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脑小血管病（cerebral small vessel disease，CSVD）是一组临床、影像、病理综合征，主要累及颅内小血管，起病隐匿。CSVD与卒中、认知下降、情感障碍、步态异常及尿便失禁密切相关，给家庭和社会带来沉重的疾病负担和经济负担。但CSVD的致病机制仍不明确，临床诊断标准不统一，临床诊疗和试验研究面临重大挑战。本文旨在汇总当前CSVD的可能病因、发病机制和临床诊疗研究的进展及局限性，展望CSVD未来可能的临床研究方向。 Abstract: Cerebral small vessel disease (CSVD) is a group of clinical, imaging and pathological syndromes mainly involving intracranial small vessels. The onset of CSVD is occult. It is closely related to stroke, cognitive decline, affective disorders, gait abnormalities and urinary and fecal incontinence. It brings heavy disease burden and economic burden to the family and society. However, the true pathogenesis of CSVD is still unclear, and the clinical diagnostic criteria are not uniform, which makes clinical diagnosis and treatment and experimental research face major challenges. The purpose of this paper is to discuss the progress and limitations of the etiology, pathogenesis, clinical diagnosis and treatment of CSVD, and to look forward to the possible clinical research direction of CSVD in the future.

明确脑小血管病（cerebral small vessel disease，CSVD）的代谢危险因素并进行及时、系统的管控至关重要。目前残余代谢危险因素与CSVD的相关性尚存争议，而靶向危险因素治疗CSVD的临床效果尚缺乏循证依据。本文综合分析炎症、肠道菌群紊乱、高同型半胱氨酸血症及高尿酸血症等残余代谢危险因素与CSVD发生、发展的相关性，进一步探讨靶向代谢危险因素的潜在治疗方案，强调代谢组学在CSVD新型代谢生物标志物发现和风险预测模型建立中的重要作用，并展望未来研究方向，为CSVD的早期诊断、机制探索、危险因素管控和多学科综合管理提供理论依据。 Abstract: It is crucial to identify the metabolic risk factors of cerebral small vessel disease (CSVD) and implement timely and systematic management. Currently, the correlation between residual metabolic risk factors and CSVD is still controversial, and there’s a lack of evidence-based support for the clinical efficacy of targeting risk factors in treating CSVD. This paper comprehensively analyzes the correlation between residual metabolic risk factors such as inflammation, gut microbiota dysbiosis, hyperhomocysteinemia, and hyperuricemia with the occurrence and development of CSVD. It further explores potential therapeutic options targeting metabolic risk factors, emphasizes the important role of metabolomics in the discovery of novel metabolic biomarkers and the establishment of risk prediction models for CSVD, and looks forward to future research directions, to provide a theoretical basis for the early diagnosis, mechanism exploration, risk factor management, and comprehensive multidisciplinary management of CSVD.

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To analyze the current research status, hotspots, and frontier fields of perivascular spaces from 2013 to 2023 based on bibliometric analysis. Methods The related English article of perivascular spaces was retrieved in the Web of Science Core Collection from January 1, 2013 to June 19, 2023. CiteSpace V6.3.R1 software was used to analyze the cooperation network among the publishing countries, institutions and authors; the co-citation network of reference, first author of reference and journals; the co-occurrence network of keywords, burst analysis of keywords and reference co-citation. VOSviewer 1.6.15 software was used for keywords cluster analysis. Results A total of 1549 papers were included. The annual publications from 2013 to 2023 showed an overall increasing trend. The United States ranked the first and China ranked the second. The top three prolific institutions were Harvard University, Massachusetts General Hospital and University of Edinburgh. Cooperative network analysis showed that the cooperation between countries was close and domestic institutions collaborated less with other institutions. Wardlaw Joanna M from University of Edinburgh ranked the first in publications. The top ten keywords in co-occurrence network were small vessel disease, enlarged perivascular spaces, MRI, brain, Virchow-Robin spaces, Alzheimer’s disease, dementia, risk, stroke and glymphatic system. Cluster analysis of keywords showed that cerebral small vessel disease, dementia and MRI were current hotspots, and glymphatic system was a new research direction. Burst analysis of keywords suggested diffusion imaging has got much attention since 2021. Conclusions The research on perivascular spaces has increased during the recent 10 years. Cerebral small vessel disease was the main hotspot and glymphatic system was a new direction. Diffusion tensor imaging was a frontier field. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

脑小血管病（small vessel disease,SVD）是衰老过程中的常见疾病，可出现卒中、认知障碍、神经心理症状或其他功能损害表现。脑小血管病国际影像标准1（standards for reporting vascular changes on neuroimaging 1，STRIVE-1）对结构MRI上所见的SVD不同影像特征，包括脑白质高信号、血管周围间隙、微出血、近期皮质下小梗死、假定血管源性腔隙和脑萎缩，进行了分类和标准化。随着对SVD影像特征认识的逐渐清晰，以及机器学习方法的迅速兴起，新的SVD研究的神经影像学标准——STRIVE-2已发布。为更全面地反映SVD对大脑的影响，STRIVE-2新增加了脑皮质的微梗死、偶发DWI阳性病灶等影像学特征，同时提出了当前SVD相关研究的困境和未来科研发展的希望。 Abstract: Cerebral small vessel disease (SVD) is a common disease in the aging process that would result in stroke, cognitive impairment, neuropsychological disorders or symptoms, and other functional impairments. Standards for reporting vascular changes on neuroimaging-1 (STRIVE-1) categorised and standardised the diverse features of SVD that are visible on structural MRI, including white matter hyperintensity, perivascular space, cerebral microbleed, recent small subcortical infarcts, lacune (of presumed vascular origin) and brain atrophy. With the understanding of the influence of SVD image features becoming clearer, combined with the rapidly emerging machine learning methods, a new neuroimaging standard for the study of small cerebral vascular disease has been updated which is STRIVE-2. In order to capture the effect of SVD on the brain more comprehensively, STRIVE-2 newly added imaging features such as cortical cerebral microinfarct and incidental DWI+ lesion. In addition, the STRIVE-2 presents the dilemmas of current researches and the hopes for future research development.

目的 探讨脑小血管病（cerebral small vessel disease，CSVD）患者排尿功能紊乱与自主神经功能的相关性。 方法 采用横断面研究的方法，连续性纳入2020年1月—2021年1月首都医科大学附属北京天坛医院收治的符合入排标准的CSVD患者。使用膀胱过度活动症评分表（overactive bladder syndrome score，OABSS）评估患者的排尿功能，使用心率变异性（heart rate variability，HRV）评估患者的自主神经功能。根据患者是否符合膀胱过度活动症（overactive bladder，OAB）诊断标准将患者分为OAB组和非OAB组，分析两组患者CSVD影像特征和HRV参数的差异。进一步采用Spearman相关分析评估CSVD患者排尿障碍与自主神经功能紊乱的相关性。 结果 共71例CSVD患者纳入分析，其中17例（23.9%）符合临床OAB的诊断标准，64例（90.1%）CSVD患者具有完整的HRV数据、排尿功能评估和影像资料。与非OAB组患者相比，OAB组患者年龄更大[（66.5±10.1）岁 vs.（57.6±10.8）岁，P=0.003]、男性比例更低（47.1% vs. 79.6%，P=0.009）、脑白质高信号更严重（76.5% vs. 49.0%，P=0.048）。OAB组与非OAB组患者HRV参数比较差异均无统计学意义。校正年龄和性别的偏相关分析结果显示，全部正常相邻R-R间期差值的均方根（r=-0.25，P50 ms of variation (pNN50) (r=-0.30, P

脑部血管周围间隙扩大是脑小血管病的影像学标志物之一，其发生发展的机制尚不明确。 现有研究表明血流动力学改变可能引起血管周围间隙扩大的发生发展。本文从血压、血管管壁僵硬 程度、脑血流量等因素对血管周围间隙扩大的影响作一简要综述，为探索血管周围间隙扩大的发病 机制及可能的治疗方法提供帮助。 Abstract: The enlarged perivascular space is one of the neuroimaging markers of cerebral small vessel disease. The mechanism of perivascular space enlargement is still unclear. Many studies have shown that abnormal hemodynamics may be correlated with the enlarged perivascular space. This article reviewed the relationship between blood pressure, stiffness of vessel wall and cerebral blood flow with the enlarged perivascular space, to provide reference for studies of pathogenesis and possible treatment methods of enlarged perivascular space.

脑小血管病（cerebral small vessel disease，CSVD）是一种主要累及脑内小血管的慢性全脑性 疾病，临床表现多样。排尿障碍和排便障碍作为CSVD的常见症状，严重影响着人们的日常生活和社 会功能。约70%的CSVD患者可出现排尿障碍，以排尿刺激症状为主，可表现为尿频、尿急、急迫性尿 失禁及夜尿增多，且与疾病的严重程度、病变部位相关。排便障碍与脑血管病关系密切，但目前尚无 有关CSVD患者排便障碍的大型流行病学数据。本文分别以CSVD患者排尿功能障碍与排便功能障碍 为切入点，探讨CSVD患者二便障碍的发生率和具体表现形式，探索可能引起CSVD患者二便障碍的病 理生理机制，为CSVD的诊治提供新的方向。 Abstract: Cerebral small vessel disease (CSVD) is a major chronic whole-brain disease mainly involving small vessels in the brain, with diverse clinical manifestation. CSVD has attracted more and more attention in recent years. As common clinical manifestation of CSVD, bowel and bladder dysfunction (BBD) seriously affect patients’ daily life and social function. Urinary dysfunction may occur in about 70% of CSVD patients, which mainly be manifested as urinary stimulation symptoms including urinary frequency, urgency, incontinence and nocturia, and the clinical symptoms are related with the severity of CSVD and lesions location. Bowel dysfunction is closely related to cerebral vascular diseases, but there is no large-scale epidemiological data on bowel disorders in patients with CSVD. This paper discussed the incidence and clinical manifestation of BBD, the possible pathogenesis of BBD in patients with CSVD, to provide a new direction for the diagnosis and treatment of CSVD.

目前认为脑小血管病（cerebral small vessel disease，CSVD）的主要机制是血管内皮损伤，而 炎症和血管内皮损伤密切相关，血清中血管内皮损伤相关标志物及炎性标志物是反映炎症损伤血管 内皮最直接、最简便的方法。关于生物标志物的研究为更深入了解CSVD的发生发展机制提供了重要 的途径。目前多项研究表明炎性及血管内皮损伤相关标志物与CSVD的发生、发展关系密切。另外炎症 与CSVD关系也可能受到人种、遗传等因素的影响。本文就血清中血管内皮相关标志物、炎性标志物与 CSVD不同影像学标志的相关性研究进展进行综述。 Abstract: It is currently believed that the main mechanism of cerebral small vessel disease (CSVD) is vascular endothelial injury, which is closely related to inflammation. Serum endothelial injury and inflammatory biomarkers are the most direct and simple methods to reflect endothelial injury. Studies on biomarkers will help us to further understand the pathogenesis of CSVD. Many studies have shown that inflammatory and endothelial injury biomarkers are closely related to the occurrence and development of CSVD. In addition, the relationship between inflammation and CSVD may be affected by race, genetics, and etc. This article reviewed the progress of relationship between serum vascular endothelial injury markers, inflammatory markers and different imaging markers of CSVD.

脑大、小血管在结构和功能上密切相关。越来越多的证据表明脑小血管病常与颅内大动 脉病变共存，严重程度具有一定相关性。颅内大动脉粥样硬化、颅内动脉延长扩张和颅内动脉僵硬 度增加分别反映了颅内大血管的结构和功能改变。本文就脑小血管病与不同颅内大动脉病理变化之 间共存及互相影响的研究现状进行综述，以探讨脑大、小血管病的关系。 Abstract: Cerebral small vessels and large arteries are closely related in structure and function. There is increasing evidence that cerebral small vessel disease often coexists with intracranial large artery disease, and their severity is consistent. Intracranial large artery atherosclerosis, intracranial arterial dolichoectasia and increased arterial stiffness all reflect structural and functional changes of large artery. This article reviewed the research status on the interaction and coexistence between cerebral small vessel disease and intracranial large artery disease.

【摘要】 脑小血管病是导致认知功能减退、步态情感障碍和痴呆的重要脑血管疾病，脑白质弥漫性损伤是该病的重要影像学特征。结合国内外近年来相关研究内容，本文对不同的脑小血管病白质损伤动物模型制作进行了系统性回顾，包括单一型动物模型如双侧颈总动脉狭窄模型、脑淀粉样血管病模型、Notch3转基因小鼠模型、自发性高血压大鼠模型、易卒中型肾血管性高血压大鼠模型，以及由两个或两个以上单一型动物模型组合而成的复合型动物模型等。 【Abstract】 In recent years, cerebral small vessel disease (CSVD) has been paid more and more concern because it can cause cognitive decline, dementia, gait abnormality, emotion disorder and etc. The important imaging feature of CSVD is diffuse white matter lesions. This article reviewed the advance in the establishment of animal models of CSVD with white matter lesion in different ways. These animal models included bilateral common carotid artery stenosis mouse model, cerebral amyloid angiopathy mouse model, Notch3 transgenic mouse model, spontaneous hypertensive rat model, stroke-prone renovascular hypertensive rat model, and mixed models composed of two or more single animal models.