Sleep Division Department of Neurology Vanderbilt University Medical Center Nashville TN.
Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville TN.
J Am Heart Assoc. 2021 Jun;10(11):e019627. doi: 10.1161/JAHA.120.019627. Epub 2021 May 15.
Background Patients with restless legs syndrome (RLS) have increased silent microvascular disease by magnetic resonance imaging. However, there has been no previous autopsy confirmation of these magnetic resonance imaging findings. RLS is also frequently associated with inflammatory and immunologically mediated medical disorders. The postmortem cortex in patients with RLS was therefore evaluated for evidence of microvascular and immunological changes. Methods and Results Ten microvascular injury samples of precentral gyrus in 5 patients with RLS (3 men, 2 women; mean age, 81 years) and 9 controls (2 men, 7 women; mean age, 90 years) were studied by hematoxylin and eosin stains in a blinded fashion. None of the subjects had a history of stroke or neurologic insults. In a similar manner, the following immunohistochemistry stains were performed: (1) glial fibrillary acidic protein (representing gliosis, reactive change of glial cells in response to damage); (2) CD3 (a T-cell marker); (3) CD19 (a B-cell marker); (4) CD68 (a macrophage marker); and (5) CD117 (a mast cell marker). Patients with RLS had significantly greater silent microvascular disease (=0.015) and gliosis (=0.003). T cells were increased in RLS compared with controls (=0.009) and tended to colocalize with microvascular disease (=0.003). Other markers did not differ. There was no correlation between microvascular lesion load and RLS severity or duration. Conclusions Patients with RLS had statistically significantly more silent cerebral microvascular disease and gliosis than controls compatible with previous magnetic resonance imaging studies and with studies showing a link between RLS and hypertension, clinical stroke, and cardiovascular disease. T-cell invasion may be a secondary phenomenon.
磁共振成像显示，不安腿综合征（RLS）患者存在更多的无症状微血管疾病。然而，之前没有通过尸检来证实这些磁共振成像发现。RLS 还经常与炎症和免疫介导的医学疾病有关。因此，评估了 RLS 患者死后皮质中是否存在微血管和免疫变化的证据。
对 5 名 RLS 患者（3 名男性，2 名女性；平均年龄 81 岁）和 9 名对照者（2 名男性，7 名女性；平均年龄 90 岁）的 10 个中央前回微血管损伤样本进行了血 红蛋白和伊红染色盲法研究。所有受试者均无卒中或神经损伤病史。以类似的方式进行了以下免疫组化染色：（1）胶质纤维酸性蛋白（代表神经胶质增生，是胶质细胞对损伤的反应性变化）；（2）CD3（T 细胞标志物）；（3）CD19（B 细胞标志物）；（4）CD68（巨噬细胞标志物）；和（5）CD117（肥大细胞标志物）。RLS 患者的无症状性微血管疾病显著增加（=0.015），神经胶质增生（=0.003）。与对照组相比，RLS 患者的 T 细胞增加（=0.009），并且倾向于与微血管疾病共定位（=0.003）。其他标志物没有差异。微血管病变负荷与 RLS 严重程度或持续时间之间无相关性。
与之前的磁共振成像研究以及显示 RLS 与高血压、临床卒中和心血管疾病之间存在关联的研究一致，RLS 患者的大脑无症状性微血管疾病和神经胶质增生明显多于对照组。T 细胞浸润可能是一种继发现象。
