无症状脑梗死的研究进展
Research Progress of Silent Brain Infarction
DOI: 10.12677/ACM.2022.1281148, PDF,   
作者: 朱景龙：青海大学，青海 西宁；李 蓉：青海大学附属医院，青海 西宁
关键词: 无症状脑梗死；危险因素；疾病转归；预防和治疗；Silent Brain Infarction； Risk Factors； Disease Outcome； Prevention and Treatment
摘要: 随着CT和MRI在临床上的广泛应用和普及，影像学报告中常出现“腔隙性梗死”，“多发、散在梗死灶”等描述，但检查者未出现肢体瘫痪、麻木，口齿不清等脑卒中的症状和体征，临床上我们将这种情况称为“无症状脑梗死(Silent brain infarction, SBI)”。无症状脑梗死如果得不到有效预防和提前干预，可发展成症状性脑梗死及血管性痴呆。本文主要从无症状脑梗死的危险因素、影像学特点、诊断、疾病转归、预防和治疗等方面进行综述。
Abstract: With the wide application and popularization of CT and MRI in clinic, there are often descriptions of “lacunar infarction”, “multiple and scattered infarction foci” in imaging reports. However, no symp-toms and signs of stroke such as limb paralysis, numbness, and unclear mouth and teeth appear in the examiners. In clinic, this situation is called “Silent brain infarction (SBI)”. Silent brain infarction can develop into symptomatic brain infarction and vascular dementia without effective prevention and early intervention. This article reviews the risk factors, imaging features, diagnosis, disease outcome, prevention and treatment of silent brain infarction.
文章引用：朱景龙, 李蓉. 无症状脑梗死的研究进展[J]. 临床医学进展, 2022, 12(8): 7972-7978. https://doi.org/10.12677/ACM.2022.1281148

参考文献

[1] Vermeer, S.E., Prins, N.D., den Heijer, T., Hofman, A., Koudstaal, P.J. and Breteler, M.M. (2003) Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline. The New England Journal of Medicine, 348, 1215-1222. [Google Scholar] [CrossRef] 
[2] Gupta, A., Giambrone, A.E., Gialdini, G., Finn, C., Delgado, D., Gutierrez, J., et al. (2016) Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis. Stroke, 47, 719-725. [Google Scholar] [CrossRef] 
[3] Longstreth Jr., W.T., Dulberg, C., Manolio, T.A., Lewis, M.R., Beauchamp Jr., N.J., O’Leary, D., et al. (2002) Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study. Stroke, 33, 2376-2382. [Google Scholar] [CrossRef] 
[4] Vermeer, S.E., Den Heijer, T., Koudstaal, P.J., Oudkerk, M., Hofman, A. and Breteler, M.M. (2003) Incidence and Risk Factors of Silent Brain Infarcts in the popula-tion-Based Rotterdam Scan Study. Stroke, 34, 392-396. [Google Scholar] [CrossRef] 
[5] Gouw, A.A., van der Flier, W.M., Fazekas, F., Oudkerk, M., Hofman, A. and Breteler, M.M. (2008) Progression of White Matter Hyperintensities and Incidence of New Lacunes over a 3-Year Period: The Leukoaraiosis and Disability Study. Stroke, 39, 1414-1420. [Google Scholar] [CrossRef] 
[6] Lim, J.S. and Kwon, H.M. (2010) Risk of “Silent Stroke” in Patients Older than 60 Years: Risk Assessment and Clinical Perspectives. Clinical Interventions in Aging, 5, 239-251. [Google Scholar] [CrossRef] 
[7] 骆秦. 无症状性脑梗死应该视为高血压靶器官损害还是伴发临床疾病, 如何处理?[J]. 中华高血压杂志, 2021, 29(2): 104-107.
[8] 韩菲, 翟菲菲, 周立新, 倪俊, 姚明, 张抒扬, 等. 顺义社区人群无症状性脑梗死的患病率及危险因素[J]. 中华神经科杂志, 2017, 50(7): 515-519.
[9] Delgado, P., Riba-Llena, I., Tovar, J.L., Jarca, C.I., Mundet, X., López-Rueda, A., et al. (2014) Prevalence and Associated Factors of Silent Brain Infarcts in a Mediterranean Cohort of Hypertensives. Hypertension, 64, 658-663. [Google Scholar] [CrossRef] 
[10] Beamer, N., Giraud, G., Clark, W., Wynn, M. and Coull, B. (1997) Diabetes, Hypertension and Erythrocyte Aggregation in Acute Stroke. Cerebrovascular Diseases, 7, 144-149. [Google Scholar] [CrossRef] 
[11] 苏燕玲, 段凯, 胡艳芳, 王健, 宋艳丽. 伴有2型糖尿病的老年无症状性脑梗死影像特点及危险因素分析[J]. 中西医结合心脑血管病杂志, 2014, 12(3): 317-318.
[12] 郑威波, 刘志阳. 老年糖尿病合并无症状性脑梗死患者的临床特点及疗效分析[J]. 中国医学创新, 2015(22): 145-146+147.
[13] Mizrahi, E.H., Noy, S., Sela, B.A., Fleissig, Y., Arad, M. and Adunsky, A. (2003) Further Evi-dence of Interrelation between Homocysteine and Hypertension in Stroke Patients. The Israel Medical Association Jour-nal, 5, 791-794.
[14] Schroecksnadel, K., Frick, B., Winkler, C., Leblhuber, F., Wirleitner, B. and Fuchs, D. (2003) Hyperhomocysteinemia and Immune Activation. Clinical Chemistry and Laboratory Medicine, 41, 1438-1443. [Google Scholar] [CrossRef] 
[15] Ravaglia, G., Forti, P., Maioli, F., Servadei, L., Martelli, M., Arnone, G., et al. (2004) Plasma Homocysteine and Inflammation in Elderly Patients with Cardiovascular Disease and Dementia. Experimental Gerontology, 39, 443-450. [Google Scholar] [CrossRef] [PubMed]
[16] 陈丽华, 周红梅, 林淑媚, 张朝顺, 黄均贤, 吴柱标. 无创呼吸机对睡眠呼吸暂停综合征患者炎症反应的影响[J]. 海南医学, 2018, 29(14): 2041-2043.
[17] 辛庆红. 阻塞性睡眠呼吸暂停低通气综合征患者血清内皮素1与尿微量白蛋白水平分析[J]. 中国医药, 2016, 11(6): 812-815.
[18] 宋哲. 阻塞性睡眠呼吸暂停低通气综合征与无症状脑梗死的相关性研究[J]. 现代中西医结合杂志, 2019, 28(27): 3020-3023.
[19] 曲思莹, 张黎明. 无症状性脑梗死的临床研究进展及与心房颤动的相关性分析[J]. 医学综述, 2017, 23(14): 2809-2813.
[20] 陈秀云, 刘楠, 张逸仙. 冠心病与无症状性脑梗死关系的临床研究[J]. 心血管康复医学杂志, 2015, 24(4): 376-379.
[21] Kim, S.H., Shin, D.W., Yun, J.M., Lee, J.E., Lim, J.S., Cho, B.L., et al. (2017) Kidney Dysfunction and Silent Brain Infarction in Generally Healthy Adults. Journal of the Neurological Sciences, 379, 89-93. [Google Scholar] [CrossRef] [PubMed]
[22] 李超. 颈动脉超声在无症状脑梗死患者中的应用分析[J]. 中国实用神经疾病杂志, 2017, 20(14): 63-66.
[23] Gomez, M., Roqueta, C., Molina, L., Cladellas, M., Ble, M., Comin-Colet, J., et al. (2015) Clinical Value of Ankle-Brachial Index in Asymptomatic Aortic Stenosis Patients. Journal of Heart Valve Disease, 24, 164-168.
[24] Baradaran, H., Al-Dasuqi, K., Knight-Greenfield, A., Giambrone, A., Del-gado, D., Ebani, E.J., et al. (2017) Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis. American Journal of Neuroradiology, 38, 2321-2326. [Google Scholar] [CrossRef] 
[25] Saba, L., Anzidei, M., Marincola, B.C., Piga, M., Raz, E., Bassareo, P.P., et al. (2014) Imaging of the Carotid Artery Vulnerable Plaque. CardioVascular and Interventional Radiology, 37, 572-585. [Google Scholar] [CrossRef] [PubMed]
[26] Baradaran, H., Gialdini, G., Mtui, E., Askin, G., Kamel, H. and Gupta, A. (2016) Silent Brain Infarction in Patients with Asymptomatic Carotid Artery Atherosclerotic Disease. Stroke, 47, 1368-1370. [Google Scholar] [CrossRef] 
[27] 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. 中国无症状脑梗死诊治共识[J]. 中华神经科杂志, 2018, 51(9): 692-698.
[28] 姚冬梅, 李震亮, 幺桂兰. 中青年无症状脑梗死患者病情与血浆同型半胱氨酸水平的相关性[J]. 临床药物治疗杂志, 2016, 14(3): 44-46.
[29] 张维文, 王晓莉, 崔永健, 孟伟建, 魏琰. 无症状脑梗死的临床特征及危险因素分析[J]. 解放军医药杂志, 2016, 28(8): 81-84.
[30] 秦锐, 冯昕. 无症状性脑梗死患者CRP及Hcy水平与认知功能障碍程度的关系[J]. 临床医学研究与实践, 2019, 4(36): 122-124.
[31] 曲伟, 姜婷婷. 老年无症状性脑梗死患者危险因素及影像学特征分析[J]. 潍坊医学院学报, 2019, 41(5): 395-397.
[32] Jacova, C., Pearce, L.A., Costello, R., McClure, L.A., Hol-liday, S.L., Hart, R.G., et al. (2012) Cognitive Impairment in Lacunar Strokes: The SPS3 Trial. Annals of Neurology, 72, 351-362. [Google Scholar] [CrossRef] [PubMed]
[33] 张为, 周博锋, 胡才友, 吕渊. 老年无症状性脑梗死患者的认知功能障碍及其影响因素[J]. 中国全科医学, 2010, 13(20): 2190-2192.
[34] 王盼, 张熙, 周波, 张增强. 蒙特利尔认知评价量表(中文版)在轻度认知损害诊断及进展过程中的作用[J]. 中国现代神经疾病杂志, 2012, 12(2): 193-197.
[35] 朱风俊, 王润润. 脑梗死后抑郁与血浆同型半胱氨酸的相关性分析[J]. 中国实用神经疾病杂志, 2013, 16(12): 52-54.
[36] 胆迎, 赵玉军. 老年缺血性脑卒中后卒中部位及时间与抑郁症的关系[J]. 山东医药, 2014, 54(22): 51-52.
[37] 姜凯. 老年无症状性脑梗死患者抑郁发生率及其与血浆同型半胱氨酸的关系[J]. 山东医药, 2016, 56(10): 68-69.
[38] 田伟. 无症状性脑梗死与抑郁状态的关系研究[J]. 基层医学论坛, 2015, 19(8): 1040-1041.
[39] Rothwell, P.M., Howard, S.C., Dolan, E., O’Brien, E., Dobson, J.E., Dahlöf, B., et al. (2010) Effects of Beta Blockers and Calcium-Channel Blockers on Within-Individual Variability in Blood Pressure and Risk of Stroke. The Lancet Neurology, 9, 469-480. [Google Scholar] [CrossRef] 
[40] Rothwell, P.M. (2010) Limitations of the Usual Blood-Pressure Hvpothesis and Importance of Variability, Instability, and Episodic Hyperten-sion. Lancet, 375, 938-948. [Google Scholar] [CrossRef] 
[41] Zhu, Y.C., Dufouil, C., Tzourio, C. and Chabriat, H. (2011) Silent Brain infarcts: A Review of MRI Diagnostic Criteria. Stroke, 42, 1140-1145. [Google Scholar] [CrossRef] 
[42] Quinn, C.T. (2014) Breakthrough: New Guidance for Si-lent Cerebral Ischemia and Infarction in Sickle Cell Disease. Hematology. American Society of Hematology Education Program, 2014, 438-443. [Google Scholar] [CrossRef] [PubMed]
[43] 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. 中国急性缺血性脑卒中诊治指南2014 [J]. 中华神经科杂志, 2015, 48(4): 246-257. [Google Scholar] [CrossRef] 
[44] 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. 中国脑血管病一级预防指南2015 [J]. 中华神经科杂志, 2015, 48(8): 629-643. [Google Scholar] [CrossRef] 
[45] 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. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014 [J]. 中华神经科杂志, 2015, 48(4): 258-273.

为你推荐