脑血流动力学改变与脑小血管病关系的研究进展

Research Progress on the Relationship between Cerebral Hemodynamic Changes and Cerebral Small Vessel Disease

摘要: 脑血流动力学包括血压变异性改变、血管搏动性、脑血流量改变、脑血管反应性改变等，血压变异性改变会导致血流的波动性增加，并且抑制血流流向小动脉的流畅性，抑制NO的产生，损害血管内皮功能，导致“神经血管单位损伤”，血脑屏障异常，从而导致小血管病变。动脉硬化及血管搏动性的改变导致管壁增厚，管腔狭窄，血流波动性增加，由于大脑血管阻力低，容易受到搏动压力变化的影响，从而促进脑小血管病的发生发展，类淋巴系统是一种全脑范围的周围液体运输系统，其循环障碍将导致血管周围间隙扩大，由于排出废物障碍，造成CSVD患者的执行、注意力和记忆功能损害。脑血流动力学的改变是脑小血管病发生、发展的重要机制，通过加重血管内皮功能障碍、血–脑屏障功能破坏等导致动脉硬化、脑血流量降低，影响氧气等营养物质及废物的运输，加速脑小血管病的发生发展。

Abstract: Cerebral hemodynamics includes changes in blood pressure variability, vascular pulsation, cerebral blood flow, and cerebrovascular reactivity. Changes in blood pressure variability lead to increased blood flow volatility, inhibit the flow of blood to arterioles, inhibit the production of NO, damage vascular endothelial function, lead to “neurovascular unit injury”, and abnormal blood- brain barri-er. This can lead to small blood vessel lesions. Arteriosclerosis and pulsating vascular changes lead to wall thickening, lumen stenosis, and increased blood flow volatility. Due to low cerebral vascular resistance, it is easily affected by pulsating pressure changes, thus promoting the occurrence and development of small cerebral vascular diseases. The glymphatic system is a kind of cerebral pe-ripheral fluid transportation system, and its circulation obstacles will lead to the expansion of the perivascular space. Executive, attention and memory functions are impaired in CSVD patients. Changes in cerebral hemodynamics are an important mechanism for the occurrence and develop-ment of cerebrovascular disease, which can lead to arteriosclerosis and decreased cerebral blood flow by aggravating vascular endothelial dysfunction and damage of blood-brain barrier function, affecting the transport of nutrients such as oxygen and waste, and accelerating the occurrence and development of cerebral small vessel disease.