Cerebral Small Vessel Disease
Cerebral Small Vessel Disease
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DOI：
10.1007/978-3-030-82367-2_66
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发表时间：
2021-11
期刊：
影响因子：
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通讯作者：
B. Gogia;R. Libman;Anand V. Patel
中科院分区：
文献类型：
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作者：
B. Gogia;R. Libman;Anand V. Patel
脑部小血管病(SVD)是一种脑内小血管的疾病，包括小动脉、毛细血管和小静脉[1]。组织学上，血管是根据其管壁的厚度进行分类的，而没有明确区分其直径。随着对缺血性疾病病理生理学的认识和1993年的TOAST分类[2]，小血管和大血管疾病的概念逐渐流行起来。小血管的确切定义尚不清楚，但通常小血管包括小肌肉动脉和大小动脉，而不是毛细血管和小静脉。通常，小动脉的直径为10-100fμm，深穿支动脉和软脑膜动脉的直径约为50-800nμm[3]。在磁共振成像(MRI)或计算机断层扫描(CT)的脑成像出现之前，SVD只能通过病理检查来诊断[4]。这些损害在临床上通常是沉默的，但可能与认知障碍、痴呆症、抑郁症、中风风险增加、中风后预后更差以及步态异常有关。更敏感的MRI方法和组织病理学研究表明，与小血管疾病相关的脑损伤不仅限于可见的病变，还可以发生在正常外观的白质和灰质中。中风进展回顾小组创造的术语神经血管单位(NVU)由神经元、星形胶质细胞、内皮细胞、周细胞和血管平滑肌细胞组成。从目前已知的情况来看，NVU调节血脑屏障(BBB)，目前对其在脑血管和神经退行性疾病中的作用进行了研究。SVD是一个在神经保护机制和血管危险因素之间平衡的基础上可以进展或消退的动态过程。
Cerebral small vessel disease (SVD) of the brain is a disorder of the small vessels in the brain including arterioles, capillaries, and venules [1]. Histologically, vessels were classified based on the thickness of their walls without a clear distinction about their diameter. With the understanding of the pathophysiology of ischemic disease and the TOAST classification in 1993 [2], the concept of small vessel and large vessel disease became popular. The exact definitions of small vessels remain unclear, but often small vessels include small muscular arteries and large sized arterioles more than capillaries and venules. Typically, arterioles have a diameter of 10–100 μm, and deep perforating and leptomeningeal arteries are approximately 50–800 μm [3]. Prior to advent of brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT), SVD was only diagnosed on pathological examination [4]. These lesions are often clinically silent but can be associated with cognitive impairment, dementia, depression, increased risk of stroke, worse outcome after stroke, and gait abnormalities. Small vessel disease-related brain damage is not confined to visible lesions but also can occur in normal appearing white matter and gray matter as evidenced by more sensitive MRI methods and histopathological studies. The term neurovascular unit (NVU) coined by the Stroke Progress Review Group [5] consists of neurons, astrocytes, endothelial cells, pericytes, and vascular smooth muscle cells. From what is known thus far, NVU regulates the blood-brain barrier (BBB), and its role in cerebrovascular and neurodegenerative diseases is currently studied [6]. SVD is a dynamic process which can progress or regress based on the balance between neural protective mechanisms and vascular risk factors.