Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension a...Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.展开更多
The glymphatic system is a relatively recently identified fluid exchange and transpo rt system in the brain.Accumulating evidence indicates thatglymphatic function is impaired not only in central nervous system disord...The glymphatic system is a relatively recently identified fluid exchange and transpo rt system in the brain.Accumulating evidence indicates thatglymphatic function is impaired not only in central nervous system disorders but also in systemic diseases.Systemic diseases can trigger the inflammatory responses in the central nervous system,occasionally leading to sustained inflammation and functional disturbance of the central nervous system.This review summarizes the current knowledge on the association between glymphatic dysfunction and central nervous system inflammation.In addition,we discuss the hypothesis that disease conditions initially associated with peripheral inflammation ove rwhelm the performance of the glymphatic system,thereby triggering central nervous system dysfun ction,chronic neuroinflammation,and neurodegeneration.Future research investigating the role of the glymphatic system in neuroinflammation may offer innovative therapeutic approaches for central nervous system disorders.展开更多
目的探讨近期皮质下小梗死(RSSI)患者颅内深髓静脉(DMV)可见性与不同区域血管周围间隙扩大(EPVS)及认知功能的相关性。方法回顾性连续纳入南京医科大学附属常州市第二人民医院神经内科自2022年10月至2023年10月收治的RSSI患者,所有患者...目的探讨近期皮质下小梗死(RSSI)患者颅内深髓静脉(DMV)可见性与不同区域血管周围间隙扩大(EPVS)及认知功能的相关性。方法回顾性连续纳入南京医科大学附属常州市第二人民医院神经内科自2022年10月至2023年10月收治的RSSI患者,所有患者入院后3 d内完成MR的常规及磁敏感加权成像(SWI)序列扫描。所有RSSI患者发病7 d内进行蒙特利尔认知评估(MoCA)量表评分。对所有患者基底节区(BG)和半卵圆中心区的EPVS进行分级评估和体积测量,使用DMV视觉评分对患者SWI幅度图或最小强度投影图上的DMV可见性进行评估,并将患者分为可见性较高的DMV低-中分组(评分0~12分,104例)及可见性较低的DMV高分组(评分13~18分,47例),采用单因素分析比较两组患者的临床和影像学资料,采用多因素Logistic回归和Spearman相关分析方法分析DMV可见性与BG-EPVS分级及体积的关系以及其与患者认知功能的关系。结果共纳入RSSI患者151例,平均年龄(69±10)岁,其中男92例(60.9%),女59例(39.1%)。DMV高分组RSSI患者的年龄[(76±5)岁比(65±10)岁,t=-10.875]、高血压病患者比例[78.7%(37/47)比54.8%(57/104),χ^(2)=7.879]、BG-EPVS分级、BG-EPVS体积[5.67(5.30,5.81)ln mm 3比4.61(3.66,5.30)ln mm 3,Z=-6.772]、脑白质高信号体积[7.67(6.23,8.43)ln mm 3比4.31(3.53,5.89)ln mm 3,Z=-6.501]均明显高于DMV低-中分组,差异均有统计学意义(均P<0.05)。DMV高分组RSSI患者的总胆固醇[3.74(3.20,4.39)mmol/L比4.09(3.47,4.96)mmol/L,Z=-2.082]、三酰甘油[1.20(0.78,1.86)mmol/L比1.53(1.05,1.99)mmol/L,Z=-2.343]、MoCA量表评分[21.0(20.0,22.0)分比24.0(22.0,25.0)分,Z=-9.862]均低于DMV低-中分组(均P<0.05)。其余基线资料差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,较高的年龄(OR=1.181,95%CI:1.070~1.304,P=0.001)、中重度BG-EPVS(OR=2.441,95%CI:1.186~5.024,P=0.015)、较高的BG-EPVS体积(OR=4.987,95%CI:1.218~19.350,P=0.020)和较高的WMH体积(OR=1.285,95%CI:1.044~1.582,P=0.018)与较高的DMV评分相关。Spearman相关性分析结果显示,DMV评分与RSSI患者的BG-EPVS分级呈正相关(r=0.613,P<0.01),与BG-EPVS体积呈正相关(r=0.549,P<0.01),与RSSI患者的MoCA量表评分呈负相关(r=-0.449,P<0.01)。结论年龄、BG-EPVS分级、BG-EPVS体积和WMH体积与RSSI患者的DMV可见性相关;RSSI患者DMV的可见性越差,认知功能损伤越严重。展开更多
目的探究女性乳腺癌患者术前新辅助化疗后脑静息态功能和类淋巴功能变化及其之间的相关性。方法40名健康女性被试及80名女性乳腺癌患者被纳入本次研究,乳腺癌患者均进行术前新辅助化疗。应用MMSE、DSST和FACT-CogPCI评分评估被试认知功...目的探究女性乳腺癌患者术前新辅助化疗后脑静息态功能和类淋巴功能变化及其之间的相关性。方法40名健康女性被试及80名女性乳腺癌患者被纳入本次研究,乳腺癌患者均进行术前新辅助化疗。应用MMSE、DSST和FACT-CogPCI评分评估被试认知功能。应用rsfMRI获取反映大脑功能活动的ALFF指标。应用DTI-ALPS技术获取反映脑类淋巴功能的ALPS指数。分析乳腺癌患者化疗前后ALFF及ALPS变化,分析各指标与认知评分之间的相关性,并分析ALFF与ALPS之间的相关性情况。结果乳腺癌患者化疗后MMSE、DSST及FACT-CogPCI评分均减低(P<0.05)。化疗后,左侧颞极中部、左侧丘脑腹外侧核及右侧顶后中回团块ALFF值减低,双侧颞叶、枕叶及顶叶多个脑区的ALFF值与FACTCogPCI评分呈正相关(pFDR-C<0.001)。化疗后ALPS指数相比正常被试增高(1.42±0.29 vs 1.56±0.24,P=0.011),同时ALPS指数与FACT-CogPCI评分呈正相关(r=0.241,P=0.04)。与此同时化疗后左侧舌状回ALFF值与ALPS指数呈正相关(r=0.69,P<0.001)。结论研究结果提示,大脑功能活动和类淋巴引流均参与化疗后认知功能改变的过程,同时两者存在相关性。展开更多
类淋巴系统可以清除脑内代谢废物,对维持中枢神经系统的内环境稳态起着重要作用,是学习、记忆等高级认知功能的重要基础。近来,越来越多的研究采用沿血管周围间隙弥散张量成像分析(diffusion tensor imaging analysis along the perivas...类淋巴系统可以清除脑内代谢废物,对维持中枢神经系统的内环境稳态起着重要作用,是学习、记忆等高级认知功能的重要基础。近来,越来越多的研究采用沿血管周围间隙弥散张量成像分析(diffusion tensor imaging analysis along the perivascular space,DTI-ALPS)方法评估类淋巴功能。相比其他需要荧光示踪技术或注射造影剂的有创检查,DTI-ALPS可以通过量化不同方向上水分子的弥散率对类淋巴系统进行流体力学评估,是一种无创的在体神经影像学方法。利用DTI-ALPS方法计算出的ALPS指数与中枢神经系统疾病及其他系统疾病的认知功能显著相关,并能反映疾病的动态变化。因此,ALPS指数有望成为预测疾病预后及临床干预疗效的新型神经影像学生物标志物。展开更多
基金supported by the National Natural Science Foundation of China,Nos.82274611 (to LZ),82104419 (to DM)Capital Science and Technology Leading Talent Training Project,No.Z1 91100006119017 (to LZ)+3 种基金Beijing Hospitals Authority Ascent Plan,No.DFL20190803 (to LZ)Cultivation Fund of Hospital Management Center in Beijing,No.PZ2022006 (to DM)R&D Program of Beijing Municipal Education Commission,No.KM202210025017 (to DM)Beijing Gold-Bridge Project,No.ZZ20145 (to DM)。
文摘Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease,the most common cerebrovascular disease.Howeve r,the causal relationship between hypertension and cerebral small vessel disease remains unclear.Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease.Chronic hypertension and lifestyle factors are associated with risks for stro ke and dementia,and cerebral small vessel disease can cause dementia and stroke.Hypertension is the main driver of cerebral small vessel disease,which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction,leukoaraiosis,white matter lesions,and intracerebral hemorrhage,ultimately res ulting in cognitive decline and demonstrating that the brain is the to rget organ of hypertension.This review updates our understanding of the pathogenesis of hypertensioninduced cerebral small vessel disease and the res ulting changes in brain structure and function and declines in cognitive ability.We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.
基金supported by the National Natural Science Foundation of China,Nos.82071249 and 81771207 (both to CH)。
文摘The glymphatic system is a relatively recently identified fluid exchange and transpo rt system in the brain.Accumulating evidence indicates thatglymphatic function is impaired not only in central nervous system disorders but also in systemic diseases.Systemic diseases can trigger the inflammatory responses in the central nervous system,occasionally leading to sustained inflammation and functional disturbance of the central nervous system.This review summarizes the current knowledge on the association between glymphatic dysfunction and central nervous system inflammation.In addition,we discuss the hypothesis that disease conditions initially associated with peripheral inflammation ove rwhelm the performance of the glymphatic system,thereby triggering central nervous system dysfun ction,chronic neuroinflammation,and neurodegeneration.Future research investigating the role of the glymphatic system in neuroinflammation may offer innovative therapeutic approaches for central nervous system disorders.
文摘目的探讨近期皮质下小梗死(RSSI)患者颅内深髓静脉(DMV)可见性与不同区域血管周围间隙扩大(EPVS)及认知功能的相关性。方法回顾性连续纳入南京医科大学附属常州市第二人民医院神经内科自2022年10月至2023年10月收治的RSSI患者,所有患者入院后3 d内完成MR的常规及磁敏感加权成像(SWI)序列扫描。所有RSSI患者发病7 d内进行蒙特利尔认知评估(MoCA)量表评分。对所有患者基底节区(BG)和半卵圆中心区的EPVS进行分级评估和体积测量,使用DMV视觉评分对患者SWI幅度图或最小强度投影图上的DMV可见性进行评估,并将患者分为可见性较高的DMV低-中分组(评分0~12分,104例)及可见性较低的DMV高分组(评分13~18分,47例),采用单因素分析比较两组患者的临床和影像学资料,采用多因素Logistic回归和Spearman相关分析方法分析DMV可见性与BG-EPVS分级及体积的关系以及其与患者认知功能的关系。结果共纳入RSSI患者151例,平均年龄(69±10)岁,其中男92例(60.9%),女59例(39.1%)。DMV高分组RSSI患者的年龄[(76±5)岁比(65±10)岁,t=-10.875]、高血压病患者比例[78.7%(37/47)比54.8%(57/104),χ^(2)=7.879]、BG-EPVS分级、BG-EPVS体积[5.67(5.30,5.81)ln mm 3比4.61(3.66,5.30)ln mm 3,Z=-6.772]、脑白质高信号体积[7.67(6.23,8.43)ln mm 3比4.31(3.53,5.89)ln mm 3,Z=-6.501]均明显高于DMV低-中分组,差异均有统计学意义(均P<0.05)。DMV高分组RSSI患者的总胆固醇[3.74(3.20,4.39)mmol/L比4.09(3.47,4.96)mmol/L,Z=-2.082]、三酰甘油[1.20(0.78,1.86)mmol/L比1.53(1.05,1.99)mmol/L,Z=-2.343]、MoCA量表评分[21.0(20.0,22.0)分比24.0(22.0,25.0)分,Z=-9.862]均低于DMV低-中分组(均P<0.05)。其余基线资料差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,较高的年龄(OR=1.181,95%CI:1.070~1.304,P=0.001)、中重度BG-EPVS(OR=2.441,95%CI:1.186~5.024,P=0.015)、较高的BG-EPVS体积(OR=4.987,95%CI:1.218~19.350,P=0.020)和较高的WMH体积(OR=1.285,95%CI:1.044~1.582,P=0.018)与较高的DMV评分相关。Spearman相关性分析结果显示,DMV评分与RSSI患者的BG-EPVS分级呈正相关(r=0.613,P<0.01),与BG-EPVS体积呈正相关(r=0.549,P<0.01),与RSSI患者的MoCA量表评分呈负相关(r=-0.449,P<0.01)。结论年龄、BG-EPVS分级、BG-EPVS体积和WMH体积与RSSI患者的DMV可见性相关;RSSI患者DMV的可见性越差,认知功能损伤越严重。
文摘目的探究女性乳腺癌患者术前新辅助化疗后脑静息态功能和类淋巴功能变化及其之间的相关性。方法40名健康女性被试及80名女性乳腺癌患者被纳入本次研究,乳腺癌患者均进行术前新辅助化疗。应用MMSE、DSST和FACT-CogPCI评分评估被试认知功能。应用rsfMRI获取反映大脑功能活动的ALFF指标。应用DTI-ALPS技术获取反映脑类淋巴功能的ALPS指数。分析乳腺癌患者化疗前后ALFF及ALPS变化,分析各指标与认知评分之间的相关性,并分析ALFF与ALPS之间的相关性情况。结果乳腺癌患者化疗后MMSE、DSST及FACT-CogPCI评分均减低(P<0.05)。化疗后,左侧颞极中部、左侧丘脑腹外侧核及右侧顶后中回团块ALFF值减低,双侧颞叶、枕叶及顶叶多个脑区的ALFF值与FACTCogPCI评分呈正相关(pFDR-C<0.001)。化疗后ALPS指数相比正常被试增高(1.42±0.29 vs 1.56±0.24,P=0.011),同时ALPS指数与FACT-CogPCI评分呈正相关(r=0.241,P=0.04)。与此同时化疗后左侧舌状回ALFF值与ALPS指数呈正相关(r=0.69,P<0.001)。结论研究结果提示,大脑功能活动和类淋巴引流均参与化疗后认知功能改变的过程,同时两者存在相关性。
文摘类淋巴系统可以清除脑内代谢废物,对维持中枢神经系统的内环境稳态起着重要作用,是学习、记忆等高级认知功能的重要基础。近来,越来越多的研究采用沿血管周围间隙弥散张量成像分析(diffusion tensor imaging analysis along the perivascular space,DTI-ALPS)方法评估类淋巴功能。相比其他需要荧光示踪技术或注射造影剂的有创检查,DTI-ALPS可以通过量化不同方向上水分子的弥散率对类淋巴系统进行流体力学评估,是一种无创的在体神经影像学方法。利用DTI-ALPS方法计算出的ALPS指数与中枢神经系统疾病及其他系统疾病的认知功能显著相关,并能反映疾病的动态变化。因此,ALPS指数有望成为预测疾病预后及临床干预疗效的新型神经影像学生物标志物。
