缺血性脑小血管病160例相关危险因素分析

目的探讨缺血性脑小血管病相关危险因素。方法基于缺血性卒中分型系统TOAST分型缺血性脑小血管病患者160例为脑卒中组,非脑卒中患者40例为对照组,对两组患者发病的危险因素进行单因素分析及多因素Logistic回归分析。结果与对照组相比,通过多因素Logistic回归分析结果显示缺血性脑小血管病的主要危险因素是年龄、高血压、高三酰甘油血症(HTG)。结论年龄、高血压、HTG是缺血性脑小血管病的独立危险因素。     

探讨青年缺血性脑小血管病血管影像特点和危险因素对策

目的探讨青年缺血性脑小血管病的血管影像特点,并对其危险因素进行分析。方法随机选取本院2012-11—2014-12收治的青年缺血性脑小血管病患者65例,实施颈部和颅内血管螺旋CT血管造影,并进行颈动脉超声检查,同时对患者的临床资料进行回顾性分析,对其吸烟、血脂异常、糖尿病、高血压等常见危险因素进行总结分析。结果多发病灶发生率明显高于单发病灶,有显著性差异(P0.05);44例患者未发现明显颅内外动脉闭塞或狭窄,血管无异常率明显高于血管异常患者(P0.05);前循环动脉病变的发生率明显高于后循环,有显著性差异(P0.05)。结论前循环供血区域深穿支动脉是青年缺血性脑小血管病高发区域,其中动脉硬化同本病的发生发展存在密切联系。吸烟、血脂异常、高血压均是青年缺血性脑小血管病的常见危险因素,临床治疗时应加强对患者的健康宣教,加强对相关危险因素的预防和针对性控制,促进患者生活质量改善。     

脑小血管病步态障碍的影像特征与危险因素研究

目的 探讨与脑小血管病（cerebral small vessel disease,CSVD）步态障碍相关的影像特征。 方法 连续收集2018年7-9月在青岛西海岸新区人民医院神经内科住院的CSVD患者,记录入组 患者的性别、年龄、吸烟史、控制不良的高血压、高脂血症、HbA1c、无症状性梗死、室周白质高信 号（periventricular white matter hyperintensities,PWMHs）评分、深部白质高信号（deep white matter hyperintensities,DWMHs）评分、皮质萎缩（外侧裂比值）、皮质下萎缩（尾状核指数）及颞叶海马萎缩 （海马沟回比）等资料。按照Holden步行功能分级（functional ambulation classification,FAC）≤3,分为跌 倒低风险组（low risk of falling,LRF）和高风险组（high risk of falling,HRF）,采用多因素Logistic回 归分析CSVD患者步态障碍的独立危险因素。 结果 研究共纳入102例CSVD患者,其中HRF组59例（57.8%）。单因素分析提示HRF组与LRF组的年龄 （P＜0.001）、HbA1c（P =0.007）、PWMHs（P =0.002）、DWMHs（P＜0.001）、外侧裂比值（P＜0.001）、尾 状核指数（P =0.003）及海马沟回比（P＜0.001）差异有统计学意义,多因素Logistic回归分析显示年龄 （OR 1.173,95%CI 1.053～1.306,P =0.004）、DWMHs（OR 8.883,95%CI 2.674～29.512,P＜0.001）及外 侧裂比值（OR 1.433,95%CI 1.028～1.999,P =0.034）是CSVD步态障碍的独立危险因素。 结论 CSVD患者步态障碍的独立危险因素包括年龄、皮层萎缩及DWMHs评分。     

脑小血管病各亚型相关危险因素分析

目的：研究脑小血管病各亚型的危险因素,为其有效防治提供依据。方法连续入组脑小血管病患者216例,均行MRI常规序列和GRE-T2*WI检查,依据结果将其分为腔隙性梗死（LI）、脑白质病变（WML）及脑微出血（CMBs）三种亚型,登记所有患者基线资料,应用非条件Logistic回归模型完成单因素及多因素分析。结果非条件 Logistic回归分析显示与LI有统计学意义的相关变量为高血压、血脂异常、糖尿病;与WML有统计学意义的相关变量为LI、高血压、血脂异常、脑动脉狭窄、高同型半胱氨酸血症;与CMBs有统计学意义的相关变量为年龄、LI、WML、性别、脑出血、高血压。结论 LI的危险因素为高血压、血脂异常、糖尿病;WML的危险因素为LI、高血压、血脂异常、脑动脉狭窄、高同型半胱氨酸血症;CMBs的危险因素为年龄、LI、WML、性别、脑出血、高血压。     

缺血性脑小血管病及其亚组危险因素Logistic回归分析

目的 探讨缺血性脑小血管病(CSVD)及其亚组的相关危险因素.方法 选取296例CSVD患者为研究组,100例头颅MRI无异常的正常老年人作对照.将CSVD患者进一步分为腔隙性梗死组(LI)、白质病变组(WML)及LI+WML组,分别进行危险因素分析.结果 CSVD组与对照组年龄、高血压、动脉硬化、同型半胱氨酸(Hcy...     

青年缺血性卒中患者脑小血管病总负荷的危险因素分析

目的 探讨青年缺血性卒中患者脑小血管病(cerebral small vessel disease,CSVD)总负荷的危险因素.方法 回顾性纳入2016年1月-2020年10月于首都医科大学附属北京朝阳医院神经内科连续收治的青年急性缺血性卒中患者.通过MRI评估腔隙、脑白质高信号、扩大的血管周围间隙及脑微出血四种CSV...     

脑小血管病及其所致认知障碍的危险因素研究进展

脑小血管病（CSVD）的高发病率不仅加重了社会及家庭的负担,也降低了患者本身的生活 质量,其严重程度不亚于大血管卒中。CSVD 的发生是由众多发病机制共同导致,目前仍未完全阐明。 CSVD 被认为是认知障碍最常见的病因,且两者存在许多共同的危险因素。因此,现就 CSVD 及其所致 认知障碍的现状、发病机制及危险因素进行概述。     

脑小血管病致血管性认知功能障碍相关因素分析

目的探讨缺血性脑小血管病(ICSVD)致血管性认知功能障碍(VCI)的相关危险因素,为临床诊治提供参考。方法选取ICSVD及ICSVD合并VCI患者80例,其中ICSVD组32例,ICSVD合并VCI组48例,对照组30例(符合纳入标准的门诊体检人员)。采集所有对象的既往史、个人史、家族史,另外采集收缩压(SBP)及舒张压(DBP)、头颅MRI、颈动脉内膜-中膜厚度(IMT)、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、同型半胱氨酸(Hcy)等资料。结果 3组受教育年限、不良习惯及合并疾病比较差异有统计学意义(P0.05),但ICSVD组与ICSVD合并VCI组两两比较差异无统计学意义(P0.05);3组彩超IMT、血压及血检数据比较差异有统计学意义(P0.05),ICSVD组与ICSVD合并VCI组两两比较差异无统计学意义(P0.05),但ICSVD组与ICSVD合并VCI组IMT和Hcy比较差异有统计学意义(P0.05)。结论受教育年限短、吸烟、饮酒、高IMT、高血压、高血糖、高血脂、高Hcy是临床引起ICSVD及VCI重要危险因素;IMT及血清Hcy数值越高,颈动脉管径越细或狭窄,动脉粥样硬化越严重,可能是ICSVD引起VCI重要危险因素。     

症状性小动脉硬化脑小血管病患者脑微出血的危险因素分析

目的 应用头颅MRI的SWI序列检测症状性小动脉硬化脑小血管病(cerebral small vessel disease,CSVD)患者脑微出血(cerebral microbleeds,CMBs)灶,分析不同部位CMBs的临床特征差异及CMBs的危险因素。方法 回顾性纳入2017年3月—2018年10月就诊于新疆昌吉州中医院神经内科的小动脉硬化的CSVD患者。根据有无微出血分为CMBs组与无CMBs组。应用二元logistic回归分析CMBs的独立危险因素;判断CMBs数量分级与独立危险因素的相关性。根据CMBs的位置分为脑叶区亚组、深部区亚组、幕下区亚组。比较脑叶区CMBs与非脑叶区CMBs、深部CMBs与非深部CMBs、幕下区CMBs与非幕下区CMBs亚组之间的临床特征差异。结果 共纳入144例CSVD患者,CMBs组42例(29.2%),无CMBs组102例(70.8%),其中脑叶区18例,深部白质区23例,幕下区9例。二元logistic回归分析显示,低载脂蛋白b水平(OR 0.308,95%CI 0.099～0.957,P=0.042)及高空腹血糖值(OR 1.128,9...     

The renin-angiotensin-aldosterone system in cerebral small vessel disease

INTRODUCTION: Cerebral small vessel disease (SVD) appears on magnetic resonance imaging (MRI) as leukoaraiosis (LA), état criblé (EC), and multiple lacunar infarctions (MLI). Although the pathophysiology of SVD is poorly understood, there is evidence of a genetic contribution. We sought to analyze the influence of the renin-angiotensin-aldosterone system (RAAS) on SVD in symptomatic patients from the Génétique de l'Infarctus Cérébral (GENIC) study, including RAAS polymorphisms and circulating angiotensin converting enzyme (ACE). METHODS: Caucasian patients (n=510) with acute brain infarction (BI) were recruited and MRIs were evaluated for SVD, including LA, EC, and MLI. We considered ACE levels and several polymorphisms, including ACE, angiotensinogen, aldosterone synthase CYP11B2, and angiotensin II receptor type I. RESULTS: Among the polymorphisms, there were marginal negative associations between aldosterone synthase CYP11B2 -344C against severe EC (adjusted OR, 0.57; 95% CI, 0.31-1.05) and severe LA (adjusted OR, 0.54; 95% CI, 0.30-0.95), both considering -344C dominant. In addition, the frequency of -344C decreased with the number of SVD abnormalities (p=0.016). Mean plasma ACE was elevated in patients with MLI, but not with LA or EC. The risk of MLI increased gradually with increasing plasma ACE (adjusted OR, 1.25; 95% CI, 1.02-1.53). CONCLUSIONS: This exploratory study found no strong evidence for RAAS involvement in severe SVD in this population. The whole spectrum of SVD, including EC, MLI, and LA, can be considered as phenotypes for genetic studies.     

脑小血管病简介

近年来,脑小血管病(cerebral small vessel disease, SVD)备受关注,这并非患者数量的剧增,而是由于医学对小血管病逐渐深入认识的结果.引起小血管病的原因很多,除部分大动脉粥样硬化的危险因素如增龄、吸烟、高血压、糖尿病以外,遗传因素和淀粉样变性是其特有的不可忽略的病因.     

Association of elevated plasma viscosity with small vessel occlusion in ischemic cerebral disease

Introduction

Elevated plasma viscosity (PV) is observed in patients with vascular risk factors, such as diabetes mellitus or arterial hypertension. In this study we investigated the association of plasma viscosity and the different clinical and radiological entities of cerebral ischemia.

Methods

PV of 465 consecutively admitted patients with clinical symptoms of acute cerebral ischemia without radiological signs of bleeding was measured. Data is expressed as median [range] unless stated otherwise. p < 0.05 was considered statistically significant.

Results

Patients with acute cerebral ischemia (TIA or Stroke) showed increased PV (TIA 1.27mPas [1.07-1.53], stroke 1.27mPas [1.07-1.56]) compared to patients without cerebral ischemia (Mimics) (1.23mPas [1.06-1.42]). The group with radiologically proven small vessel disease (SVD) had a significantly higher mean values of PV (1.29mPas [1.06-1.54]) compared to those with signs of large vessel disease or cardioembolic events (1.22mPas [1.07-1.56], p < 0.001).Patients with chronic heart failure (p = 0.007), arterial hypertension (p < 0.001) and diabetes mellitus (p = 0.002) had higher PV compared to patients without these cardiovascular risk factors. Hyperlipidemia or nicotine abuse showed no relation to PV.

Conclusion

Elevated PV is not only associated TIA and Stroke but is also found in patients with radiological signs of cerebral SVD. High levels of PV could be an underestimated risk for TIA and Stroke and participate in the complex pathophysiology of SVD. Prospective observational and interventional studies are warranted for further evaluation of PV in neurological ischemic diseases.     

脑小血管病研究进展

脑小血管病系指颅内小血管病变,包括颅内小动脉、微小动脉,以及毛细血管和小静脉病变。近年来,脑小血管病的研究取得了初步进展,但明确诊断仍需依靠组织活检,鉴于病理学资料难以获得,临床更多关注影像学和临床表现,因此正确认识脑小血管病的影像学和临床表现有助于早期识别脑小血管病。本文拟对脑小血管病的研究现状、常见影像学表现、发病机制、临床症状与体征,以及治疗原则进行阐述。     

脑小血管病淡漠的研究现状

淡漠是以动机丧失为主要特征的一种严重危害身心健康的疾病。近年来研究发现,脑小血管病患者中淡漠的发生比例很高,严重影响患者的日常工作及生活。因脑小血管病淡漠发病过程和机制不明确,缺乏有效的治疗方式,近年来已成为研究的热点。现就淡漠的评估方法、脑小血管病患者淡漠的研究现状及治疗进行综述,以期更好地理解并干预脑小血管病患者的淡漠症状。     

脑小血管病变与临床诊治

随着对脑血管病临床研究的不断深入和核磁共振成像各项检测功能的开发和利用,脑小血管病变（SVD）正日益受到人们的关注。由于SVD是隐匿性渐进发展的,所以以往人们对它往往认识不足。血管性认知损害和痴呆与SVD有着密切的关系,SVD的后期可对患者造成不可逆性损害。本文就SVD的病理生理变化、相关危险因素以及临床治疗中的一些注意事项作一综述。     

The clinical manifestations and pathophysiology of cerebral small vessel disease

Small vessel disease (SVD) is responsible for brain chronic circular disorder, and accounts for 20%–30% cases of ischemic stroke as well as cerebral hemorrhage, and to a great extent, encephalopathy. Binswanger’s disease and multiple small strokes, which are common in older people, are also closely associated with SVD. These disorders often cause decline in cognition, vascular dementia, impairment in gait and balance, mood depression, and urinary incontinence, and often brings great social and economic burdens. SVD-related encephalopathy increases the incidences of fall, disability and death in elderly people. With the aging of the society, more attention should be paid to the importance of early diagnosis and prophylactic treatment of SVD. Here the clinical manifestations and pathophysiology of SVD are reviewed.     

Alpha2-macroglobulin as a promising biomarker for cerebral small vessel disease in acute ischemic stroke patients

Alpha2-macroglobulin is a protease inhibitor that enhances procoagulant properties via the neutralization of plasmin, plasminogen activators and metalloproteinases. Additionally, alpha2-macroglobulin is thought to be involved in inflammatory reactions as a carrier protein for interleukin-6 (IL-6). The objective of this study was to evaluate the usefulness of alpha2-macroglobulin as a biomarker for cerebrovascular diseases. Patients with acute ischemic stroke (n = 159; 93 male and 66 female, 71.6 ± 10.3 years) and patients with no previous history of stroke (n = 77; 38 male and 39 female, 70.7 ± 9.5 years) were consecutively enrolled in this study. White matter lesions were assessed via the fluid-attenuated inversion recovery image of magnetic resonance images using the Fazekas classification. The serum alpha2-macroglobulin levels were measured by nephelometry. The serum alpha2-macroglobulin levels at admission in patients with acute ischemic stroke were higher than those in the control patients (230.2 ± 73.7 vs. 205.0 ± 55.8 mg/dl, p = 0.009). The serum alpha2-macroglobulin levels were positively correlated with age and the severity of the white matter lesions (R ² = 0.048, p < 0.001 and R ² = 0.058, p < 0.001, respectively), although there was no significant association between serum alpha2-macroglobulin levels and IL-6 levels. In addition, multivariate analysis showed that increased serum alpha2-macroglobulin levels were independently associated with the severity of white matter lesions [standardized partial regression coefficient (β) 0.102, p = 0.026]. Increased serum alpha2-macroglobulin levels might be involved in the pathophysiology of acute ischemic stroke. Furthermore, serum alpha2-macroglobulin levels, which were associated with high-grade white matter lesions, may reflect the chronic pathophysiological condition of cerebral small vessel disease.