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Stroke:小脑表面铁沉积在脑淀粉样血管病中的意义

2021-09-21 MedSci原创 MedSci原创

小脑表面铁沉积可能是CAA的一个新的标志。

尽管越来越多的证据表明小脑与脑淀粉样血管病(CAA)相关,但小脑表面铁沉积被认为不是疾病标志物。

近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,该研究旨在调查散发性和荷兰型遗传性CAA患者和深部穿通动脉病相关脑内出血患者小脑表面铁沉积频率及其与出血性磁共振成像标志物之间的关系。

研究人员从3项前瞻性3 Tesla磁共振成像研究中招募了患者,并对铁沉积和出血进行了评分。小脑铁质沉着症在磁敏感加权或T2*加权磁共振成像检查中被确定为低信号线性信号丢失(黑色),该成像检查结果至少累积小脑皮层(包括蚓部)的一个脑叶。

研究人员纳入了50名荷兰型遗传性CAA受试者(平均年龄为50岁)、45名散发性CAA患者(平均年龄为72岁)和43名患有深部穿通动脉病相关脑内出血患者(平均年龄为54岁)。50名荷兰型遗传性CAA患者中有5名(10%[95%CI为2-18])存在小脑表面铁沉积,4/45(9%[95%CI为1-17])名散发性CAA患者存在小脑表面铁沉积,43名深部穿通动脉病相关的脑内出血患者中有0名(0%[95%CI为0-8])患者存在小脑表面铁沉积。与没有标记的患者相比,小脑表面铁质沉积患者更大可能出现幕上大叶(中位数为9 vs. 2,相对风险为2.9[95%CI为2.5-3.4])和小脑浅表大出血(中位数为2 vs. 0,相对风险为20.3[95%CI为8.6-47.6])。皮质表面铁沉积和表面小脑微出血的频率相当。

由此可见,小脑表面铁沉积可能是CAA的一个新的标志。

原始出处:

Emma A. Koemans.et al.Cerebellar Superficial Siderosis in Cerebral Amyloid Angiopathy.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.035019

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  5. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=谭桂峰, createdTime=Tue Sep 21 23:04:20 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
    2021-09-22 ms6000001113694287

    学习了

    0

  6. 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    2021-09-22 查查佳佳

    那坨青骄课堂了么哭咯,晕啦

    0

  7. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Wed Sep 22 06:26:29 CST 2021, time=2021-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053630, encodeId=663c105363082, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Wed Sep 22 06:02:38 CST 2021, time=2021-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053598, encodeId=4f8f1053598db, content=小脑表面铁沉积被认为不是疾病标志物。, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=谭桂峰, createdTime=Tue Sep 21 23:04:20 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
    2021-09-22 与狼共舞

    学习学习

    0

  8. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Wed Sep 22 06:26:29 CST 2021, time=2021-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053630, encodeId=663c105363082, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1e05489924, createdName=ms1000002136354097, createdTime=Wed Sep 22 06:02:38 CST 2021, time=2021-09-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053598, encodeId=4f8f1053598db, content=小脑表面铁沉积被认为不是疾病标志物。, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=谭桂峰, createdTime=Tue Sep 21 23:04:20 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
    2021-09-22 黄小丫

    😀学习

    0

  9. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=谭桂峰, createdTime=Tue Sep 21 23:04:20 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
    2021-09-22 ms1000002136354097

    学习了

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=谭桂峰, createdTime=Tue Sep 21 23:04:20 CST 2021, time=2021-09-21, status=1, ipAttribution=)]
    2021-09-21 谭桂峰

    小脑表面铁沉积被认为不是疾病标志物。

    0

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非痴呆性CAA患者存在视觉空间功能障碍,尤其是视觉物体感知障碍,且与脑白质损伤的后向倾向独立相关,而与SVD影像学标志物的整体严重程度或出血标志物的分布模式无关。这一发现提示后部白质的损害而不是整体

Neurology : 脑淀粉样血管病病理改变与PET下淀粉样蛋白-β的关系

本研究尚不能证实,经尸检证实的局部CAA负荷显著影响患者生前完成PET中临近该局部区域的PIB信号,即淀粉样PET成像在脑叶水平上不受到CAA影响,但对于更严重的CAA表型例如肺叶出血仍需进一步研究。

Neurology:脑淀粉样血管病患者CSF生物标志物概况分析!

由此可见,Aβ42、Aβ40、t-tau和p-tau的特异性CSF模式可能是CAA的分子生物标志物,但需要在更大的CAA队列中进行分析。

Stroke:皮层表面铁质沉积者随访 MRI 的意义

皮层表面微血管淀粉沉积是脑淀粉样血管病(cerebral amyloid angiopathy,CAA),它是老年自发性脑叶出血的主要病因。

Stroke:脑淀粉样血管病的急性卒中患者血管内治疗效果分析

血管内血栓切除术联合或不联合溶栓对伴有CAA的急性缺血性卒中患者都有益,但与较差的功能结局相关。

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