心房颤动伴发脑小血管病的研究进展  

Research progress in atrial fibrillation with cerebral small vessel disease

作　　者：金玲 刘运海 黄清[2,3,4] JIN Ling;LIU Yunhai;HUANG Qing(Department of Neurology,First People’s Hospital of Changde City,Changde Hunan 415003;Hunan Cerebrovascular Disease Clinical Medical Research Center,Changsha 410008;National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Changsha 410008;Department of Neurology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]常德市第一人民医院神经内科,湖南常德415003 [2]湖南省脑血管病临床医学研究中心,长沙410008 [3]国家老年疾病临床研究中心(湘雅医院),长沙410008 [4]中南大学湘雅医院神经内科,长沙410008

出　　处：《中南大学学报（医学版）》2022年第2期258-264,共7页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81400978);国家老年疾病临床医学研究中心临床研究基金康复医学专项基金(2021KFJJ04)。

摘　　要：非瓣膜性心房颤动是一种常见的心律失常,是心源性栓塞型脑卒中的主要危险因素。脑小血管病是指颅内小血管病变所致临床、认知、影像和病理表现的综合征,头颅磁共振常表现为近期皮质下小梗死、血管源性腔隙、脑白质高信号、血管周围间隙扩大、脑微出血和脑萎缩,是老年人神经功能丧失和认知能力下降的主要原因。目前研究认为,心房颤动可能通过微栓塞、低灌注、炎症及内皮功能障碍和类淋巴系统功能障碍等一系列机制增加脑小血管病的影像负荷。心房颤动伴发脑小血管病的影像学特征与心房颤动患者认知功能下降有一定关系,与脑卒中的发生和预后相关,对缺血性脑卒中的病因研究及二级预防策略的制订有一定提示作用。Non-valvular atrial fibrillation is a common arrhythmia and a major risk factor for cardioembolic stroke.Small cerebral vascular disease is a syndrome of clinical,cognitive,imaging,and pathological manifestations caused by intracranial small vascular lesions.The imaging findings on cranial magnetic resonance usually shows recent subcortical small infarction,vascularised lacunae,white matter hypersignal,perivascular space enlargement,cerebral microhemorrhage,and brain atrophy.It is a major cause of neurological loss and cognitive function decline in the elderly.Current studies suggest that atrial fibrillation may increase the imaging load of cerebral small vessel disease through a series of mechanisms such as microembolization,hypoperfusion,inflammation,endothelial dysfunction,and lymphoid system dysfunction.The imaging of cerebral small vessel disease with atrial fibrillation has a potential relationship with cognitive function decline and is related to the occurrence and prognosis of stroke,even more has a potential role in suggesting the etiology and secondary prevention strategies of ischemic stroke.

关 键 词：非瓣膜性心房颤动 脑小血管病 神经影像 缺血性脑卒中 认知功能 

分 类 号：R541.75[医药卫生—心血管疾病] R743[医药卫生—内科学]