Higher blood-brain barrier permeability is associated with higher white matter hyperintensities burden
Higher blood-brain barrier permeability is associated with higher white matter hyperintensities burden
复制标题
DOI：
10.1007/s00415-017-8550-8
复制
发表时间：
2017-07-01
影响因子：
6
通讯作者：
Hu, Wenli
中科院分区：
文献类型：
--
作者：
Li, Yue;Li, Man;Hu, Wenli
白色高信号（WMH）的发病机制尚不完全清楚，但血脑屏障（BBB）功能障碍可能起关键作用。本研究旨在探讨血脑屏障通透性与WMH负荷严重程度之间的关系。在这项横断面研究中招募了没有症状性卒中史的连续参与者进行体格检查，并根据总Fazekas评分将其分为三个WMH负担组。他们接受动态对比增强磁共振成像以测量BBB通透性，并接受简易精神状态检查（MMSE）和蒙特利尔认知评估（莫卡）。共招募了102名年龄在49-90岁（平均年龄69.82岁）的参与者（36名WMH低负荷，35名WMH中等负荷，31名WMH高负荷）。多变量线性回归分析显示，在校正年龄、性别和血管危险因素后，WMH负荷较高的参与者在正常白色物质、WMH、皮质灰质和深部灰质（DGM）中的BBB渗漏率和渗漏曲线下面积显著较高。在调整年龄、性别、WMH负担和受教育年限后，MMSE和莫卡评分随WMH和DGM泄漏率的增加而降低。我们发现，较高的血脑屏障通透性与较高的WMH负担和认知能力下降相关。受损的BBB完整性可能是WMH发病机制的关键因素，也是最终导致认知障碍的一系列病理过程的一部分。
The pathogenesis of white matter hyperintensities (WMH) is incompletely understood but blood-brain barrier (BBB) dysfunction may play a key role. This study aimed to investigate the relationship between BBB permeability and the severity of WMH burden. Consecutive participants without symptomatic stroke history presented for physical examination were recruited in this cross-sectional study and divided into three WMH burden groups according to total Fazekas scores. They received dynamic contrast-enhanced-magnetic resonance imaging to measure BBB permeability, and received Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A total of 102 participants aged 49-90 years (mean age of 69.82 years) were enrolled (36 with low WMH burden, 35 with medium WMH burden, and 31 with high WMH burden). Multivariable linear regression analyses revealed that participants with higher WMH burden had significantly higher BBB leakage rate and area under the leakage curve in normal-appearing white matter, WMH, cortical gray matter, and deep gray matter (DGM) after adjustment for age, sex, and vascular risk factors. Scores on MMSE and MoCA decreased with increasing leakage rate in WMH and DGM after adjustment for age, sex, WMH burden, and education years. We found that higher BBB permeability is associated with higher WMH burden and cognitive decline. The compromised BBB integrity may be a critical contributor to the pathogenesis of WMH and part of a series of pathological processes that finally lead to cognitive impairment.