SINAPSE Collaboration, SFC Brain Imaging Research Centre, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, EH4 2EX, UK.
J Neurol Sci. 2010 Dec 15;299(1-2):66-71. doi: 10.1016/j.jns.2010.08.042. Epub 2010 Sep 18.
Increasing evidence from neuro and retinal imaging, neuropathology, epidemiology and experimental models suggests that the primary underlying initiating cause of cerebral small vessel disease is the derangement of the blood-brain barrier. This may start some years before the first symptoms, leads to the small vessel structural changes (vessel wall thickening, disorganisation and eventual breakdown) and perivascular changes (oedema, enlarged perivascular spaces, tissue damage interpreted as "infarcts") and is fundamentally different to traditional "ischaemic" mechanisms, although small vessel occlusion due to thrombus formation on damaged vessel walls may be a late secondary phenomenon. Space limits a detailed discussion of the epidemiology and experimental evidence, so this brief review will focus on neuroimaging evidence and summarise the appearances, risk factors and associations of different components of cerebral small vessel disease as identified on imaging, discuss potential causes and, in particular, the evidence that disordered blood-brain barrier precipitates or worsens progression of cerebral small vessel disease. This mechanism may also play a role in other common disorders of ageing such as Alzheimer's disease.
越来越多的神经和视网膜影像学、神经病理学、流行病学和实验模型的证据表明，脑小血管病的主要潜在始发原因是血脑屏障的紊乱。这种紊乱可能在首发症状出现前数年就已开始，导致小血管结构改变（血管壁增厚、组织紊乱和最终破裂）和血管周围改变（水肿、扩大的血管周围间隙、被解释为“梗死”的组织损伤），与传统的“缺血性”机制有根本的不同，尽管由于受损血管壁上血栓形成导致的小血管闭塞可能是一种晚期的继发现象。篇幅限制了对流行病学和实验证据的详细讨论，因此本综述将重点介绍神经影像学证据，并总结影像学上识别出的脑小血管病不同成分的表现、危险因素和关联，讨论潜在的病因，特别是血脑屏障紊乱可促使或加重脑小血管病进展的证据。该机制可能在阿尔茨海默病等其他常见老年疾病中也发挥作用。
