Small vessel disease: mechanisms and clinical implications
小血管疾病：机制和临床意义
摘要：
Small vessel disease is a disorder of cerebral microvessels that causes white matter hyperintensities and several other common abnormalities (eg, recent small subcortical infarcts and lacunes) seen on brain imaging. Despite being a common cause of stroke and vascular dementia, the underlying pathogenesis is poorly understood. Research in humans has identified several manifestations of cerebral microvessel endothelial dysfunction including blood-brain barrier dysfunction, impaired vasodilation, vessel stiffening, dysfunctional blood flow and interstitial fluid drainage, white matter rarefaction, ischaemia, inflammation, myelin damage, and secondary neurodegeneration. These brain abnormalities are more dynamic and widespread than previously thought. Relationships between lesions and symptoms are highly variable but poorly understood. Major challenges are the determination of which vascular dysfunctions are most important in pathogenesis, which abnormalities are reversible, and why lesion progression and symptomatology are so variable. This knowledge will help to identify potential targets for intervention and improve risk prediction for individuals with small vessel disease.
小血管疾病是脑微血管疾病，其引起白质高信号和在脑成像中看到的若干其他常见异常（例如，最近的小皮质下梗塞和腔隙）。尽管是中风和血管性痴呆的常见原因，但其潜在的发病机制却知之甚少。对人类的研究已经确定了脑微血管内皮功能障碍的几种表现，包括血脑屏障功能障碍，血管舒张受损，血管硬化，血流不畅和间质液引流，白质稀疏，局部缺血，炎症，髓鞘损伤和继发性神经变性。这些大脑异常比以前认为的更具活力和广泛性。病变和症状之间的关系变化很大，但知之甚少。主要挑战是确定哪些血管功能障碍在发病机制中最重要，哪些异常是可逆的，以及为什么病变进展和症状变化如此多变。这些知识将有助于确定干预的潜在目标，并改善小血管疾病患者的风险预测。