脑小血管病:病理生理机制综述。

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Translational Stroke Research Pub Date : 2024-12-01 Epub Date: 2023-10-21 DOI:10.1007/s12975-023-01195-9
Yousef Hannawi
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引用次数: 0

摘要

脑小血管病(cSVD)是指涉及脑小血管并导致血管认知障碍、脑出血和急性腔隙性缺血性中风的年龄依赖性病理过程。尽管cSVD给公共卫生带来了巨大负担,但由于对潜在病理生理机制的不完全了解,疾病特异性疗法仍然不可用。神经成像获取和处理能力的最新进展以及cSVD动物模型的发现揭示了几种年龄依赖性过程在cSVD发病机制中的关键作用,包括动脉硬化、血管氧化应激、低度全身炎症、肠道生态失调和盐摄入量增加。这些因素相互作用,导致内皮细胞功能障碍,损害大脑血流调节并打破血脑屏障。神经炎症随后导致神经元损伤和cSVD临床表现。通过免疫系统清除脑废物的障碍是另一个潜在的过程,最近被强调是导致认知能力下降的原因。这篇综述详细介绍了这些机制,并试图解释它们复杂的相互作用。此外,还确定了cSVD机制理解方面的相关知识差距,并提出了未来转化和早期临床研究的系统方法,以揭示新的cSVD机制并开发疾病特异性治疗方法。
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Cerebral Small Vessel Disease: a Review of the Pathophysiological Mechanisms.

Cerebral small vessel disease (cSVD) refers to the age-dependent pathological processes involving the brain small vessels and leading to vascular cognitive impairment, intracerebral hemorrhage, and acute lacunar ischemic stroke. Despite the significant public health burden of cSVD, disease-specific therapeutics remain unavailable due to the incomplete understanding of the underlying pathophysiological mechanisms. Recent advances in neuroimaging acquisition and processing capabilities as well as findings from cSVD animal models have revealed critical roles of several age-dependent processes in cSVD pathogenesis including arterial stiffness, vascular oxidative stress, low-grade systemic inflammation, gut dysbiosis, and increased salt intake. These factors interact to cause a state of endothelial cell dysfunction impairing cerebral blood flow regulation and breaking the blood brain barrier. Neuroinflammation follows resulting in neuronal injury and cSVD clinical manifestations. Impairment of the cerebral waste clearance through the glymphatic system is another potential process that has been recently highlighted contributing to the cognitive decline. This review details these mechanisms and attempts to explain their complex interactions. In addition, the relevant knowledge gaps in cSVD mechanistic understanding are identified and a systematic approach to future translational and early phase clinical research is proposed in order to reveal new cSVD mechanisms and develop disease-specific therapeutics.

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来源期刊
Translational Stroke Research
Translational Stroke Research CLINICAL NEUROLOGY-NEUROSCIENCES
CiteScore
13.80
自引率
4.30%
发文量
130
审稿时长
6-12 weeks
期刊介绍: Translational Stroke Research covers basic, translational, and clinical studies. The Journal emphasizes novel approaches to help both to understand clinical phenomenon through basic science tools, and to translate basic science discoveries into the development of new strategies for the prevention, assessment, treatment, and enhancement of central nervous system repair after stroke and other forms of neurotrauma. Translational Stroke Research focuses on translational research and is relevant to both basic scientists and physicians, including but not restricted to neuroscientists, vascular biologists, neurologists, neuroimagers, and neurosurgeons.
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