脑微血管疾病中的小动脉神经病理学,Neuropathology and Applied Neurobiology

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脑微血管疾病中的小动脉神经病理学
Neuropathology and Applied Neurobiology ( IF 4.0 ) Pub Date : 2022-12-23 , DOI: 10.1111/nan.12875
Chuo Fang ₁ , Shino D Magaki ₂ , Ronald C Kim ₃ , Raj N Kalaria ₄ , Harry V Vinters _{2,

5} , Mark Fisher _{1,

3}

Affiliation

脑微血管疾病（MVD）是血管性认知障碍的重要原因。MVD 的病因学多种多样，从普遍性衰老到散发性（高血压、散发性脑淀粉样血管病 [CAA] 和慢性肾病）以及遗传性（例如，家族性 CAA、常染色体显性遗传性脑动脉病伴皮质下梗死和白质脑病 [CADASIL] 和伴有皮质下梗死和白质脑病的常染色体隐性脑动脉病[CARASIL]）。MVD 的脑实质后果主要包括腔隙性梗塞（腔隙）、微梗塞、衰老性白质疾病和微出血。MVD 的特征是严重的小动脉神经病理学，涉及普遍存在的血管平滑肌细胞 (SMC) 异常。脑 MVD 的特点是多种小动脉损伤，但仅有有限的实质表现。我们推断脑小动脉在每种类型 MVD 的发病机制中起主导作用。信号传导和功能的扰动（即增殖、凋亡、表型转换和 SMC 迁移的变化）在脑 MVD 的发病机制中很突出，使得“脑血管肌病”成为描述一系列病理异常的合适术语。有证据表明，脑小动脉既是 MVD 实质损伤的来源又是介质。

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Arteriolar neuropathology in cerebral microvascular disease

Cerebral microvascular disease (MVD) is an important cause of vascular cognitive impairment. MVD is heterogeneous in aetiology, ranging from universal ageing to the sporadic (hypertension, sporadic cerebral amyloid angiopathy [CAA] and chronic kidney disease) and the genetic (e.g., familial CAA, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy [CADASIL] and cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy [CARASIL]). The brain parenchymal consequences of MVD predominantly consist of lacunar infarcts (lacunes), microinfarcts, white matter disease of ageing and microhaemorrhages. MVD is characterised by substantial arteriolar neuropathology involving ubiquitous vascular smooth muscle cell (SMC) abnormalities. Cerebral MVD is characterised by a wide variety of arteriolar injuries but only a limited number of parenchymal manifestations. We reason that the cerebral arteriole plays a dominant role in the pathogenesis of each type of MVD. Perturbations in signalling and function (i.e., changes in proliferation, apoptosis, phenotypic switch and migration of SMC) are prominent in the pathogenesis of cerebral MVD, making ‘cerebral angiomyopathy’ an appropriate term to describe the spectrum of pathologic abnormalities. The evidence suggests that the cerebral arteriole acts as both source and mediator of parenchymal injury in MVD.

更新日期：2022-12-23

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