脑小血管病总负担评估量表的研究进展

doi:10.11817/j.issn.1673-9248.2023.02.010

随着对脑小血管病（CSVD）临床、影像和病理生理机制的不断深入研究发现，CSVD各影像标志物之间存在关联性，其互相影响并可对临床症状产生协同或叠加作用。越来越多的证据表明，CSVD与卒中复发、认知功能下降、运动障碍、情绪异常和二便障碍等密切相关，应被作为一种全脑性疾病来对待。本文就不同CSVD影像标志物负担的评估和临床意义，以及CSVD总负担评分方法的研究进展进行总结，以期对进一步改良总CSVD评分提供一定参考。

关键词: 脑小血管病, 总负担, 脑淀粉样血管病

With the in-depth study of the clinical, imaging, and pathophysiological mechanism of cerebral small vessel disease (CSVD) , it was found that the various imaging markers of CSVD were interrelated and interacted with each other, and they might have synergistic or superimposed effects on the clinical symptoms. Increasing evidence showed that CSVD was closely related to stroke recurrence, cognitive decline, dyskinesia, emotional abnormality, dysuria, and defecation disorder, which should therefore be treated as a whole brain disease. We reviewed the evaluation and clinical significance of CSVD imaging markers together with the research progress of CSVD total burden scoring methods, in order to provide some reference for further improvement of CSVD total burden score.

Key words: Cerebral small vessel disease, Total burden, Cerebral amyloid angiopathy

表1 不同研究下CSVD总负担评分方法

序号	文献	WMH	CMBs	EPVS	腔隙	急性腔隙性梗死	脑萎缩	皮质表面铁沉积	总分（分）
1	Kim等^[3]	PWMH≥3或DWMH≥2，1分	深部CMBs≥1个，1分	-	≥1个，1分	≥1个，1分	-	-	0~4
2	Hong等^[11]	中度WMH（总分3~4），1分；重度WMH（总分5~6），2分	1~4个，1分；≥5个，2分	BG-EPVS 11~20个，1分；BG-EPVS＞20个，2分	≥1个，1分	-	-	-	0~7
2	Hong等^[11]	中度WMH（总分3~4），1分；重度WMH（总分5~6），2分	1~4个，1分；≥5个，2分	（BG/CSO）-EPVS 11~20个，1分；（BG/CSO）-EPVS＞20个，2分	≥1个，1分	-	-	-
3	Zhi等^[12]	中度WMH（总分3~4分），1分；重度WMH（总分5~6分），2分	1~4个深部CMBs，1分；≥5个深部CMBs，2分	BG-EPVS＞20个，1分	≥1个，1分	-	-	-	0~6
4	Molad等^[18]	PWMH≥3或DWMH≥2，1分	≥1个，1分	（BG+CSO）-EPVS≥30个，1分	≥1个，1分	-	-	-	0~4
5	Xia等^[19]	PWMH≥3或DWMH≥2，1分	≥1个，1分	（BG/CSO）-EPVS＞20个，1分	≥1个，1分	-	-	-	0~4
6	Yang等^[26]	PWMH≥3或DWMH≥2，1分	深部CMBs≥1个，1分	BG-EPVS＞10个，1分	≥1个，1分	-	中重度，1分	-	0~5
7	Charidimou等^[31]	PWMH≥3或DWMH≥2，1分	2~4个脑叶CMBs，1分；≥5个脑叶CMBs，2分	CSO-EPVS＞20个，1分	-	-	-	≤3个脑沟；＞3个脑沟，2分	0~6
8	Staals等^[34]	PWMH≥3或DWMH≥2，1分	≥1个，1分	BG-EPVS＞10个，1分	≥1个，1分	-	-	-	0~4
9	Xu等^[35]	PWMH≥2或DWMH≥2，1分	≥1个，1分	BG-EPVS＞10个，1分	≥1个，1分	-	-	-	0~4

表1 不同研究下CSVD总负担评分方法

序号	文献	WMH	CMBs	EPVS	腔隙	急性腔隙性梗死	脑萎缩	皮质表面铁沉积	总分（分）
1	Kim等^[3]	PWMH≥3或DWMH≥2，1分	深部CMBs≥1个，1分	-	≥1个，1分	≥1个，1分	-	-	0~4
2	Hong等^[11]	中度WMH（总分3~4），1分；重度WMH（总分5~6），2分	1~4个，1分；≥5个，2分	BG-EPVS 11~20个，1分；BG-EPVS＞20个，2分	≥1个，1分	-	-	-	0~7
2	Hong等^[11]	中度WMH（总分3~4），1分；重度WMH（总分5~6），2分	1~4个，1分；≥5个，2分	（BG/CSO）-EPVS 11~20个，1分；（BG/CSO）-EPVS＞20个，2分	≥1个，1分	-	-	-
3	Zhi等^[12]	中度WMH（总分3~4分），1分；重度WMH（总分5~6分），2分	1~4个深部CMBs，1分；≥5个深部CMBs，2分	BG-EPVS＞20个，1分	≥1个，1分	-	-	-	0~6
4	Molad等^[18]	PWMH≥3或DWMH≥2，1分	≥1个，1分	（BG+CSO）-EPVS≥30个，1分	≥1个，1分	-	-	-	0~4
5	Xia等^[19]	PWMH≥3或DWMH≥2，1分	≥1个，1分	（BG/CSO）-EPVS＞20个，1分	≥1个，1分	-	-	-	0~4
6	Yang等^[26]	PWMH≥3或DWMH≥2，1分	深部CMBs≥1个，1分	BG-EPVS＞10个，1分	≥1个，1分	-	中重度，1分	-	0~5
7	Charidimou等^[31]	PWMH≥3或DWMH≥2，1分	2~4个脑叶CMBs，1分；≥5个脑叶CMBs，2分	CSO-EPVS＞20个，1分	-	-	-	≤3个脑沟；＞3个脑沟，2分	0~6
8	Staals等^[34]	PWMH≥3或DWMH≥2，1分	≥1个，1分	BG-EPVS＞10个，1分	≥1个，1分	-	-	-	0~4
9	Xu等^[35]	PWMH≥2或DWMH≥2，1分	≥1个，1分	BG-EPVS＞10个，1分	≥1个，1分	-	-	-	0~4

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Research progress in total burden assessment scale for cerebral small vessel disease

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Research progress in total burden assessment scale for cerebral small vessel disease