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中华脑科疾病与康复杂志(电子版) ›› 2017, Vol. 07 ›› Issue (02) : 94 -98. doi: 10.3877/cma.j.issn.2095-123X.2017.02.011

所属专题: 文献

综述

脑微出血的危险因素及临床意义
倪睿涵1, 李娅2, 楚兰2,()   
  1. 1. 550004 贵阳,贵州医科大学
    2. 550004 贵阳,贵州医科大学附属医院神经内科
  • 收稿日期:2016-10-17 出版日期:2017-04-01
  • 通信作者: 楚兰

Risk Factors and Clinical Implications of Cerebral Microbleed

Ruihan Ni1, Ya Li2, Lan Chu2,()   

  1. 1. Guizhou Medical University, Guiyang 550004, China
    2. Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guizhou 550004, China
  • Received:2016-10-17 Published:2017-04-01
  • Corresponding author: Lan Chu
  • About author:
    Corresponding author: Chu Lan, Email:
引用本文:

倪睿涵, 李娅, 楚兰. 脑微出血的危险因素及临床意义[J]. 中华脑科疾病与康复杂志(电子版), 2017, 07(02): 94-98.

Ruihan Ni, Ya Li, Lan Chu. Risk Factors and Clinical Implications of Cerebral Microbleed[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2017, 07(02): 94-98.

脑微出血(CMB)具有一定"隐匿性",临床中容易对其忽视或漏检。随着影像学技术的迅速发展,这一影像学表现逐渐受到重视。CMB是脑小血管病的亚型之一,常与腔隙性脑梗死、脑白质高信号并存。目前研究认为它是一种亚临床疾病状态,与认知功能障碍、脑血管事件发生、相关死亡率的增加等临床事件的发生有着密不可分的关系,对相关治疗也有一定影响。因此,对于CMB的防治以及个体化治疗的选择,成为临床工作中关心的重点。本文主要就CMB的相关危险因素及可能的致病机制以及临床意义作一研究综述,进而对这一研究的进展进行理论梳理。

Cerebral microbleed(CMB) has the property of "latent or silent" to a certain degree, which always be ignored or missed in clinical practice. With advances in technology of imaging, the area of CMB which is thought to be a potential imaging manifestation has generated substantial interest. It is widely known that CMB is belong to cerebral small vessel disease and always coexisted with lacunar infarct and white matter hyperintensities. Current research suggests that the CMB is a state of subclinical disease which has the association with cognitive impairment, cerebrovascular disease and increased mortality, as well as correlative treatment. Accordingly, it is cause for concern that how to opt for the prevention and treatment protocol for individuals with CMB-related risk factors. This review summaries the risk factors, possible pathogenesis and clinical implications of CMB.

[1]
中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国脑小血管病诊治共识[J]. 中华神经科杂志,2015,48(10):838-844.
[2]
Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration[J].Lancet Neurol,2013,12(8):822-838.
[3]
Lam CK, Yoo T, Hiner B, et al. Embolus extravasation is an alternative mechanism for cerebral microvascular recanalization[J].Nature,2010,465(7297):478-482.
[4]
Akoudad S, Portegies MLP, Koudstaal PJ, et al. Cerebral Microbleeds are Associated With an Increased Risk of Stroke: The Rotterdam Study[J].Circulation,2015,132(6):509-516.
[5]
Bokura H, Saika R, Yamaguchi T, et al. Microbleeds Are Associated With Subsequent Hemorrhagic and Ischemic Stroke in Healthy Elderly Individuals[J].Stroke,2011,42(7):1867-1871.
[6]
Ding J, Sigurdsson S, Garcia M, et al. Risk Factors Associated With Incident Cerebral Microbleeds According to Location in Older People[J].JAMA Neurol,2015,72(6):682.
[7]
Romero JR, Preis SR, Beiser A, et al. Risk Factors, Stroke Prevention Treatments, and Prevalence of Cerebral Microbleeds in the Framingham Heart Study[J].Stroke,2014,45(5):1492-1494.
[8]
Shams S, Martola J, Granberg T, et al. Cerebral microbleeds: different prevalence, topography, and risk factors depending on dementia diagnosis-the Karolinska Imaging Dementia Study[J].AJNR Am J Neuroradiol,2015,36(4):661-666.
[9]
Kim DE, Bae HJ, Lee SH, et al. Gradient echo magnetic resonance imaging in the prediction of hemorrhagic vs ischemic stroke: a need for the consideration of the extent of leukoariosis[J].Arch Neurol,2002,59(3):425-429.
[10]
Lee SH, Park JM, Kwon SJ, et al. Left ventricular hypertrophy is associated with cerebral microbleeds in hypertensive patients[J]. Neurology,2004,63(1):16-21.
[11]
Liu W, Liu R, Sun W, et al. Different impacts of blood pressure variability on the progression of cerebral microbleeds and white matter lesions[J]. Stroke,2012,43(11):2916-2922.
[12]
李玉林主编. 病理学[M]. 8版.北京: 人民卫生出版社,2013:140-141.
[13]
Benedictus MR, Prins ND, Goos JDC, et al. Microbleeds, Mortality, and Stroke in Alzheimer Disease: The MISTRAL Study[J].JAMA Neurol,2015,72(5):539.
[14]
Wieberdink RG, Poels MM, Vernooij MW, et al. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study[J]. Arterioscler Thromb Vasc Biol,2011,31(12):2982-2989.
[15]
Lee SH, Lee ST, Kim BJ, et al. Dynamic temporal change of cerebral microbleeds: long-term follow-up MRI study[J]. PLoS One,2011,6(10):e25930.
[16]
Wu Y, Chen T. An Up-to-Date Review on Cerebral Microbleeds[J].J Stroke Cerebrovasc Dis,2016,25(6):1301-1306.
[17]
Thrift A, Mcneil J, Donnan G. Reduced frequency of high cholesterol levels among patients with intracerebral haemorrhage[J].J Clin Neurosci,2002,9(4):376-380.
[18]
Drinka P. Letter by Drinka regarding article, "Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study" [J]. Circulation,2009,120(25):e293.
[19]
Noda H, Iso H, Irie F, et al. Low-density lipoprotein cholesterol concentrations and death due to intraparenchymal hemorrhage: the Ibaraki Prefectural Health Study[J]. Circulation,2009,119(16):2136-2145.
[20]
Saito T, Kawamura Y, Tanabe Y, et al. Cerebral microbleeds and asymptomatic cerebral infarctions in patients with atrial fibrillation[J].J Stroke Cerebrovasc Dis,2014,23(6):1616-1622.
[21]
Haji S, Planchard R, Zubair A, et al. The clinical relevance of cerebral microbleeds in patients with cerebral ischemia and atrial fibrillation[J].J Neurol,2016,263(2):238-244.
[22]
Song TJ, Kim J, Song D, et al. Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation[J]. Neurology,2014,83(15):1308-1315.
[23]
Zakeri R, Borlaug BA, Mcnulty SE, et al. Impact of atrial fibrillation on exercise capacity in heart failure with preserved ejection fraction: a RELAX trial ancillary study[J].Circ Heart Fail,2014,7(1):123-130.
[24]
Akar JG, Jeske W, Wilber DJ. Acute onset human atrial fibrillation is associated with local cardiac platelet activation and endothelial dysfunction[J].J Am Coll Cardiol,2008,51(18):1790-1793.
[25]
Schreiber S, Bueche CZ, Garz C, et al. Blood brain barrier breakdown as the starting point of cerebral small vessel disease?—New insights from a rat model[J].Exp Transl Stroke Med,2013,5(1):4.
[26]
Loehrer E, Ikram MA, Akoudad S, et al. Apolipoprotein E genotype influences spatial distribution of cerebral microbleeds[J].Neurobiol Aging,2014,35(4):899-905.
[27]
Kleinig TJ. Associations and implications of cerebral microbleeds[J].J Clin Neurosci,2013,20(7):919-927.
[28]
Tai LM, Thomas R, Marottoli FM, et al. The role of APOE in cerebrovascular dysfunction[J]. Acta Neuropathol,2016,131(5):709-723.
[29]
Volonghi I, Pezzini A, Del ZE, et al. Role of COL4A1 in basement-membrane integrity and cerebral small-vessel disease. The COL4A1 stroke syndrome[J].Curr Med Chem,2010,17(13):1317-1324.
[30]
Schuur M, van Swieten JC, Schol-Gelok S, et al. Genetic risk factors for cerebral small-vessel disease in hypertensive patients from a genetically isolated population[J].J Neurol Neurosurg Psychiatry,2011,82(1):41-44.
[31]
Shoamanesh A, Preis SR, Beiser AS, et al. Inflammatory biomarkers, cerebral microbleeds, and small vessel disease: Framingham Heart Study[J].Neurology,2015,84(8):825-832.
[32]
Wang BR, Ou Z, Jiang T, et al. Independent Correlation of Serum Homocysteine with Cerebral Microbleeds in Patients with Acute Ischemic Stroke due to Large-Artery Atherosclerosis[J].J Stroke Cerebrovasc Dis,2016,25(11):2746-2751.
[33]
Miwa K, Tanaka M, Okazaki S, et al. Relations of blood inflammatory marker levels with cerebral microbleeds[J].Stroke,2011,42(11):3202-3206.
[34]
Lahousse L, Vernooij MW, Darweesh SKL, et al. Chronic Obstructive Pulmonary Disease and Cerebral Microbleeds. The Rotterdam Study[J]. Am J Respir Crit Care Med,2013,188(7):783-788.
[35]
Ryu WS, Lee SH, Kim CK, et al. The relation between chronic kidney disease and cerebral microbleeds: difference between patients with and without diabetes[J].Int J Stroke,2012,7(7):551-557.
[36]
Peng Q, Sun W, Liu W, et al. Longitudinal relationship between chronic kidney disease and distribution of cerebral microbleeds in patients with ischemic stroke[J].J Neurol Sci,2016,362:1-6.
[37]
Giorda CB, Avogaro A, Maggini M, et al. Incidence and risk factors for stroke in type 2 diabetic patients: the DAI study[J].Stroke,2007,38(4):1154-1160.
[38]
Dannenberg S, Scheitz JF, Rozanski M, et al. Number of cerebral microbleeds and risk of intracerebral hemorrhage after intravenous thrombolysis[J].Stroke,2014,45(10):2900-2905.
[39]
Shams S, Martola J, Granberg T, et al. Cerebral microbleeds: different prevalence, topography, and risk factors depending on dementia diagnosis-the Karolinska Imaging Dementia Study[J].AJNR Am J Neuroradiol,2015,36(4):661-666.
[40]
Goos JD, Teunissen CE, Veerhuis R, et al. Microbleeds relate to altered amyloid-beta metabolism in Alzheimer′s disease[J]. Neurobiol Aging,2012,33(5):1011.
[41]
Haller S, Bartsch A, Nguyen D, et al. Cerebral microhemorrhage and iron deposition in mild cognitive impairment: susceptibility-weighted MR imaging assessment[J]. Radiology,2010,257(3):764-773.
[42]
Akoudad S, Wolters FJ, Viswanathan A, et al. Association of Cerebral Microbleeds With Cognitive Decline and Dementia[J].JAMA Neurol,2016,73(8):934-943.
[43]
Werring DJ, Frazer DW, Coward LJ, et al. Cognitive dysfunction in patients with cerebral microbleeds on T2*-weighted gradient-echo MRI[J].Brain,2004,127(Pt 10):2265-2275.
[44]
Xu X, Chan QL, Hilal S, et al. Cerebral microbleeds and neuropsychiatric symptoms in an elderly Asian cohort[J].J Neurol Neurosurg Psychiatry,2017,88(1):7-11.
[45]
Poliakova T, Levin O, Arablinskiy A, et al. Cerebral microbleeds in early Alzheimer′s disease[J].J Neurol,2016,263(10):1961-1968.
[46]
Ayaz M, Boikov AS, Haacke EM, et al. Imaging cerebral microbleeds using susceptibility weighted imaging: one step toward detecting vascular dementia[J].J Magn Reson Imaging,2010,31(1):142-148.
[47]
Karussis D, Leker RR, Abramsky O. Cognitive dysfunction following thalamic stroke: a study of 16 cases and review of the literature[J].J Neurol Sci,2000,172(1):25-29.
[48]
Nardone R, De Blasi P, Seidl M, et al. Cognitive function and cholinergic transmission in patients with subcortical vascular dementia and microbleeds: a TMS study[J].J Neural Transm (Vienna),2011,118(9):1349-1358.
[49]
Nishikawa T, Ueba T, Kajiwara M, et al. Cerebral microbleeds predict first-ever symptomatic cerebrovascular events[J].Clin Neurol Neurosurg,2009,111(10):825-828.
[50]
Wilson D, Charidimou A, Ambler G, et al. Recurrent stroke risk and cerebral microbleed burden in ischemic stroke and TIA[J].Neurology,2016:87(14):1501-1510.
[51]
Greenberg SM, Eng JA, Ning M, et al. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage[J].Stroke,2004,35(6):1415-1420.
[52]
van Etten ES, Auriel E, Haley KE, et al. Incidence of symptomatic hemorrhage in patients with lobar microbleeds[J].Stroke,2014,45(8):2280-2285.
[53]
Akoudad S, de Groot M, Koudstaal PJ, et al. Cerebral microbleeds are related to loss of white matter structural integrity[J].Neurology,2013,81(22):1930-1937.
[54]
Fan YH, Zhang L, Lam WW, et al. Cerebral microbleeds as a risk factor for subsequent intracerebral hemorrhages among patients with acute ischemic stroke[J].Stroke,2003,34(10):2459-2462.
[55]
Huang Y, Cheng Y, Wu J, et al. Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, double-blind, pilot study[J].Lancet Neurol,2008,7(6):494-499.
[56]
Charidimou A, Kakar P, Fox Z, et al. Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts[J].Stroke,2013,44(4):995-1001.
[57]
Liu S, Li C. Antiplatelet Drug Use and Cerebral Microbleeds: A Meta-analysis of Published Studies[J].J Stroke Cerebrovasc Dis,2015,24(10):2236-2244.
[58]
Charidimou A, Shoamanesh A. Clinical relevance of microbleeds in acute stroke thrombolysis: Comprehensive meta-analysis[J].Neurology,2016,87(15):1534-1541.
[59]
Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke,2016,47(2):581-641.
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