基于影像的脑小血管病的远隔缺血适应保护机制研究

Cerebral small vessel disease (cSVD) is an important risk factor for stroke, dementia and age-related disability, accounting for approximately one-fifth of all strokes and 45% of dementia worldwide, which seriously endangers people's health and brings a heavy economic burden. Specific treatment strategies to reduce functional deficiencies attributed to SVD are lacking. Remote ischemic conditioning (RIC), an endogenous protective strategy to against ischemia-reperfusion injury, is noninvasive, safe, simple and inexpensive, which has been demonstrated to be safe and effective in reducing stroke recurrence in patients with intracranial arterial stenosis. By means of multimodal MRI technology, our aim is to evaluate efficacy of RIC on brain network in cSVD patients and to explore the protective mechanisms of RIC on cSVD.

脑小血管病（cerebral small vessel disease，cSVD）占所有缺血性卒中病因的25%，全部痴呆的45%，严重危害人民身体健康，带来沉重经济负担。随人口老龄化进程加速，cSVD发病率仍呈上升趋势，已成为重要社会问题，目前仍缺乏有效治疗手段。远隔缺血适应（remote ischemic conditioning, RIC）为机体内源性的抗缺血损伤策略，无创安全、简便易行、成本低廉，满足临床转化条件。我们团队从基础到临床对RIC开展了系统性研究，证实RIC能有效改善脑灌注、缩小脑损伤程度及范围、减少卒中复发、改善认知功能，但具体机制尚不清楚。本研究拟利用多模态MRI技术，构建cSVD患者脑网络并分析脑网络特征，探讨RIC对cSVD的脑保护作用机制，筛选评价cSVD预后和RIC疗效的客观生物学指标，进而为RIC的临床推广提供证据。

脑小血管病（cerebral small vessel disease，cSVD）与卒中、痴呆、老龄关系密切，占所有缺血性卒中病因的25%左右；是引起血管性痴呆的最常见病因，同时是混合性痴呆的重要致病因素；目前仍缺乏有效的治疗手段。远隔缺血适应（remote ischemic conditioning, RIC）被证实是一种改善脑血流灌注、减少症状性颅内动脉狭窄患者卒中复发的有效方法。本项目发现cSVD患者与大动脉狭窄患者危险因素及发病机制可能存在不同，而吸烟状态对cSVD患者抗血小板药物的疗效存在影响。本项目利用多模态MRI技术，构建cSVD患者脑网络并分析脑网络特征，发现cSVD患者DTI、不同脑区之间功能连接性的下降，早于常规核磁的改变，与患者的临床症状和预后相关。证明了RIC对cSVD的保护作用，探讨RIC对cSVD的脑保护作用机制，进而为RIC的临床推广提供证据。项目资助发表中文核心期刊论文5篇，SCI论文1篇，获批专利1项。项目投入经费21万元，支出15.0565万元，各项支出基本与预算相符，剩余经费5.9435万元，剩余经费计划用于本研究的后续支出。