脑小血管病患者步态障碍的脑结构改变研究进展

Research progress in brain structural changes in cerebral small vessel disease patients with gait disturbance

步态障碍是脑小血管病(CSVD)的重要皮质下损害特征,显著增加跌倒风险,其发病机制目前尚不明确。在CSVD传统影像学特征中,脑白质高信号(WMH)与步态障碍最为相关,且以脑室旁白质高信号(PWMH)和幕下WMH为著;WMH严重程度与步态障碍可能是一种阈值关系,即仅重度WMH影响步态活动。在GMV及CTh方面,CSVD患者全脑灰质体积减少和皮质变薄均与步态障碍密切相关。弥散张量成像(DTI)研究发现CSVD步态障碍患者存在着包括高级认知控制和下行运动纤维束在内的广泛白质微结构受损,且不同的白质纤维结构可能与不同的步态损害特征有关。该文分别从传统影像学表现、灰质体积(GMV)、皮质厚度(CTh)及脑白质微结构等方面综述CSVD步态障碍在脑结构方面取得的研究进展。该文分别从传统影像学表现、灰质体积(GMV)、皮质厚度(CTh)及脑白质微结构等方面综述CSVD步态障碍在脑结构方面取得的研究进展,这有利于进一步提高对CSVD步态障碍神经机制的认识。

Gait disturbance is an important feature of subcortical damage in patients with cerebral small vascular disease(CSVD),which significantly increases the risk of falls.However,the mechanism of gait disturbance is still unclear.In this paper,we review the research progress in brain structural changes in CSVD patients with gait disturbance,including traditional imaging manifestations,gray matter volume(GMV),cortical thickness(CTh),and white matter microstructure.In traditional imaging findings,white matter hyperintensities(WMH)is mostly associated with gait disturbance,especially periventricular white matter hyperintensities and in⁃fratentorial WMH.There may be a threshold relationship rather than a dose-effect relationship between WMH severity and gait distur⁃bance because only severe WMH leads to gait disturbance.In terms of GMV and CTh,CSVD patients with gait disturbance present sig⁃nificantly decreased GMV and CTh.In addition,diffusion tensor imaging shows that CSVD patients with gait disturbance have exten⁃sive damage in white matter microstructure including the fibers involved in higher cognitive control and descending motor tracts.More⁃over,different white matter fiber structures may be related to specific characteristics of gait disturbance.This paper contributes to fur⁃ther understanding of the neural mechanism of gait disturbance in CSVD,but there are still many questions to be answered.