Neurology:脑淀粉样血管病患者中,有腔梗者更易出现脑出血

2021-04-10 Freeman MedSci原创

脑淀粉样血管病患者中,有腔梗者更易出现脑出血

散发性脑淀粉样血管病(Sporadic cerebral amyloid angiopathy,CAA)是老年人常见的小血管疾病,病理特点是β淀粉样蛋白在皮质和软网膜血管中堆积。

CAA可导致脑叶内出血(ICH)、和脑叶微出血(CMBs)、以及白质高信号病变(WMH)、皮质脑微梗死(CMIs)等缺血性病变。腔梗(lacune),病理上定义为动脉穿支闭塞导致的小梗塞,在脑小血管疾病患者中也很常见。

最近研究表明,与高血压深部ICH(HTNICH)患者相比,位于脑叶区域的lacune在CAA相关ICH患者中更为常见。腔梗(lacune)和CMIs是散发的脑部病变,可能与缺血有关,但在CAA患者中尚未研究其关联性和机制。潜在的机制可能包括散发的微小血管闭塞或CAA中的全局性血管功能障碍; 后者可以使用从fMRI获得的血氧水平依赖性(BOLD)信号进行量化。

藉此,哈佛大学的Elif Gokcal等人,探究了腔梗与皮质脑微梗死(CMIs)的关系,评估其与血管功能障碍的关系,并研究其对脑淀粉样血管病(CAA)发生脑内出血(ICH)风险的影响。

在这项研究中,他们假设:lacune和CMIs有相似的机制,因此CAA伴有lacune的患者更可能有CMIs。

此外,血管功能障碍是CAA中全局性脑缺血的主要贡献者,但与lacune和CMI的形成无关,并认为这主要是由于局灶性血管病变所致。

最后,探讨了腔梗的存在对CAA患者ICH事件风险的潜在影响。

他们利用了前瞻性注册的CAA队列中,回顾性地分析了腔梗(深部/脑叶)、CMIs和WMH体积的数量和地形,该队列接受了高分辨率MRI。在多变量模型中评估了腔梗与CMIs和其他CAA相关标志物的关系,包括血氧水平依赖性信号达到峰值(TTP)的时间。最后通过Cox回归模型用于研究腔梗和ICH事件之间的关系。

他们纳入了122名无痴呆的可能CAA(probable CAA)患者(平均年龄69.4±7.6岁)。31例患者(25.4%)存在腔梗,除一例外,其余均位于脑叶区域。

与无腔梗的患者相比,有裂隙的患者皮质CMIs更常见(51.6% vs 20.9%,p = 0.002)。TTP与裂隙或CMI无关(均P>0.2),但较长的TTP反应与较高的WMH体积独立相关(P=0.001)。

在单变量和多变量Cox回归模型中,腔梗与ICH风险增加相关(分别为p = 0.048和p = 0.026)。

这个在CAA中的研究,重要意义在于发现了,CAA 中脑叶腔梗的发病率很高,经常与CMIs共存,提示这2种病变类型可能是CAA相关梗死共同谱系的一部分。腔梗与血管功能障碍无关,但可预测ICH的发生,会导致严重的局灶性血管受累,而不是全局性缺血作为其机制。


原文出处:

Lacunes, Microinfarcts, and Vascular Dysfunction in Cerebral Amyloid Angiopathy
Elif Gokcal, Mitchell J. Horn, Susanne J. van Veluw,et al.
Neurology Mar 2021, 96 (12) e1646-e1654; DOI: 10.1212/WNL.0000000000011631

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    2021-12-29 yinhl1978
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    2021-04-10 ms1000001799055092

    学习一下

    0

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    2021-04-10 yangchou

    好文章,共享之

    0

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    2021-04-10 学医无涯

    学习一下

    0

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