老年病学会会议幻灯三终稿脑小血管病课件.ppt

总结 脑小血管病已成为国际热点议题，虽症状隐匿，但其危害较大，后果不容小觑 脑小血管病与腔梗、WMC、脑微出血、silent stroke等关系密切，容易导致认知功能损害甚至痴呆 纵观目前治疗药物，尼莫地平从血管角度对脑小血管病的治疗价值值得探索 1 2 3 * * C：微细血管硬化 * 脑小血管病导致脑损伤的发病机理 * * * HABS, Helsinki (Finland) Aging Brain Study; CHS, Cardiovascular Health Study; RSS, Rotterdam Scan Study; NILS-LSA, National Institute for Longevity Sciences-Longitudinal Study of Aging; MEMO, Memory and Morbidity in Augsburg Elderly study; and FHS, Framingham Heart Study. * 2010年7月在线发表于《英国医学杂志》的一项研究中，研究者在pubmed上检索了1966年～2009年11月23日年间经磁共振成像评估白质高信号对痴呆等影响的前瞻性纵向研究，并进行荟萃分析进行风险评估，结果显示白质高信号与痴呆风险增高显著相关。鉴于上述相关性，在脑成像检查过程中即便是偶然发现存在白质高信号，医生也要对患者进行详细的卒中和痴呆危险因素筛查。 * * 皮层下VCI是VCI最常见的类型，而腔隙性梗死更容易导致皮层下VCI。2007年发表于《Stroke》的研究证实，校正年龄后，腔梗与所有的认知域损害均显著相关。 * * * DTI：弥散张量成像 * 美国国立卫生院(NIH)共识小组对预防AD和认知功能损害提出6个关键问题： 1. What factors are associated with the reduction of risk of AD? 2. What factors are associated with reduction of risk of cognitive decline in older persons? 3. What are the therapeutic and adverse effects of interventions to delay the onset of AD? Are there differences in outcomes among identifiable subgroups? 4. What are the therapeutic and adverse effects of interventions to improve or maintain cognitive ability or functions? Are there different outcomes in identifiable subgroups? 5. What are the relationships between the factors that affect AD and the factors that affect cognitive decline? 6. What studies need to be done to provide quality and strength of evidence necessary to make such recommendations? * * 17位需要作SAH动脉瘤钳夹术的患者在局部血管滴注了尼膜同输注，在治疗后，所有的血管都有所扩张，与脑大动脉相比，血管直径小于1mm的脑动脉小分支的程度更高。 Five minutes after beginning of Nimodipine-infusion,mean overall pial arterial dilatation was 8.1 ±2.4% (mean standard error SEM), significantly different from arteries in the Placebo-treated group ( - 1 .4± 1.3%). After 10 minutes, a 6.3 ± 2.4% Nimodipine-induced dilatation was observed, significantly more than the 1.6 ± 1.4% of the Placebo-group . Pial arteries smaller than 70 /xm dilated 18.4 ±4.9% (SEM) five minu