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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.

针对脑血管病的危险因素积极进行早期干预管理是减少脑血管病危害最有效的方法。本章节介绍脑血管病高危人群管理的推荐意见，包括对不可干预和可干预血管危险因素的控制，阿司匹林在缺血性卒中一级预防中的应用以及首次卒中风险评估等方面。 Abstract: Early intervention to manage the risk factors of cerebrovascular disease is the most effective way to reduce the harm of cerebrovascular diseases. This chapter presents recommendations for the management of populations at high risk for cerebrovascular disease, including control of non-interventionable and interventionable vascular risk factors, the use of aspirin in the primary prevention of ischaemic stroke, and the risk assessment of first-time stroke.

全球卒中的疾病负担沉重，抗血小板治疗是缺血性卒中二级预防的必要手段，然而东西 方人群的疾病特点存在差异，可能对抗血小板治疗的选择产生影响。本综述从卒中发病特点、患者复 发和出血风险差异以及抗血小板治疗反应多样性等多角度出发，探讨适合亚洲人群的缺血性卒中抗 血小板治疗方案。 Abstract: Stroke has become a global disease burden. Antiplatelet therapy is a necessary method for secondary prevention of ischemic stroke. However, there are differences between Easterners and Westerners on features of disease, which may lead to different antiplatelet therapy. Through the analysis of difference in disease characteristics, risk of recurrence and bleeding, and variability of platelet response, this review will explore the appropriate antiplatelet therapy for ischemic stroke patients in Asia.

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.

脑小血管病（cerebral small vessel disease，CSVD）是由各种病因影响脑内小血管所导致的一系列临床、影像、病理学综合征，其在国际上尚无统一诊断标准，症状轻微，故临床上主要根据神经影像学表现分为新近皮质下小梗死、假定血管源性腔隙、假定血管源性脑白质高信号、血管周围间隙、脑微出血、脑皮质表面铁沉积和脑萎缩。证据表明，CSVD可能与诸多神经心理学症状相关，然而，神经心理症状与CSVD发生和发展之间的关系目前尚不明确。本文对情感淡漠、疲劳、焦虑、抑郁和心理应激与CSVD影像学关系的研究进展进行了综述。 Abstract: Cerebral small vessel disease (CSVD) is a series of clinical, imaging and pathological syndrome caused by various causes affecting the small blood vessels in the brain. There is no unified diagnostic standard in the world for CSVD, and the symptoms are mild. Therefore, based on neuroimaging findings, it can be divided into recent small subcortical infarct, lacune of presumed vascular origin, white matter hyperintensity of presumed vascular origin, perivascular space, cerebral microbleed, cortical superficial siderosis, and brain atrophy. Evidence suggests that CSVD may be associated with a variety of neuropsychological manifestations. However, the relationship between neuropsychological symptoms and the occurrence and development of CSVD is not clear. In this paper, the research progress of the relationship between apathy, fatigue, anxiety, depression and psychological stress and the imaging of CSVD was reviewed.

脑小血管病（small vessel disease，SVD）是一类以脑内小血管受损为主的临床影像综合征，可能会导致卒中、血管性认知障碍、神经心理疾病与其他功能障碍等。自2013年血管性神经病变的影像报告标准（standards for reporting vascular changes on neuroimaging，STRIVE）发布以来，SVD的神经影像学特征得到了初步的分类与标准化。然而，在临床实践与科学研究中，对SVD影像特征的认识和应用仍存在诸多不一致和不规范之处。随着对SVD病理生理机制的深入探索与影像技术的不断进步，新的SVD影像特征和定量标志物被相继发现，为SVD的诊断和评估提供了更为全面且精准的信息。在此基础上，STRIVE-2应运而生，以期能更全面地揭示SVD对脑功能与结构的影响。为了规范中国SVD的神经影像学评估和诊断，本共识将在STRIVE-2的基础上，结合中国具体国情，对SVD的神经影像学特征进行深入解读，旨在推动SVD影像学诊断术语的标准化，提高临床诊断的准确性，进一步促进相关领域的研究与进步。 Abstract: Small vessel disease (SVD) is a clinical and imaging syndrome characterized by damage to small blood vessels in the brain, which can lead to stroke, vascular cognitive impairment, neuropsychological diseases, and other functional impairments. Since the publication of the standards for reporting vascular changes on neuroimaging (STRIVE) in 2013, the neuroimaging features of SVD have been preliminarily classified and standardized. However, there are still inconsistencies and lack of standardization in the understanding and application of SVD imaging features in clinical practice and scientific research. With the deepening exploration of the pathophysiological mechanisms of SVD and the continuous advancement of imaging technology, new imaging features and quantitative biomarkers of SVD have been discovered, providing more comprehensive and accurate information for the diagnosis and assessment of SVD. Based on this, the STRIVE-2 has been developed to comprehensively reveal the effects of SVD on brain function and structure. In order to standardize the neuroimaging evaluation and diagnosis of SVD in China, this consensus will provide a detailed interpretation of the neuroimaging features of SVD based on the STRIVE-2, combined with the specific national conditions of China, aiming to promote the standardization of the terms of SVD imaging diagnosis, improve the accuracy of clinical diagnosis, and further promote the research and progress in related fields.

目的 通过文献计量学的方法分析2013—2023年血管周围间隙的研究现状、热点及前沿领域。 方法 在Web of Science核心合集数据库中检索2013年1月1日—2023年6月19日血管周围间隙相关英文论著。使用CiteSpace V6.3.R1软件分析文献的发文国家、研究机构、作者的合作网络，参考文献、第一作者、期刊的共被引网络，关键词的共现网络，关键词及参考文献共被引的突现情况；使用VOSviewer 1.6.15软件对关键词进行聚类分析。 结果 共纳入1549篇文献。2013—2023年的年发文量整体呈增长趋势。美国的发文量最多，其次为中国。发文量位列前3的研究机构分别是哈佛大学、麻省总医院和爱丁堡大学。合作网络分析发现国家间合作相对紧密，国内研究机构与其他研究机构合作较少。爱丁堡大学的Wardlaw Joanna M发文量最多。关键词共现图谱显示前10个高频关键词分别为小血管病、扩大的血管周围间隙、MRI、脑、Virchow-Robin间隙、阿尔茨海默病、痴呆、风险、卒中和类淋巴系统。关键词聚类分析发现脑小血管病、痴呆、MRI 为当前研究热点，类淋巴系统为新兴的研究方向。关键词突现分析表明弥散成像从2021年至今备受关注。 结论 近10年血管周围间隙的研究热度逐年攀升。脑小血管病是主要的研究热点，类淋巴系统为新兴的研究方向，前沿领域为弥散张量成像等MRI技术。 Abstract: 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.

目的 分析自发性椎动脉夹层（spontaneous vertebral artery dissection，sVAD）、椎-基底动脉夹层（spontaneous vertebral-basilar artery dissection，sV-BAD）及基底动脉夹层（spontaneous basilar artery dissection，sBAD）相关脑梗死病灶分布特征及其与病变血管节段间的关系。 方法 本研究为单中心、回顾性研究，连续纳入2015年1月1日—2021年11月15日出院诊断为sVAD、sV-BAD和sBAD相关脑梗死住院患者，收集患者的一般临床资料、既往病史、脑梗死病灶特点、受累血管节段等信息。根据脑梗死病灶数量将患者分为单发脑梗死组和多发脑梗死组，比较两组上述指标的差异。 结果 本研究共入组41例患者，其中单发脑梗死组患者17例（41.5%），多发脑梗死组24例（58.5%）。单发脑梗死组与多发脑梗死组不同受累血管节段患者数量对比：V3段[右侧7（41.2%）vs. 8（33.3%），P=0.61；左侧7（41.2%）vs. 7（29.2%），P=0.42]；V4段[右侧9（52.9%）vs. 6（25.0%），P=0.07；左侧 6（35.3%）vs. 8（34.8%），P=0.97]，差异均无统计学意义。单发脑梗死组与多发脑梗死组不同脑梗死部位的患者数量对比：丘脑[0（0）vs. 9（39.1%），P=0.005]、枕叶[0（0）vs. 8（33.3%），P=0.01]、小脑[2（11.8%）vs. 20（83.3%），P＜0.001]、脑桥[1（5.9%）vs. 11（45.8%），P=0.006]、延髓 [14（82.4%）vs. 3（12.5%），P＜0.001]，单发脑梗死组延髓最多见，其余部位在多发脑梗死组更多见，差异均有统计学意义。单发脑梗死组与多发脑梗死组不同受累血管节段数量的患者例数对比：单一节段7（41.2%）vs. 9（37.5%）、两个节段7（41.2%）vs. 9（37.5%）、多节段3（17.6%）vs. 6（25.0%），差异无统计学意义（P=0.68）。 结论 本研究纳入的sVAD、sV-BAD和sBAD相关脑梗死病例中，单发脑梗死病灶多见于延髓，主要受累血管节段为V3段、V4段，脑梗死病灶数量与受累动脉节段数之间的关系尚不明确。 Objective To investigate the relationship between the distribution characteristics of cerebral infarction and vascular segments in patients with spontaneous vertebral artery dissection (sVAD), spontaneous vertebral-basilar artery dissection (sV-BAD) and spontaneous basilar artery dissection dissection (sBAD). Methods This was a single-center retrospective study. Hospitalized patients diagnosed with cerebral infarction caused by sVAD, sV-BAD and sBAD from January 1, 2015 to November 15, 2021 were continuously enrolled. General clinical data, past medical history, characteristics of cerebral infarction lesions, and involved vascular segments of patients were collected. The patients were divided into single cerebral infarction group and multiple cerebral infarction group according to the number of cerebral infarction lesions. The differences of the above indexes were compared between the two groups. Results A total of 41 patients were enrolled in this study, including 17(41.5%) in single cerebral infarction group and 24(58.5%) in multiple cerebral infarction group. Comparison of the main affected vascular segments between single cerebral infarction group and multiple cerebral infarction group: V3 segment[right side 7(41.2%) vs. 8(33.3%), P=0.61; left side 7(41.2%) vs. 7(29.2%), P=0.42]; V4 segment[right side 9(52.9%) vs. 6(25.0%), P=0.07; left side: 6(35.3%) vs. 8(34.8%), P=0.97]. The difference was not statistically significant. Comparison of the location of cerebral infarction between single cerebral infarction group and multiple cerebral infarction group: thalamus [0(0) vs. 9(39.1%), P=0.005], occipital lobe [0(0) vs. 8(33.3%), P=0.01], cerebellum [2(11.8%) vs. 20(83.3%), P

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.

脑小血管病（cerebral small vessel disease,CSVD）是衰老过程中的常见疾病，可能会导致卒中、认知障碍、神经心理疾病或症状以及其他功能损害。CSVD常与神经退行性疾病并存，进一步加重认知损害及其他症状的发生，从而影响患者的日常生活能力。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CSVD不同影像特征进行了分类和标准化。2023年发布的STRIVE-2进一步更新了CSVD血管变化的神经影像学指南。本文将对STRIVE-2更新要点进行解读。 Abstract: Cerebral small vessel disease (CSVD) is a common disease in the aging process that would result in stroke, cognitive disorder, neuropsychological disorders or symptoms, and other functional impairments. CSVD often co-exists with neurodegenerative diseases, further exacerbating cognitive impairment or other symptoms that affect the patient's ability to live independently. Standards for reporting vascular changes on neuroimaging 1 (STRIVE-1) classifies and standardizes the different features of CSVD seen on structural MRI. The STRIVE-2, published in 2023, further updates the neuroimaging guidelines for vascular changes in CSVD. This paper will explain the update points of STRIVE-2.

目的 探索血清丙氨酸转氨酶（alanine aminotransferase，ALT）水平与急性缺血性脑血管病不良临床结局的关系。 方法 以中国国家卒中登记研究Ⅱ中丙氨酸转氨酶（alanine aminotransferase，ALT）水平

我国正面临着全球最大的卒中挑战。全球疾病负担（global b urden o f d isease，GBD）研究结果显示，2019年我国新发卒中394万例，卒中患者达到2876万例，卒中死亡人数为219万例。此外，卒中也是我国伤残调整生命年（disability-adjusted life years，DALYs）的首位原因，2019年卒中所致DALYs达到4590万。近期的几项大型流行病学调查对与卒中有关的既往疾病数据进行了更新。2018年我国18～69岁成人的超重和肥胖率分别为34.4%和16.8%；18岁及以上无高血压病史的成人中50.9%处于高血压前期，成人高血压的加权患病率为27.5%。根据美国糖尿病学会诊断标准，2017年我国18岁及以上成人中，总糖尿病和糖尿病前期的加权患病率分别为12.8%和35.2%；45岁以上成人的心房颤动加权患病率为1.8%，患者人数相当于790万人。医院质量监测系统（hospital quality monitoring system，HQMS）中1672家三级公立医院的数据显示，2019年收治卒中病例3 411 168例，其中缺血性卒中（ischemic stroke，IS）2 818 875例（82.6%），脑出血（intracebral hemorrhage，ICH）485 474例（14.2%），蛛网膜下腔出血（subarachnoid hemorrhage，SAH）106 819例（3.1%）。中位年龄为66岁，59.6%为男性。在I S、I CH和SAH中儿童卒中（年龄

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

目的 调查蛛网膜下腔出血（subarachnoid hemorrhage，SAH）患者继发症状性癫痫的发生率、相关危险因素及其与院内结局的关系。 方法 本研究数据来源于中国卒中联盟（China Stoke Center Alliance，CSCA）登记数据库2015年8月1日-2019年7月31日入组的SAH患者。症状性癫痫限定为住院期间发作。依据是否出现继发症状性癫痫，将研究对象分为SAH继发癫痫组和无继发癫痫组，比较组间的人口学特征、入院GCS评分、血管危险因素、手术以及医院级别和地区的差异。采用多因素Logistic回归，分析SAH继发癫痫的危险因素，以及SAH继发癫痫与院内死亡、缺血性卒中、脑出血及肺炎的相关性。 结果 本研究纳入11 210例SAH患者，女性6623例（59.1%），平均年龄60.0±12.9岁，入院GCS评分的中位数为15分。总计228例（2.0%）继发症状性癫痫。年龄（OR 0.92，95%CI 0.87～0.97）、既往卒中/TIA（OR 1.61，95%CI 1.20～2.17）、颈动脉狭窄（OR 3.17，95%CI 1.27～10.85）、心房颤动（OR 2.64，95%CI 1.12～6.24）、脂代谢紊乱（OR 1.79，95%CI 1.03～3.13）和脑室外分流术（OR 2.30，95%CI 1.31～4.02）是SAH继发症状性癫痫的独立影响因素。SAH继发症状性癫痫可能与更高的院内死亡（OR 1.71，95%CI 0.96～3.05）、缺血性卒中（OR 4.21，95%CI 2.70～6.56）、脑出血（OR 3.87，95%CI 2.81～5.33）及肺炎（OR 2.96，95%CI 2.26～3.86）事件风险相关。 结论 症状性癫痫是SAH患者较为常见的神经系统并发症，低龄、既往卒中/TIA、颈动脉狭窄、心房颤动、脂代谢紊乱以及脑室外分流术是SAH继发症状性癫痫的独立危险因素。SAH继发症状性癫痫增加院内死亡、缺血性卒中、脑出血以及肺炎的风险。 【Abstract】 Objective To investigate the incidence and risk factors of symptomatic seizures after subarachnoid hemorrhage (SAH), and the relationship between secondary seizures and in-hospital outcomes. Methods The in-hospital SAH patients from the China Stoke Center Alliance (CSCA) registry database from August 1, 2015, to July 31, 2019 were enrolled in the retrospective analysis. According to the presence of symptomatic seizures or not after SAH during hospitalization, all the subjects were divided into SAH with seizure group and SAH without seizure group. Differences in demographics, score of Glasgow comma scale (GCS) at admission, vascular risk factors, surgery, and the class and region of hospitals were compared. A multivariate logistic regression model was used to identify risk factors of seizures after SAH and evaluate the association of in-hospital death, ischemic stroke, intracerebral hemorrhage (ICH) and pneumonia with symptomatic seizures after SAH. Results A total of 11 210 SAH patients were enrolled in this study, with the average age of 60.0±12.9 years and 6623 (59.1%) females, and the median GCS score was 15 points. A total of 228 (2.0%) cases had symptomatic seizures after SAH. Age (OR 0.92, 95%CI 0.87-0.97), prior stroke/TIA (OR 1.61, 95%CI 1.20-2.17), carotid stenosis (OR 3.17, 95%CI 1.27-10.85), atrial fibrillation (OR 2.64, 95%CI 1.12-6.24), dyslipidemia (OR 1.79, 95%CI 1.03-3.13), and external ventricular drainage (OR 2.30, 95%CI 1.31-4.02) were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH may be associated with a higher risk of in-hospital death (OR1.71, 95%CI 0.96-3.05), ischemic stroke (OR 4.21, 95%CI 2.70-6.56), ICH (OR 3.87, 95%CI 2.81-5.33) and pneumonia (OR 2.96, 95%CI 2.26-3.86). Conclusions Symptomatic seizures is a common neurological complication in SAH patients. Younger age, prior stroke/TIA, carotid stenosis, atrial fibrillation, dyslipidemia and external ventricular drainages were independent risk factors for symptomatic seizures after SAH. Symptomatic seizures after SAH increased the risk of in-hospital death, cerebral infarction, ICH pneumonia.

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.

血管源性脑白质高信号（white matter hyperintensity，WMH）是脑小血管病的典型影像学征 象之一。临床上有一部分WMH病例无高血压、糖尿病等传统血管危险因素，却伴有偏头痛、晕厥、睡 眠呼吸暂停、睡眠障碍、直立性低血压等非传统危险因素或临床症状。本文对研究WMH与非传统血 管危险因素关系的文献进行整理和总结。对非传统血管危险因素的深入研究有助于进一步认识WMH 的潜在机制。针对非传统血管危险因素的控制和治疗可能有助于WMH的预防和治疗。 Abstract: Cerebral white matter hyperintensity (WMH) of presumed vascular origin is one of the typical neuroimaging features of cerebral small vessel diseases. A certain number of clinical cases with WMH had no traditional stroke risk factors such as hypertension and diabetes, while had non-traditional symptoms/risk factors including migraine, syncope, obstructive sleep apnea, sleep disorders and orthostatic hypotension. This article reviews the advances in relationship between WMH and non-traditional risk factors (migraine, syncope, obstructive sleep apnea, sleep disorders and orthostatic hypotension). The further study on non-traditional vascular risk factors will help us to understand the potential mechanism of WMH, and interventions for these non-traditional factors may be helpful for prevention and treatment of WMH.

脑小血管病（cerebral small vessel disease，CSVD）是临床上常见的一类与年龄相关的脑血管 疾病。脑白质高信号（white matter hypertensities，WMH）是CSVD的影像标志物之一。WMH患病率极高， 与认知障碍的发生发展密切相关，但其影像表现及临床症状的异质性为早期发现、早期诊断带来了 困难。本文从病理学、影像学及生物学3方面对WMH发生发展及其导致认知障碍的机制研究现况进 行综述，同时总结目前的治疗策略，提出了接下来的研究目标及方向：能够反映预后的标志物及预测 模型的研究，WMH发生发展的病理生理学机制研究，针对早期干预、药物开发的潜在靶点的研究等。 Abstract: Cerebral small vascular disease (CSVD) is one of the most common age-related cerebrovascular diseases. White matter hyperintensity (WMH) of presumed vascular origin is one of the imaging markers of CSVD. The prevalence of WMH is extremely high, and which is closely related to the occurrence and development of cognitive impairment. However, the heterogeneity of imaging manifestations and clinical symptoms of WMH brings some difficulties to early detection and diagnosis. What’s more, the potential mechanism for disease development is not clear, so it leads to a relative lag in prevention and treatment of these diseases. This paper reviewed the current state of research on the mechanisms of cognitive impairment in the development of WMH from pathology, imaging and biology, and summarized the current treatment strategies, and raised some research objectives and directions in the next, for example, to establish the biomarkers and prediction model for assessing prognosis, to explore pathophysiological mechanism of WMH development, and find new potential targets for early intervention.

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.

目的 本研究旨在比较支架置入与球囊扩张治疗特发性颅内高压（idiopathic intracranial hypertension， IIH）伴静脉窦狭窄的疗效差异。 方法 对2012年1月-2015年12月在首都医科大学附属北京天坛医院接受介入治疗（支架置入或球囊 扩张）的IIH伴静脉窦狭窄患者的基线特征、手术过程、围手术期管理和临床结局进行了前瞻性连续 性登记。介入治疗方案由神经介入医师和患者协商决定。临床结局改善程度分为3级：症状消失、症 状改善、症状无变化或加重。通过比较支架组和球囊扩张组术后3个月、6个月、12个月症状消失的比 例，探讨两种治疗方法的疗效差异。 结果 本研究共纳入45例患者，其中支架组26例，球囊扩张组19例。两组患者的基线人口学 特征差异无统计学意义。支架组术后颅内静脉窦狭窄两端的压力差显著低于球囊扩张组（中位 数：0 vs 7 mm Hg，P

目的 探讨不同胰岛素抵抗状态对无糖尿病史的非致残性缺血性脑血管病（non-disabling ischemic cerebrovascular events，NICE）患者卒中复发风险的影响。 方法 使用稳态模型胰岛素抵抗（homeostasis model assessment of insulin resistance，HOMA-I R）指数 对胰岛素抵抗进行评估。根据不同胰岛素抵抗状态，使用四分位法将无糖尿病史的NICE患者分为4 组。该研究的主要研究终点为90 d新发卒中（包括缺血性和出血性卒中）。利用多元Cox回归模型校正 潜在协变量，评估不同胰岛素抵抗状态与卒中复发风险之间的关系，同时对不同抗血小板聚集治疗、 不同胰岛素抵抗状态与卒中复发之间的交互作用进行统计分析。 结果 本研究共纳入2325例NICE患者。根据患者不同胰岛素抵抗状态分组，4组界值分别为Q1 （HOMA-IR指数﹤1.35）、Q2（1.35≤HOMA-IR指数﹤2.17）、Q3（2.17≤HOMA-IR指数﹤3.39）及Q4（HOMAIR 指数≥3.39），4组患者人数分别为585例、575例、585例及580例。90 d随访时，共出现167例卒中复 发，其中氯吡格雷联合阿司匹林组为68例，阿司匹林组为99例。与Q1组（6.3%）比较，Q2组（9.2%，校 正HR 1.56，95%CI 1.01～2.41，P =0.04）、Q3组（5.6%，校正HR 1.04，95%CI 0.64～1.69，P =0.89）和 Q4组（7.6%，校正HR 1.35，95%CI 0.85～2.15，P =0.21）患者卒中复发风险均未明显上升。 结论 本研究未在NICE患者中发现胰岛素抵抗与卒中复发风险升高相关。 Abstract: Objective To explore the effect of different insulin resistance state on the prognosis of patients with non-disabling ischemic cerebrovascular events (NICE). Methods The homeostasis model HOMA-IR index was used to evaluate insulin resistance. According to different insulin resistance status, patients were divided into four groups by quartile method. The primary endpoint was 90-day new-onset stroke (including ischemic and hemorrhagic stroke). Multivariate Cox regression model was used to assess the relationship between different insulin resistance status and recurrent stroke. The interaction between different antiplatelet therapeutic regimen and different insulin resistance status on recurrent stroke was also analyzed. Results A total of 2325 NICE patients were enrolled in this study. According to different insulin resistance status, all patients were divided into 4 groups: Q1 (HOMA-IR index

目的 探讨特发性颅内高压（idiopathic intracranial hypertension，IIH）患者入院时炎症指标与近期视力 下降的相关性。 方法 对2011年9月-2018年9月在首都医科大学附属北京天坛医院血管神经病学科诊治的58例 IIH患者临床资料进行回顾性分析。根据患者入院时近1个月内是否出现视力下降，分为近期视力 下降组（13例）和非近期视力下降组（45例）。应用秩和检验比较两组患者的血清超敏C反应蛋白 （hypersensitive C reactive protein，hs-CRP）、红细胞沉降率（erythrocyte sedimentation rate，ESR）、白细 胞绝对值、中性粒细胞绝对值、淋巴细胞绝对值、中性粒细胞/淋巴细胞比值等炎症指标的差异。 结果 近期视力下降组血清hs-CRP及ESR水平显著高于非近期视力下降组[5.50（3.35～8.45）vs 2.60（2.10～2.90）mg/L，P＜0.001；18.0（13.0～24.0）vs 11.0（5.0～14.5）mm/h，P＜0.032]；而血清 白细胞绝对值、中性粒细胞绝对值、淋巴细胞绝对值及中性粒细胞/淋巴细胞比值在两组间差异无 统计学意义。 结论 在IIH患者中，存在近期视力下降的患者血清hs-CRP及ESR水平更高，提示炎症反应可能参与 IIH患者视力障碍病程的急性进展。 Abstract: Objective To investigate the correlation between serum inflammatory factor level and recent visual impairment in patients with idiopathic intracranial hypertension (IIH). Methods Clinical data of 58 patients with IIH who were hospitalized in Department of Neurology, Beijing Tian Tan Hospital from September 2011 to September 2018 were retrospectively analyzed. According to whether patients had visual impairment or not within recent 1 month on admission, they were divided into the recent visual impairment group (n =13) and non-recent visual impairment group (n =45). Kruskal-Wallis test was used to compare the difference of serum hypersensitive C reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), white blood cell counts, neutrophile granulocyte cell counts, lymphocyte cell counts and neutrophile granulocyte / lymphocyte cell ratio and other inflammatory indicators between the two groups. Results Serum hs-CRP and ESR level in the recent visual impairment group were significantly higher than that in non-recent visual impairment group [5.50 (3.35-8.45) vs 2.60 (2.10-2.90) mg/L, P

缺血性脑血管病的梗死模式具有多样性，根据梗死数目可分为无梗死、单发梗死和多发 梗死。单发梗死主要根据病灶的位置和大小进行分类，多发梗死则根据血管的供血范围进行分类。 单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。 Abstract: The infarct patterns of ischemic cerebrovascular diseases are diverse. Based on the number of infarct, the infarct pattern can be classified as no infarct, single infarct or multiple infarcts. Single infarct can be classified according to the size and location of the infarcts, and multiple infarcts can be classified according to the involved territory of culprit artery. Different patterns of single and multiple infarcts are related to the etiology and mechanism.

【摘要】 目的 探讨多发颅内动脉狭窄对轻型缺血性卒中和TIA早期卒中复发的影响。 方法 纳入氯吡格雷用于急性非致残性脑血管事件高危人群的疗效（Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events，CHANCE）研究影像亚组1089例非心源性高危TIA和轻型缺血性卒中患者。根据患者入院时MRA序列的检查结果分为无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄3组。随访患者90 d卒中复发（缺血性和出血性卒中）事件。采用Cox回归分析多发颅内动脉狭窄对轻型缺血性卒中和TIA患者90 d卒中复发风险的影响。 结果 无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄组分别有608例、298例和183例患者；90 d卒中发生风险比例分别为5.43%、9.06%和18.03%。与无颅内动脉狭窄患者相比，伴有颅内动脉狭窄（包含单发和多发颅内动脉狭窄）患者卒中复发风险显著高于非颅内动脉狭窄患者（12.50% vs 5.40%，P＜0001）。其中，多发颅内动脉狭窄卒中复发风险最高（18.03%），是无颅内动脉狭窄患者的3.578倍（HR 3.578，95%CI 2.189～5.850）。 结论 多发颅内动脉狭窄是非心源性TIA和轻型卒中患者早期卒中复发的独立危险因素。 【Abstract】 Objective To investigate the effect of multiple intracranial atherosclerotic stenosis (ICAS) on early stroke recurrence in patients with TIA and minor ischemic stroke. Methods 1089 patients with noncardioembolic high-risk TIA and minor ischemic stroke in the imaging subgroup of the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) randomized clinical trial were included in this study. Based on MRA results after admission, ICAS status were grouped into no ICAS, single ICAS and multiple ICAS. The outcomes were recurrent stroke (including ischemic or hemorrhagic stroke) during 90-day follow-up. Cox proportional hazards models were used to assess the association of ICAS status and stroke recurrence. Results 608 patients had no ICAS, 298 patients had single ICAS and 183 patients had multiple ICAS, and theircorresponding risk of recurrent stroke was 5.43%, 9.06% and 18.03%, respectively. Patients with ICAS (including single and multiple ICAS) had a significantly higher risk of recurrent stroke than patients without ICAS (12.50% vs 5.40%, P