Cerebral small vessel disease（CSVD） is a common etiology of vascular cognitive impairment with no dementia（V-CIND）. Studies have revealed that cerebral microbleeds（CMBs）, a feature of CSVD, contribute to cogniti...Cerebral small vessel disease（CSVD） is a common etiology of vascular cognitive impairment with no dementia（V-CIND）. Studies have revealed that cerebral microbleeds（CMBs）, a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients（29.3%） had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits（odds ratio = 4.4; 95% confidence interval： 1.602-12.081, P = 0.004） and 5 or more CMBs overall（odds ratio = 17.6, 95% confidence interval： 3.23-95.84, P = 0.001） had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs.展开更多
We aimed to assess the associations of large artery stenosis(LAS)and cerebral small vessel disease(CSVD)with the risk of ischemic stroke and to investigate their respective and combined contributions.In the prospectiv...We aimed to assess the associations of large artery stenosis(LAS)and cerebral small vessel disease(CSVD)with the risk of ischemic stroke and to investigate their respective and combined contributions.In the prospective population-based Shunyi Study,1,082 stroke-free participants aged 55.9±9.1 years were included.Participants were followed for incident stroke throughout the study period(2013-2019).Total small vessel disease score was used to measure CSVD burden.Cervico-cerebral large artery stenosis was evaluated via brain magnetic resonance angiography and carotid ultrasound.We estimated the risk of ischemic stroke in relation to LAS and CSVD with Cox regression models.During a mean follow-up of 4.2 years,34 participants(3.1%)experienced at least one ischemic stroke.Severe LAS(≥50% stenosis versus no stenosis:HR=3.27(95%CI:1.31-8.18))and high CSVD burden(total small vessel disease score 2-4 versus 0 point:HR=12.73(4.83-33.53))were associated with increased stroke risk independently.In multivariate models,CSVD burden(7.72%)explained a larger portion of the variation in stroke risk than severity of LAS(3.49%).Our findings identified that both LAS and CSVD were associated with future ischemic stroke in asymptomatic subjects,while those with high CSVD burden deserve more attention in primary prevention of stroke.展开更多
目的 探讨脑小血管病(CSVD)患者近期皮质下小梗死与认知功能的相关性。方法 回顾性连续纳入2018年2月―2022年9月就诊于北京大学第一医院神经内科经头部MRI诊断的CSVD患者,收集一般人口学资料和临床资料,使用简易精神状态量表(MMSE)、...目的 探讨脑小血管病(CSVD)患者近期皮质下小梗死与认知功能的相关性。方法 回顾性连续纳入2018年2月―2022年9月就诊于北京大学第一医院神经内科经头部MRI诊断的CSVD患者,收集一般人口学资料和临床资料,使用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,根据磁共振DWI分为近期皮质下小梗死(RSSI)组和非RSSI组,统计RSSI的部位和数目。比较两组患者的一般人口学资料、临床资料、认知功能,分析RSSI影像学特征与认知功能的关系。结果 共纳入CSVD患者181例,RSSI组91例,非RSSI组90例。RSSI组与非RSSI组相比,BMI高[(25.43±3.53)kg/m^(2) vs(24.27±3.33)kg/m^(2),t=2.228, P=0.027],收缩压高[(145.3±16.2)mmHg vs(139.6±20.2)mmHg,t=2.013,P=0.046],MoCA总分较低[22(18.8,26) vs 24(21,27),Z=-1.980,P=0.048],视空间与执行能力[3(2,4) vs 4(3,5),Z=-2.756,P=0.006]、语言[2(2,3) vs 2(1,2), Z=-2.020,P=0.043]、抽象[2(1,2) vs 2(1,2)分,Z=-2.052,P=0.04]得分均较低,差异均具有显著性统计学意义(P<0.05)。RSSI基底节梗死组与非RSSI组相比,MoCA总分较低[21(17,23) vs 24(21,27),Z=-2.018,P=0.044],视空间与执行[3(1.5,3.5) vs 4(3,5),Z=-2.601,P=0.009]得分较低,RSSI脑干梗死组与非RSSI组相比,视空间与执行[3(2,4) vs 4(3,5),Z=-2.325,P=0.020]、语言[2(1,2) vs 2(2,3),Z=-2.338,P=0.019]得分较低,差异具有显著性统计学意义。结论 CSVD患者中RSSI可导致认知功能障碍,与RSSI梗死部位相关,RSSI不同梗死部位导致不同的认知损害模式。预防RSSI发生,对于预防CSVD相关认知功能障碍具有重要意义。展开更多
目的探讨脑小血管(cerebral small vessel disease,CSVD)负担评分对短暂性脑缺血发作(transient ischemic attack,TIA)患者复发性脑血管事件(recurrence cerebrovascular events,RCVEs)的预测价值。材料与方法回顾性分析2019年10月至202...目的探讨脑小血管(cerebral small vessel disease,CSVD)负担评分对短暂性脑缺血发作(transient ischemic attack,TIA)患者复发性脑血管事件(recurrence cerebrovascular events,RCVEs)的预测价值。材料与方法回顾性分析2019年10月至2022年12月期间于安徽省第二人民医院就诊的182例TIA患者病例资料,依据MRI检查计算CSVD总体负担评分,根据随访1个月内有无发生RCVEs分为RCVEs组(n=46)和未RCVEs组(n=136)。比较两组临床资料和CSVD总体负担评分,采用多因素logistic回归分析模型分析RCVEs的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析CSVD影像特征得分及总负担评分对TIA患者RCVEs的预测价值。结果RCVEs组和未RCVEs组TIA发作次数、症状持续时间、既往高血压病史、CSVD总负担评分及分级情况比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:TIA发作次数、症状持续时间、CSVD总负担评分是TIA患者发生RCVEs的独立危险因素(P<0.05)。ROC曲线分析结果显示:CSVD影像特征评分及总负担评分预测TIA患者发生RCVEs的曲线下面积(areas under the curve,AUC)分别为0.771(95%CI:0.673~0.869,P<0.001)、0.745(95%CI:0.655~0.835,P<0.001)、0.664(95%CI:0.549~0.780,P=0.009)、0.845(95%CI:0.766~0.924,P<0.001)、0.945(95%CI:0.896~0.994,P<0.001),其中CVSD总负担评分预测的AUC最高,当最佳截断值为2分时,敏感度为86.05%,特异度为83.02%。结论CSVD总负担评分对TIA患者发生RCVEs的预测价值良好,有助于临床评估TIA患者的短期预后。展开更多
脑小血管病(cerebral small vessel disease,CSVD)是导致卒中和痴呆的常见原因。而除了常见的小动脉硬化性脑小血管病,非动脉硬化性脑小血管病的防治也不容忽视,目前这类疾病尚缺乏特异的治疗药物,且机制未明、异质性较强,但临床对症治...脑小血管病(cerebral small vessel disease,CSVD)是导致卒中和痴呆的常见原因。而除了常见的小动脉硬化性脑小血管病,非动脉硬化性脑小血管病的防治也不容忽视,目前这类疾病尚缺乏特异的治疗药物,且机制未明、异质性较强,但临床对症治疗方面已有部分证据,在深入挖掘机制的同时也探索出潜在疗法。现旨在对该领域治疗进展予以综述。展开更多
目的探讨远隔缺血预适应联合盐酸多奈哌齐片治疗脑小血管病(cerebral small vessel disease,CSVD)患者的临床效果。方法选取78例CSVD患者作为研究对象,观察组(盐酸多奈哌齐片联合远隔缺血预适应治疗)39例,对照组(盐酸多奈哌齐片治疗)39...目的探讨远隔缺血预适应联合盐酸多奈哌齐片治疗脑小血管病(cerebral small vessel disease,CSVD)患者的临床效果。方法选取78例CSVD患者作为研究对象,观察组(盐酸多奈哌齐片联合远隔缺血预适应治疗)39例,对照组(盐酸多奈哌齐片治疗)39例。治疗结束后比较2组的疗效,并比较2组治疗前后蒙特利尔认知量表(Montreal cognitive scale,MoCA)、简化36医疗结局研究量表(36-item short form survey instrument,SF-36)生活质量评分、脑血管灌注参数[平均通过时间(mean transit time,MTT)、脑血流量(cerebral blood flow,CVB)、血流速度(blood flow velocity,CBF)]、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-8(interleukin-8,IL-8)、中枢神经特异性蛋白(central nervous system specific protein,S100β)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平。结果治疗前2组各参数比较差异均无统计学意义(P>0.05),治疗后2组MoCA、SF-36量表、CVB、CBF、BDNF、VEGF上升,MTT、TNF-α、IL-8、S100β水平下降(P<0.05);与对照组比较,观察组MoCA、SF-36量表、CVB、CBF、BDNF、VEGF及总有效率更高,MTT、TNF-α、IL-8、S100β更低(P<0.05)。治疗后观察组及对照组的总有效率分别为89.74%、71.79%,2组比较差异有统计学意义(P<0.05)。结论远隔缺血预适应联合盐酸多奈哌齐片可显著改善CSVD患者的认知功能障碍、脑血流灌注及炎性反应,并能提高患者的生活质量。展开更多
基金supported by the Medical Scientific Research Foundation of Guangdong Province,China(No.A2015160)
文摘Cerebral small vessel disease（CSVD） is a common etiology of vascular cognitive impairment with no dementia（V-CIND）. Studies have revealed that cerebral microbleeds（CMBs）, a feature of CSVD, contribute to cognitive impairment. However, the association between CMBs and dementia conversion in individuals with V-CIND is still unclear. Here, we analyzed the predictive role of CMBs in the conversion from V-CIND to dementia in CSVD patients. We recruited and prospectively assessed 85 patients with CSVD and V-CIND. V-CIND was evaluated using a series of comprehensive neuropsychological scales, including the Chinese version of the Montreal Cognitive Assessment and the Clinical Dementia Rating. MRI assessments were used to quantify lacunar infarcts, white matter hyperintensities, CMBs, and medial temporal lobe atrophy. Eighty-two of the 85 patients completed the assessment for dementia conversion at a 1-year follow-up assessment. Multivariate logistic regression analyses were conducted to examine independent clinical and MRI variables associated with dementia conversion. Twenty-four patients（29.3%） had converted to dementia at the 1-year follow-up, and these individuals had significantly more CMBs in the fronto-subcortical circuits. Multivariate logistic regression analyses revealed that the patients with CMBs in the fronto-subcortical circuits（odds ratio = 4.4; 95% confidence interval： 1.602-12.081, P = 0.004） and 5 or more CMBs overall（odds ratio = 17.6, 95% confidence interval： 3.23-95.84, P = 0.001） had a significantly increased risk of dementia at the 1-year follow-up. These findings indicate that CMBs in the fronto-subcortical circuits may be predictive of dementia conversion in CSVD patients with V-CIND, and thus extend the clinical significance of CMBs.
基金supported by the National Key Research and Development Program of China(2016YFB1001402)National Natural Science Foundation of China(81971138)+2 种基金Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)(2017-I2M-3-008)Strategic Priority Research Program(Pilot study)“Biological basis of aging and therapeutic strategies”of the Chinese Academy of Sciences(XDPB10)Research Foundation for Young Scholars of Peking Union Medical College Hospital(PUMCH201911275)。
文摘We aimed to assess the associations of large artery stenosis(LAS)and cerebral small vessel disease(CSVD)with the risk of ischemic stroke and to investigate their respective and combined contributions.In the prospective population-based Shunyi Study,1,082 stroke-free participants aged 55.9±9.1 years were included.Participants were followed for incident stroke throughout the study period(2013-2019).Total small vessel disease score was used to measure CSVD burden.Cervico-cerebral large artery stenosis was evaluated via brain magnetic resonance angiography and carotid ultrasound.We estimated the risk of ischemic stroke in relation to LAS and CSVD with Cox regression models.During a mean follow-up of 4.2 years,34 participants(3.1%)experienced at least one ischemic stroke.Severe LAS(≥50% stenosis versus no stenosis:HR=3.27(95%CI:1.31-8.18))and high CSVD burden(total small vessel disease score 2-4 versus 0 point:HR=12.73(4.83-33.53))were associated with increased stroke risk independently.In multivariate models,CSVD burden(7.72%)explained a larger portion of the variation in stroke risk than severity of LAS(3.49%).Our findings identified that both LAS and CSVD were associated with future ischemic stroke in asymptomatic subjects,while those with high CSVD burden deserve more attention in primary prevention of stroke.
文摘目的 探讨脑小血管病(CSVD)患者近期皮质下小梗死与认知功能的相关性。方法 回顾性连续纳入2018年2月―2022年9月就诊于北京大学第一医院神经内科经头部MRI诊断的CSVD患者,收集一般人口学资料和临床资料,使用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能,根据磁共振DWI分为近期皮质下小梗死(RSSI)组和非RSSI组,统计RSSI的部位和数目。比较两组患者的一般人口学资料、临床资料、认知功能,分析RSSI影像学特征与认知功能的关系。结果 共纳入CSVD患者181例,RSSI组91例,非RSSI组90例。RSSI组与非RSSI组相比,BMI高[(25.43±3.53)kg/m^(2) vs(24.27±3.33)kg/m^(2),t=2.228, P=0.027],收缩压高[(145.3±16.2)mmHg vs(139.6±20.2)mmHg,t=2.013,P=0.046],MoCA总分较低[22(18.8,26) vs 24(21,27),Z=-1.980,P=0.048],视空间与执行能力[3(2,4) vs 4(3,5),Z=-2.756,P=0.006]、语言[2(2,3) vs 2(1,2), Z=-2.020,P=0.043]、抽象[2(1,2) vs 2(1,2)分,Z=-2.052,P=0.04]得分均较低,差异均具有显著性统计学意义(P<0.05)。RSSI基底节梗死组与非RSSI组相比,MoCA总分较低[21(17,23) vs 24(21,27),Z=-2.018,P=0.044],视空间与执行[3(1.5,3.5) vs 4(3,5),Z=-2.601,P=0.009]得分较低,RSSI脑干梗死组与非RSSI组相比,视空间与执行[3(2,4) vs 4(3,5),Z=-2.325,P=0.020]、语言[2(1,2) vs 2(2,3),Z=-2.338,P=0.019]得分较低,差异具有显著性统计学意义。结论 CSVD患者中RSSI可导致认知功能障碍,与RSSI梗死部位相关,RSSI不同梗死部位导致不同的认知损害模式。预防RSSI发生,对于预防CSVD相关认知功能障碍具有重要意义。
文摘目的探讨脑小血管(cerebral small vessel disease,CSVD)负担评分对短暂性脑缺血发作(transient ischemic attack,TIA)患者复发性脑血管事件(recurrence cerebrovascular events,RCVEs)的预测价值。材料与方法回顾性分析2019年10月至2022年12月期间于安徽省第二人民医院就诊的182例TIA患者病例资料,依据MRI检查计算CSVD总体负担评分,根据随访1个月内有无发生RCVEs分为RCVEs组(n=46)和未RCVEs组(n=136)。比较两组临床资料和CSVD总体负担评分,采用多因素logistic回归分析模型分析RCVEs的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析CSVD影像特征得分及总负担评分对TIA患者RCVEs的预测价值。结果RCVEs组和未RCVEs组TIA发作次数、症状持续时间、既往高血压病史、CSVD总负担评分及分级情况比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:TIA发作次数、症状持续时间、CSVD总负担评分是TIA患者发生RCVEs的独立危险因素(P<0.05)。ROC曲线分析结果显示:CSVD影像特征评分及总负担评分预测TIA患者发生RCVEs的曲线下面积(areas under the curve,AUC)分别为0.771(95%CI:0.673~0.869,P<0.001)、0.745(95%CI:0.655~0.835,P<0.001)、0.664(95%CI:0.549~0.780,P=0.009)、0.845(95%CI:0.766~0.924,P<0.001)、0.945(95%CI:0.896~0.994,P<0.001),其中CVSD总负担评分预测的AUC最高,当最佳截断值为2分时,敏感度为86.05%,特异度为83.02%。结论CSVD总负担评分对TIA患者发生RCVEs的预测价值良好,有助于临床评估TIA患者的短期预后。
文摘脑小血管病(cerebral small vessel disease,CSVD)是导致卒中和痴呆的常见原因。而除了常见的小动脉硬化性脑小血管病,非动脉硬化性脑小血管病的防治也不容忽视,目前这类疾病尚缺乏特异的治疗药物,且机制未明、异质性较强,但临床对症治疗方面已有部分证据,在深入挖掘机制的同时也探索出潜在疗法。现旨在对该领域治疗进展予以综述。
