无症状脑梗死中西医临床研究进展
Progress of Clinical Research on Silent Brain Infarction in Traditional Chinese Medicine and Western Medicine
DOI: 10.12677/acm.2024.143892, PDF,   
作者: 艾丽菲热·艾海买提:新疆医科大学第四临床医学院,新疆 乌鲁木齐;沙地克·沙吾提*:新疆维吾尔自治区中医医院脑病一科,新疆 乌鲁木齐
关键词: 脑梗死无症状脑梗死危险因素综述Cerebral Infarction Silent Brain Infarction Risk Factors Review
摘要: 近年来无症状脑梗死受到了广泛的关注,成为了老年化社会的热门话题。无症状脑梗死(silent brain infarction, SBI),或称为“静止性”或“隐匿性”脑梗死,是指患者没有明确的脑卒中或TIA的既往病史,但在头颅CT或MRI检查时发现有与脑血管分布一致的脑梗死灶或脑软化灶,而临床上没有与病灶相关的神经功能缺损的症状和体征。SBI在人群中患病率为8%~28%不等,其危险因素与其他类型的脑梗死相同,但有一些特殊因素值得重视,在进展过程中可能有症状性脑梗死、认知功能减退、抑郁状态等。多项研究中SBI是否进行脑血管二级预防仍然存在争议。同时,中医药历来重视“治未病”,现就SBI的中西医临床研究进行阐述。
Abstract: Asymptomatic silent brain infarction has received a lot of attention in recent years and has become a hot topic in an aging society. Silent brain infarction (SBI), or “silent” or “insidious” brain infarction, is a condition in which the patient does not have a clear past history of stroke or TIA, Foci of cerebral infarction or cerebral softening consistent with the distribution of cerebral blood vessels detected on cranial CT or MRI examination and there are no clinical signs and symptoms of neurologic deficits associated with the lesion. The prevalence of SBI in the population ranges from 8% to 28%, and its risk factors are the same as those for other types of cerebral infarction. However, there are some specific factors that deserve attention, and there may be symptomatic cerebral infarction, cognitive impairment, and depressive states during progression. Whether secondary cerebrovascular prevention is performed in SBI in several studies remains controversial. At the same time, traditional Chinese medicine has always emphasized the “treatment of future diseases”, and now we are going to elaborate on the traditional Chinese medicine and western clinical research on SBI.
文章引用:艾丽菲热·艾海买提, 沙地克·沙吾提. 无症状脑梗死中西医临床研究进展[J]. 临床医学进展, 2024, 14(3): 1666-1672. https://doi.org/10.12677/acm.2024.143892

参考文献

[1] Yun, X. (2018) Importance of Standardized Diagnosis and Treatment of Silent Brain Infarction. Chinese Journal of Neurology, 51, 664-665.
[2] Smith, E.E., Saposnik, G., Biessels, G.J., et al. (2017) Prevention of Stroke in Patients with Silent Cerebrovascular Disease: A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 48, e44-e71. [Google Scholar] [CrossRef
[3] 高佳慧, 尹莲花, 刘志臻. 2005-2021年无症状性脑梗死危险因素研究趋势可视化分析[J]. 中国医药科学, 2022, 12(22): 164-168.
[4] Escudero-Martínez, I., Ocete, R.F., Mancha, F., et al. (2020) Prevalence and Risk Factors of Silent Brain Infarcts in Patients with AF Detected by 3T-MRI. Journal of Neurology, 267, 2675-2682. [Google Scholar] [CrossRef] [PubMed]
[5] Gupta, A., Giambrone, A.E., Gialdini, G., et al. (2016) Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis. Stroke, 47, 719-725. [Google Scholar] [CrossRef
[6] Longstreth, W.T., Dulberg, C., Manolio, T.A., 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
[7] Fanning, J.P., Walters, D.L., Platts, D.G., et al. (2014) Characterization of Neurological Injury in Transcatheter Aortic Valve Implantation: How Clear Is the Picture? Circulation, 129, 504-515. [Google Scholar] [CrossRef
[8] Gómez-Angelats, E., De la Sierra, A., Sierra, C., et al. (2004) Blood Pressure Variability and Silent Cerebral Damage in Essential Hypertension. American Journal of Hypertension, 17, 696-700. [Google Scholar] [CrossRef] [PubMed]
[9] Vermeer, S.E., Longstreth, W.T. and Koudstaal, P.J. (2007) Silent Brain Infarcts: A Systematic Review. The Lancet Neurology, 6, 611-619. [Google Scholar] [CrossRef
[10] Fanning, J.P., Wong, A.A. and Fraser, J.F. (2014) The Epidemiology of Silent Brain Infarction: A Systematic Review of Population-Based Cohorts. BMC Medicine, 12, Article No. 119. [Google Scholar] [CrossRef] [PubMed]
[11] Leung, L.Y., Bartz, T.M., Rice, K., et al. (2017) Blood Pressure and Heart Rate Measures Associated with Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults. Arteriosclerosis, Thrombosis, and Vascular Biology, 37, 1579-1586. [Google Scholar] [CrossRef
[12] Olmez, I. and Ozyurt, H. (2012) Reactive Oxygen Species and Ischemic Cerebrovascular Disease. Neurochemistry International, 60, 208-212. [Google Scholar] [CrossRef] [PubMed]
[13] Yoshida, M., Tomitori, H., Machi, Y., et al. (2009) Acrolein, IL-6 and CRP as Markers of Silent Brain Infarction. Atherosclerosis, 203, 557-562. [Google Scholar] [CrossRef] [PubMed]
[14] Hoshi, T., Kitagawa, K., Yamagami, H., et al. (2005) Relations of Serum High-Sensitivity C-Reactive Protein and Interleukin-6 Levels with Silent Brain Infarction. Stroke, 36, 768-772. [Google Scholar] [CrossRef
[15] Wardlaw, J.M., Sandercock, P.A.G., Dennis, M.S., et al. (2003) Is Breakdown of the Blood-Brain Barrier Responsible for Lacunar Stroke, Leukoaraiosis, and Dementia? Stroke, 34, 806-812. [Google Scholar] [CrossRef
[16] Knottnerus, I.L.H., Govers-Riemslag, J.W.P., Hamulyak, K., et al. (2010) Endothelial Activation in Lacunar Stroke Subtypes. Stroke, 41, 1617-1622. [Google Scholar] [CrossRef
[17] Vermeer, S.E., Van Dijk, E.J., Koudstaal, P.J., et al. (2002) Homocysteine, Silent Brain Infarcts, and White Matter Lesions: The Rotterdam Scan Study. Annals of Neurology, 51, 285-289. [Google Scholar] [CrossRef] [PubMed]
[18] Longstreth Jr., W.T., Katz, R., Olson, J., et al. (2004) Plasma Total Homocysteine Levels and Cranial Magnetic Resonance Imaging Findings in Elderly Persons: The Cardiovascular Health Study. Archives of Neurology, 61, 67-72. [Google Scholar] [CrossRef] [PubMed]
[19] Das, R.R., Seshadri, S., Beiser, A.S., et al. (2008) Prevalence and Correlates of Silent Cerebral Infarcts in the Framingham Offspring Study. Stroke, 39, 2929-2935. [Google Scholar] [CrossRef
[20] Oh, S.H., Park, S.Y., Kim, N.K., et al. (2012) Relationships between Plasma Homocysteine Level and Cervicocerebral Atherosclerosis and Microangiopathy in Non-Stroke Individuals (P05.234). Neurology, 78, P05.234.
[21] Knottnerus, I.L.H., Gielen, M., Lodder, J., et al. (2011) Family History of Stroke Is an Independent Risk Factor for Lacunar Stroke Subtype with Asymptomatic Lacunar Infarcts at Younger Ages. Stroke, 42, 1196-1200. [Google Scholar] [CrossRef
[22] Morrison, A.C., Fornage, M., Liao, D., et al. (2000) Parental History of Stroke Predicts Subclinical but Not Clinical Stroke: The Atherosclerosis Risk in Communities Study. Stroke, 31, 2098-2102. [Google Scholar] [CrossRef
[23] Kempster, P.A., Gerraty, R.P. and Gates, P.C. (1988) Asymptomatic Cerebral Infarction in Patients with Chronic Atrial Fibrillation. Stroke, 19, 955-957. [Google Scholar] [CrossRef
[24] Cha, M.-J., Park, H.-E., Lee, M.-H., et al. (2014) Prevalence of and Risk Factors for Silent Ischemic Stroke in Patients with Atrial Fibrillation as Determined by Brain Magnetic Resonance Imaging. The American Journal of Cardiology, 113, 655-661. [Google Scholar] [CrossRef] [PubMed]
[25] Berman, J.P., Norby, F.L., Mosley, T., et al. (2019) Atrial Fibrillation and Brain Magnetic Resonance Imaging Abnormalities: The ARIC Study. Stroke, 50, 783-788. [Google Scholar] [CrossRef
[26] Conen, D., Rodondi, N., Müller, A., et al. (2019) Relationships of Overt and Silent Brain Lesions with Cognitive Function in Patients with Atrial Fibrillation. Journal of the American College of Cardiology, 73, 989-999. [Google Scholar] [CrossRef] [PubMed]
[27] Finn, C., Giambrone, A.E., Gialdini, G., et al. (2017) The Association between Carotid Artery Atherosclerosis and Silent Brain Infarction: A Systematic Review and Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases, 26, 1594-1601. [Google Scholar] [CrossRef] [PubMed]
[28] Moroni, F., Ammirati, E., Magnoni, M., et al. (2016) Carotid Atherosclerosis, Silent Ischemic Brain Damage and Brain Atrophy: A Systematic Review and Meta-Analysis. International Journal of Cardiology, 223, 681-687. [Google Scholar] [CrossRef] [PubMed]
[29] Takahashi, W., Fujii, H., Ide, M., et al. (2005) Atherosclerotic Changes in Intracranial and Extracranial Large Arteries in Apparently Healthy Persons with Asymptomatic Lacunar Infarction. Journal of Stroke and Cerebrovascular Diseases, 14, 17-22. [Google Scholar] [CrossRef] [PubMed]
[30] 冯微, 张炜, 李建玲, 等. 25-羟维生素D3 Hcy LDL与无症状性脑梗死患者颈动脉斑块的关系分析[J]. 中国实用神经疾病杂志, 2020, 23(18): 1584-1589.
[31] 李月. 肥胖指标与老年无症状腔隙性脑梗死发病的相关性分析[J]. 中国老年保健医学, 2020, 18(1): 110-111.
[32] Indja, B., Woldendorp, K., Vallely, M.P., et al. (2019) Silent Brain Infarcts Following Cardiac Procedures: A Systematic Review and Meta-Analysis. Journal of the American Heart Association, 8, e010920. [Google Scholar] [CrossRef
[33] Mrkobrada, M., Chan, M.T.V., Cowan, D., et al. (2019) Perioperative Covert Stroke in Patients Undergoing Non-Cardiac Surgery (Neurovision): A Prospective Cohort Study. The Lancet, 394, 1022-1029. [Google Scholar] [CrossRef
[34] Windham, B.G., Griswold, M.E., Shibata, D., et al. (2012) Covert Neurological Symptoms Associated with Silent Infarcts from Midlife to Older Age: The Atherosclerosis Risk in Communities Study. Stroke, 43, 1218-1223. [Google Scholar] [CrossRef
[35] Koton, S., Tsabari, R., Molshazki, N., et al. (2013) Burden and Outcome of Prevalent Ischemic Brain Disease in a National Acute Stroke Registry. Stroke, 44, 3293-3297. [Google Scholar] [CrossRef
[36] Chen, D.W., Wang, Y.X., Shi, J., et al. (2017) Multiple Silent Brain Infarcts Are Associated with Severer Stroke in Patients with First-Ever Ischemic Stroke Without Advanced Leukoaraiosis. Journal of Stroke and Cerebrovascular Diseases, 26, 1988-1995. [Google Scholar] [CrossRef] [PubMed]
[37] Kobayashi, S., Okada, K., Koide, H., et al. (1997) Subcortical Silent Brain Infarction as a Risk Factor for Clinical Stroke. Stroke, 28, 1932-1939. [Google Scholar] [CrossRef
[38] Putaala, J., Haapaniemi, E., Kurkinen, M., et al. (2011) Silent Brain Infarcts, Leukoaraiosis, and Long-Term Prognosis in Young Ischemic Stroke Patients. Neurology, 76, 1742-1749. [Google Scholar] [CrossRef
[39] Vermeer, S.E., Den Heijer, T., Koudstaal, P.J., et al. (2003) Incidence and Risk Factors of Silent Brain Infarcts in the Population-Based Rotterdam Scan Study. Stroke, 34, 392-396. [Google Scholar] [CrossRef
[40] Liebetrau, M., Steen, B., Hamann, G.F., et al. (2004) Silent and Symptomatic Infarcts on Cranial Computerized Tomography in Relation to Dementia and Mortality: A Population-Based Study in 85-Year-Old Subjects. Stroke, 35, 1816-1820. [Google Scholar] [CrossRef
[41] Song, I.U., Kim, J.S., Kim, Y.I., et al. (2007) Clinical Significance of Silent Cerebral Infarctions in Patients with Alzheimer Disease. Cognitive and Behavioral Neurology, 20, 93-98. [Google Scholar] [CrossRef
[42] Wright, C.B., Festa, J.R., Paik, M.C., et al. (2008) White Matter Hyperintensities and Subclinical Infarction: Associations with Psychomotor Speed and Cognitive Flexibility. Stroke, 39, 800-805. [Google Scholar] [CrossRef
[43] Yamashita, H., Fujikawa, T., Yanai, I., et al. (2002) Cognitive Dysfunction in Recovered Depressive Patients with Silent Cerebral Infarction. Neuropsychobiology, 45, 12-18. [Google Scholar] [CrossRef] [PubMed]
[44] Hamada, T., Murata, T., Omori, M., et al. (2003) Abnormal Nocturnal Blood Pressure Fall in Senile-Onset Depression with Subcortical Silent Cerebral Infarction. Neuropsychobiology, 47, 187-191. [Google Scholar] [CrossRef] [PubMed]
[45] Shephard, R.J. (2012) Lower Prevalence of Silent Brain Infarcts in the Physically Active: The Northern Manhattan Study. Yearbook of Sports Medicine, 2012, 252-254.
[46] Nakagawa, T., Sekizawa, K., Nakajoh, K., et al. (2000) Silent Cerebral Infarction: A Potential Risk for Pneumonia in the Elderly. Journal of Internal Medicine, 247, 255-259. [Google Scholar] [CrossRef] [PubMed]
[47] Meschia, J.F., Bushnell, C., Boden-Albala, B., et al. (2014) Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 45, 3754-3832. [Google Scholar] [CrossRef
[48] Maestrini, I., Altieri, M., Di Clemente, L., et al. (2018) Longitudinal Study on Low-Dose Aspirin versus Placebo Administration in Silent Brain Infarcts: The Silence Study. Stroke Research and Treatment, 2018, Article ID: 7532403. [Google Scholar] [CrossRef] [PubMed]
[49] Mcneil, J.J., Nelson, M.R., Woods, R.L., et al. (2018) Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. New England Journal of Medicine, 379, 1519-1528. [Google Scholar] [CrossRef
[50] Reid, C.M., Storey, E., Wong, T.Y., et al. (2012) Aspirin for the Prevention of Cognitive Decline in the Elderly: Rationale and Design of a Neuro-Vascular Imaging Study (ENVIS-Ion). BMC Neurology, 12, Article No. 3. [Google Scholar] [CrossRef] [PubMed]
[51] Ryan, J., Storey, E., Murray, A.M., et al. (2020) Randomized Placebo-Controlled Trial of the Effects of Aspirin on Dementia and Cognitive Decline. Neurology, 95, e320-e331. [Google Scholar] [CrossRef
[52] Katsanos, A.H., Lioutas, V.-A., Charidimou, A., et al. (2020) Statin Treatment and Accrual of Covert Cerebral Ischaemia on Neuroimaging: A Systematic Review and Meta-Analysis of Randomized Trials. European Journal of Neurology, 27, 1023-1027. [Google Scholar] [CrossRef] [PubMed]
[53] Smith, E.E. and Markus, H.S. (2020) New Treatment Approaches to Modify the Course of Cerebral Small Vessel Diseases. Stroke, 51, 38-46. [Google Scholar] [CrossRef
[54] 高长玉, 吴成翰, 赵建国, 等. 中国脑梗死中西医结合诊治指南(2017) [J]. 中国中西医结合杂志, 2018, 38(2): 136-144.
[55] 王孝理, 黄美丽, 曹晓岚. 无症状中风的中医辨治思路[J]. 山东中医杂志, 2007(9): 589-591. [Google Scholar] [CrossRef