Lammie G A, Brannan F, Slattery J, Warlow C
University Department of Pathology, Western General Hospital, Edinburgh, United Kingdom.
Stroke. 1997 Nov;28(11):2222-9. doi: 10.1161/01.str.28.11.2222.
Cerebral small-vessel disease (SVD) is a common aging phenomenon that is exacerbated by hypertension and diabetes mellitus. It is regarded as an important cause of lacunar infarction and intracerebral hemorrhage. The present study was performed to highlight the existence and to some extent the frequency of pathologically verified SVD lacking in classic risk factors and to extend the scope of risk factor analysis.
The study group comprised 70 consecutively referred autopsy brains with microscopic evidence of SVD. In each case clinical records, autopsy reports, and central nervous system and systemic autopsy histology were reviewed. SVD was graded as mild, moderate, or severe in six standardized brain regions, and the results analyzed in relation to the presence or absence of classic SVD risk factors.
SVD was manifest largely as concentric hyaline wall thickening; lipohyalinosis and fibrinoid necrosis were rarely observed. Thirty-one percent of cases failed to meet stringent clinicopathological criteria for significant prior hypertension. In 9% of cases, patients had been nonelderly, nondiabetic, and normotensive. Five of six cases lacking classic risk factors had systemic conditions known to enhance small-vessel permeability.
The nature of SVD appears to have been modified by effective treatment of hypertension. Classic risk factors are often absent. The hypothesis that a variety of conditions that enhance small-vessel permeability may contribute to the pathogenesis of SVD merits consideration.
脑小血管病（SVD）是一种常见的衰老现象，高血压和糖尿病会使其加重。它被视为腔隙性脑梗死和脑出血的重要病因。本研究旨在突出缺乏经典危险因素的经病理证实的SVD的存在及其在一定程度上的发生率，并扩大危险因素分析的范围。
研究组包括70例连续送检的尸检脑标本，具有SVD的微观证据。对每例患者的临床记录、尸检报告以及中枢神经系统和全身尸检组织学进行了回顾。在六个标准化脑区将SVD分为轻度、中度或重度，并根据是否存在经典SVD危险因素对结果进行分析。
SVD主要表现为同心性透明样壁增厚；很少观察到脂质透明变性和纤维蛋白样坏死。31%的病例不符合显著既往高血压的严格临床病理标准。在9%的病例中，患者非老年、非糖尿病且血压正常。缺乏经典危险因素的六例病例中有五例存在已知可增强小血管通透性的全身性疾病。
高血压的有效治疗似乎改变了SVD的性质。经典危险因素往往不存在。各种可增强小血管通透性的疾病可能促成SVD发病机制的假说值得考虑。
