive compared to non‐hypertensive patients with cerebral small vessel disease

Although cerebral small vessel disease (SVD) is traditionally associated with aging and hypertension (HT), there are patients exhibiting sporadic SVD, free of HT. We aimed to investigate the differences in clinical and neuroradiological presentation in SVD patients in reference to the presence of HT as a risk factor (RF). Vascular RF, cognitive and functional status were evaluated in a cohort of 424 patients. Patients were classified in two groups based on the presence of HT. Severity of vascular lesions was assessed using 1.5 T magnetic resonance imaging with Age‐Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular (PV) and deep subcortical (DS) scores. No difference between groups in age and sex distribution was noted. In univariate analysis, HT was associated with vascular cognitive impairment (vCI) (OR 2.30, 1.53‐3.45, P < 0.0001), functional status (OR 1.47, 1.11‐1.95, P = 0.007), depression (OR 2.13, 1.23‐3.70, P = 0.007), tARWMC (OR 1.10, 1.05‐1.16 95% CI, P < 0.0001), Fazekas PV score (OR 1.34, 1.08‐1.67 95% CI, P = 0.008), Fazekas DS score (OR 1.95, 1.44‐2.63 95% CI, P < 0.0001) and total number of lacunes (OR 1.10, 1.02‐1.18 95% CI, P = 0.009). Multivariate logistic regression analysis indicated that HT was an independent RF for vCI (OR 1.74, 1.09‐2.76 95% CI, P = 0.020) and higher Fazekas DS score (OR 1.57, 1.11‐2.22 95% CI, P = 0.011). The Kaplan‐Meier curve of estimates of survival of SVD patients without vCI revealed a higher proportion of patients with HT progressing to vCI over time when compared to HT‐free cases. In patients with sporadic SVD, HT is a contributing factor to worse clinical outcomes and neuroradiological presentation.     

脑小血管病患者血清8-OHdG、CX3CL1水平与认知功能障碍的相关性

目的]探究脑小血管病(CSVD)患者血清8-羟基脱氧鸟苷酸(8-OHdG)、趋化因子C-X3-C配体1(CX3CL1)水平与认知功能障碍的关系。 [方法]选取2021年5月—2022年5月本院收治的CSVD患者128例,依据蒙特利尔认知评估量表(MoCA)评分分为认知障碍组与无认知障碍组两组,测定两组血清8-OHdG、CX3CL1水平,应用Pearson相关性分析血清8-OHdG、CX3CL1水平与CSVD患者MoCA评分的关系,Logistic回归分析影响CSVD患者认知功能障碍的因素,并绘制ROC曲线研究血清8-OHdG、CX3CL1水平对CSVD患者认知功能障碍的预测效能。 [结果]认知功障碍组患者血清8-OHdG和CX3CL1水平分别高于无认知障碍组,但其MoCA评分低于无认知障碍组(均P＜0.05)。血清8-OHdG、CX3CL1水平均与MoCA评分呈负相关(r＝－0.715、－0.413,P＜0.05)。血清8-OHdG水平,重度认知障碍组分别高于中度和轻度认知障碍组(均P＜0.05),中度认知障碍组高于轻度认知障碍组(P＜0.05)。CX3CL1水平,重度认知障碍组分别高于中度和轻度认知障碍组(均P＜0.05),中度认知障碍组高于轻度认知障碍组(P＜0.05)。8-OHdG诊断CSVD患者认知功能障碍的ROC曲线下面积(AUC)为0.866,灵敏度、特异度分别为76.53%和80.00%(均P＜0.05);CX3CL1诊断CSVD患者认知功能障碍的AUC为0.868,灵敏度、特异度分别为86.73%和80.00%(均P＜0.05);8-OHdG、CX3CL1二者联合诊断CSVD患者认知功能障碍的AUC为0.922,灵敏度、特异度分别为88.78%和86.67%(均P＜0.05)。血清8-OHdG＞2.69 μg/L、CX3CL1＞179.18 pg/L均为CSVD患者认知功能障碍的影响因素(P＜0.05)。 [结论]血清8-OHdG、CX3CL1水平与CSVD患者认知功能障碍呈正相关,两者可作为预测CSVD患者出现认知功能障碍的辅助指标。     

The cognitive dysfunction related to Alzheimer disease or cerebral small vessel disease: What's the differences

Alzheimer disease (AD) and sporadic cerebral small vessel disease (CSVD) are common cognitive disorders. Both AD and CSVD have mental symptoms including chronic progressive cognitive impairment, dysfunction, and behavioral abnormalities. However, the differences on the cognitive dysfunction of AD and CSVD remain unclear. It is necessary to elucidate the cognitive dysfunction differences of AD and CSVD, and to identify the potential risk factors.AD or sporadic CSVD patients treated in our hospital from December 1, 2018 to May 31, 2019 were included. And we selected healthy participants as controls. The mini-mental state examination and Montreal Cognitive Assessment Scale were used for neuropsychological assessment, and related medical information were collected and compared.A total of 190 patients were included. The total mini-mental state examination scores in AD, CSVD group were significantly less than that of control group, there were significant differences in the domains of directional ability, attention and computing ability, delayed recall, and visual perception (all P < .05); the total Montreal Cognitive Assessment Scale scores in AD, CSVD group were significantly less than that of control group. There were significant differences in the domains of visual space and execution, immediate remember, attention and computing ability, language, delayed recall, and directional ability (all P < .05); diabetes was a risk factor both for AD (hazard ratio = 1.63, 95% confidence interval: 1.35–1.97) and CSVD (hazard ratio = 1.15, 95% confidence interval: 1.08–1.27).The cognitive dysfunctions of AD are difference to that of CSVD patients, and diabetes is the risk factor both for AD and CSVD, future studies are needed to further identify the prevention and treatment of AD and CSVD.     

缺血性脑小血管病患者脂蛋白和内皮系统生物学标志物与血管性认知障碍的相关性

目的 分析缺血性脑小血管病(CSVD)患者脂蛋白a[Lp(a)]、血管性血友病因子(vWF)、细胞间黏附因子-1(ICAM-1)与血管性认知障碍的关系。方法 回顾性分析河北省沧州中西医结合医院2019年1月至12月收治的110例缺血性脑小血管病患者的临床资料。根据简易智能状态量表(MMSE)与韦氏成人智力量表(WAIS)评分结果将患者分为认知障碍组(CSVD-1组,59例;MMSE≤26分,WAIS≤69分)与认知正常组(CSVD-2组,51例;MMSE>26分,WAIS>69分)。另选取同时期50名健康体检者作为对照组。采用免疫比浊法检测Lp(a)水平,采用酶联免疫荧光法检测vWF和ICAM-1,分析三者与CSVD认知障碍的关系。采用SPSS 25.0统计软件进行数据分析。根据数据类型,多组间比较采用方差分析,进一步两两比较采用LSD-t检验。应用logistic回归分析CSVD患者认知障碍的危险因素。应用受试者工作特征(ROC)曲线评估Lp(a)和ICAM-1水平对CSVD患者的预测价值。结果 与对照组比较,CSVD-1与CSVD-2组总胆固醇(TC)、Lp(a)、vW...     

Framingham Stroke Risk Profile is related to cerebral small vessel disease progression and lower cognitive performance in patients with hypertension

The Framingham Stroke Risk Profile (FSRP) was developed to predict clinical stroke. We investigated if FSRP is associated with more “silent” effects of cerebrovascular disease, namely progression of cerebral small vessel disease (cSVD)‐related brain damage and cognitive performance in hypertensive patients. Ninety patients with essential hypertension underwent a brain MRI scan and FSRP assessment at baseline, and a second brain MRI scan and neuropsychological assessment at 9‐year follow‐up. We visually rated progression of cSVD‐related MRI markers. FSRP was associated with progressive periventricular white matter hyperintensities (P = .017) and new microbleeds (P = .031), but not after correction for the FSRP age component. FSRP was associated with lower overall cognitive performance (P < .001) and this remained significant after correction for the FSRP age component. A vascular risk score might be useful in predicting progression of cSVD‐related brain damage or future cognitive performance in hypertensive patients. Age seems to be the most important component in FSRP.     

Analysis of adhesion molecules in patients with idiopathic portal hypertension

BACKGROUND: The aetiology of idiopathic portal hypertension (IPH) is unknown. However, some evidence of immunological abnormalities in IPH patients has been reported. METHODS: As adhesion molecules are important in the interaction between lymphocytes and accessory and target cells, the expression and release of the soluble form of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule (ICAM-1) were examined in this study. RESULTS: In IPH patients, the serum level of soluble VCAM-1 was found to be increased, compared with that of healthy subjects, fatty liver patients and chronic hepatitis patients. The level of soluble ICAM-1 of IPH patients was found to be slightly increased, compared with that of healthy subjects; however, it was not different from the level in patients with other diseases. The expression of VCAM-1 was observed in the sinusoidal lining cells and endothelial cells around the liver vessels of several IPH patients. In contrast, ICAM-1 was weakly expressed in sinusoidal lining cells and hepatocytes in the liver tissue of only one of four IPH patients. CONCLUSIONS: This differential pattern of VCAM-1 and ICAM-1 was found in IPH patients and it was suggested that VCAM-1 might be an important molecule in the occurrence of IPH.     

糖尿病患者血清可溶性细胞间粘附分子-1和可溶性血管细胞粘附分子-1变化的研究

目的　研究糖尿病患者血清可溶性细胞间粘附分子 - 1(s ICAM- 1)和可溶性血管细胞粘附分子 - 1(s VCAM- 1)水平的变化。方法　应用酶联免疫吸附法 (EL ISA)检测了 18例 1型糖尿病和 47例 2型糖尿病患者及 2 0例健康对照者的血清 s ICAM- 1、s VCAM- 1以及甘油三酯 (TG)水平。结果　 1血清 s ICAM- 1和 s VCAM- 1水平 ,1型、2型糖尿病患者组均显著高于健康对照组 (P<0 .0 5～ 0 .0 1) ,2型糖尿病有微血管病变组又高于无微血管病变组 (P<0 .0 5～ 0 .0 1) ,1型糖尿病与 2型糖尿病组之间无显著性差异 ;2血清 s VCAM- 1水平 ,2型糖尿病的高甘油三酯血症组 (A组 )、高甘油三酯血症合并高血压组 (B组 )高于单纯高血压组 (C组 )和甘油三酯、血压正常组 (D组 ) (P均 <0 .0 5 ) ;3 1型糖尿病和 2型糖尿病患者血清 s ICAM- 1和 s VCAM- 1之间均呈正相关关系 (r=0 .83、0 .5 3,P均 <0 .0 1)。结论　 12型糖尿病患者血清 s VCAM- 1升高与高甘油三酯血症有关 ;2血清 s ICAM- 1和 s VCAM- 1参与了糖尿病微血管病变的发病过程 ,并可作为糖尿病病情变化的监测指标     

高原地区急性脑梗死患者炎性反应相关因子含量的变化

目的探讨高原不同海拔地区急性脑梗死(acute cerebral ischemic,ACI)患者炎性反应相关因子之间的关系。方法采用ELISA法和放射免疫法,检测高海拔(3400 m)ACI患者40例(高海拔ACI组)、中度海拔(2260 m)ACI患者48例(中度海拔ACI组)血清可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素(IL)的IL-1β、IL-2、IL-6和IL-8和TNF-α的水平。同期选择健康体检者70例作为高海拔对照组(30例)和中度海拔对照组(40例)。结果不同海拔地区ACI组TNF-α、IL-1β、sICAM-1和IL-8水平显著高于各对照组;高海拔ACI组IL-6显著高于对照组(P<0.01);与中度海拔ACI组比较,高海拔ACI组血清TNF-α、IL-1β、IL-6和sICAM-1水平明显增高(P<0.01)。除高海拔对照组TNF-α水平高于中度海拔对照组(P<0.05),两对照组其余指标无显著性差异。IL-2在4组间变化不大。ACI患者血清sICAM-1水平与TNF-α、IL-1β和IL-6呈正相关(r=0 564,P<0 01),而与IL-2和IL-8无相关性。结论在高原ACI的发病过程中,可能存在由TNF-α、IL-1β、IL-6和IL-8介导的炎性反应,sICAM-1参与脑缺血的发病过程。随着海拔增高及慢性缺氧加重,炎性反应增强,导致脑组织损伤加重的倾向。     

脑小血管病与轻度认知功能障碍的关系

目的探讨脑小血管病变（SVD）与轻度认知功能障碍（MCI）的关系。方法收集临床SVD相关的MCI（SVD-MCI）患者66例和认知功能正常的老年人57例作为对照组。根据视觉评分,评估白质病变（WML）和内侧颞叶萎缩（MTA）病变的程度,并记录大脑不同部位腔隙性梗死（LI）的数目,应用多元Logistic回归分析LI、WML和MTA与SVD-MCI之间的相关性。结果①与对照组相比,SVD-MCI组患者患高血压比例和血中TC含量明显升高（P〈0.05）;吸烟、患糖尿病的比例和血中总胆固醇、低密度脂蛋白胆固醇含量有所升高,但差异无统计学意义（P〉0.05）;②与对照组相比,SVD-MCI组患者丘脑、侧脑室周围白质和皮质下白质LI的数目明显增加（P〈0.05）;SVD-MCI组患者侧脑室周围和皮质下WML以及双侧MTA评分分值也显著增加（P〈0.05）;③控制了年龄和多种血管危险因素的影响之后,多元Logistic回归分析显示,丘脑LI、侧脑室旁WML和左侧MTA与SVD-MCI相关。结论丘脑LI、侧脑室旁WML和左侧MTA可能是SVD-MCI的独立危险因素,积极预防和治疗SVD,也许可降低MCI的发生率。