Blood-brain barrier permeability and long-term clinical and imaging outcomes in cerebral small vessel disease.
Blood-brain barrier permeability and long-term clinical and imaging outcomes in cerebral small vessel disease.
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DOI：
10.1161/strokeaha.112.669994
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发表时间：
2013-02
期刊：
影响因子：
8.3
通讯作者：
Dennis MS
中科院分区：
文献类型：
--
作者：
Wardlaw JM;Doubal FN;Valdes-Hernandez M;Wang X;Chappell FM;Shuler K;Armitage PA;Carpenter TC;Dennis MS
血脑屏障（BBB）通透性增加发生在脑小血管病（SVD）中。尚不清楚BBB变化是否早于SVD进展。我们随访了非致残性腔隙性或皮质性卒中患者，并在其原始卒中后进行了BBB渗透性MR成像。大约三年后，我们评估了功能结局（牛津残疾评分，OHS，不良结局定义为3-6），复发性神经系统事件和MRI上的白色高信号（WMH）进展。在70例患者中，平均年龄68（SD±11）岁，临床随访的中位时间为39个月（IQR 30-45），中位OHS为2（IQR 1-3）;功能结局不良与基线WMH评分较高（p<0.001）和基底节BBB通透性增加（p=0.046）相关。在48例随访MRI的患者中，随访时WMH进展与基线WMH（ANCOVA p<0.0001）和年龄（ANCOVA p=0.032）相关。需要在足够大的研究中进行进一步的长期研究，以评估BBB功能障碍在SVD进展中的作用，以解释关键的预后影响，如基线WMH和年龄。
Increased blood-brain barrier (BBB) permeability occurs in cerebral small vessel disease (SVD). It is not known if BBB changes predate progression of SVD. We followed up patients with non-disabling lacunar or cortical stroke and BBB permeability MR imaging following their original stroke. About three years later, we assessed functional outcome (Oxford Handicap Score, OHS, poor outcome defined as 3-6), recurrent neurological events and white matter hyperintensity (WMH) progression on MRI. Amongst 70 patients, mean age 68 (SD±11) years, median time to clinical follow up was 39 months (IQR 30-45), median OHS was 2 (IQR 1-3); poor functional outcome was associated with higher baseline WMH score (p<0.001) and increased basal ganglia BBB permeability (p=0.046). Amongst 48 patients with follow-up MRI, WMH progression at follow-up was associated with baseline WMH (ANCOVA p<0.0001) and age (ANCOVA p=0.032). Further long term studies to evaluate the role of BBB dysfunction in progression of SVD are required in studies that are large enough to account for key prognostic influences such as baseline WMH and age.