Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum9506410.26442/2075-1753_2018.9.22-29ArticlesСтатьиResearch ArticleStrategies of cerebral small vessel disease early diagnostics and therapyСтратегии ранней диагностики и терапии болезни мелких сосудов головного мозгаPutilinaM. VПутилинаМарина Викторовна

д-р мед. наук, проф. каф. неврологии

profput@mail.ruN.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian FederationФГБОУ ВО «РНИМУ им. Н.И.Пирогова»15092018209VOL 20, NO9 (2018)ТОМ 20, №9 (2018)222928122021Copyright ©; 2018, Consilium MedicumCopyright ©; 2018, ООО "Консилиум Медикум"2018Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/95064

Sporadic cerebral small vessel disease is one of the most widespread pathologic processes that has an essential role in stroke and cognitive decline development and at the same time it is a systemic disorder that affects other organs. The search for optimal medications for small vessel disease prevention and treatment is still going, new studies that will result in new treatment strategies development have emerged. At present the priority for background therapy use (antiplatelet, antihypertensive, statin therapy) is preserved.

Спорадическое заболевание мелких сосудов головного мозга является одним из наиболее распространенных патологических процессов и играет важную роль в развитии инсульта и когнитивных нарушений, в то же время это системное расстройство, при котором страдают различные органы. Поиск оптимальных препаратов для профилактики и терапии болезни мелких сосудов продолжается, появились исследования, которые в дальнейшем создадут новые лечебные стратегии. На сегодняшний день сохраняется приоритет базовой терапии (антиагрегантной, антигипертензионной, статинов).

small vessel diseasecognitive declinegenetic disordersendothelial dysfunction markersболезнь мелких (малых сосудов)когнитивные нарушениянаследственные заболеваниямаркеры эндотелиальной дисфункцииPantoni L, Gorelick P.B. A book review on Cerebral Small Vessel Disease: Cambridge University Press, Cambridge, UK, 2014; p. 371. DOI: 10.1017/CBO9781139382694Charidimou A. Book review: "Cerebral small vessel disease". What’s the big deal about small vessels? Front Neurol 2015; 6: 175. DOI: 10.3389/fneur.2015.00175Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9: 689-701. DOI: 10.1016/S1474-4422 (10)70104-6Charidimou A, Pantoni L, Love S. The concept of sporadic cerebral small vessel disease: A road map on key definitions and current concepts. http: //journals.sagepub.com/home/wso,2015https: //doi.org/10.1177/1747493015607485Issac T.Gr, Chandra S.R, Christopher R et al. Cerebral Small Vessel Disease Clinical, Neuropsychological, and Radiological Phenotypes, Histopathological Correlates, and Described Genotypes: A Review. J Geriatrics 2015. http: //dx.doi.org/10.1155/2015/564870Vermeer S.E, Longstreth W.T., Koudstaal P.J. Silent Brain Infarcts: A Systematic Review. Lancet Neurology 2007; 6: 611-9. http: //dx.doi.org/10.1016/S1474-4422 (07)70170-9Shi Y, Wardlaw J.M. Update on cerebral small vessel disease: a dynamic whole-brain disease. https: //svn.bmj.com/content/1/3/83 http: //dx.doi.org/10.1136/svn-2016-000035Tsai C.F, Thomas B, Sudlow C.L. Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology 2013; 81: 264-72. DOI: 10.1212/WNL.0b013e31829bfde3CrossRefPubMedGoogle ScholarWardlaw J.M, Smith E.E, Biessels G.J et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12: 822-38. DOI: 10.1016/S1474-4422Issac Thg, Chandra S.R, Christofer R et al. Cerebral Small Vessel Disease Clinical, Neuropsychological, and Radiological Phenotypes, Histopathological Correlates, and Described Genotypes: A Review. J Geriatrics 2015. http: //dx.doi.org/10.1155/2015/564870Kwon H.M, Lynn M.J, Turan T.N. Frequency, risk factors, and outcome of coexistent small vessel disease and intracranial arterial stenosis: results from the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial. JAMA Neurol 2016; 73: 36-42. DOI: 10.1001/jamaneurol.2015.3145PubMedGoogle ScholarMoran С. Cerebral small vessel disease: a review of clinical, radiological, and histopathofogical phenotypes. Int J Stroke 2012; 7. Issue 1: 36-46. DOI: 10.1111/j.1747-4949.2011.00725.xWardlaw J, Smith E, Biessels G et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12 (8): 822-38. DOI: 10.1016/s1474-4422 (13)70124-8Duering M, Csanadi E, Gesierich B. Incident lacunes preferentially localized to the edge of white matter hyperintensities: insights into the pathophysiology of cerebral small vessel disease. Brain 2013; 136: 2717-26. DOI: 10.1161/01.STR.0000240513.00579.bfAbstract/FREE Full TextGoogle ScholarValdes Hernandez Mdel C, Maconick L.C, Munoz Maniega S. A comparison of location of acute symptomatic vs. "silent" small vessel lesions. Int J Stroke 2015; 10: 1044-50. DOI: 10.1111/ijs.12558CrossRefPubMedGoogle ScholarSchmidt R, Seiler S, Loitfelder M. Longitudinal change of small-vessel disease-related brain abnormalities. J Cereb Blood Flow Metab 2016; 36: 26-39. DOI: 10.1038/jcbfm.2015.72CrossRefPubMedGoogle ScholarGreenberg S.M. Small vessels, big problems. N Engl J Med 2006; 354: 1451-3. DOI: 10.1056/NEJMp068043Charidimou A. Book review: "Cerebral small vessel disease". What’s the big deal about small vessels? Front Neurol 2015; 6: 175. DOI: 10.3389/fneur.2015.00175Patel B, Markus H.S. Magnetic resonance imaging in cerebral small vessel disease and its use as a surrogate disease marker. Int J Stroke 2011; 6 (1): 47-59. https: //doi.org/10.1111/j.1747-4949.2010.00552.xАраблинский А.В., Макотрова Т.А., Трусова Н.А., Левин О.С. Нейровизуализационные маркеры церебральной микроангиопатии по данным магнитно-резонансной томографии. Russian Electronic J Radiol 2014; 1: 24-31. http: //www.rejr.ruМищенко В.Н., Соколик В.В. Болезнь мелких сосудов мозга (нейрорадиологические и биохимические маркеры). Український вісник психоневрології. 2014; 4 (81Arboix A, Alsina M, Caballero M et al. Lacunar Infarcts: Clinical and Risk Factors in 864 Patients. J Heart Stroke 2017; 2 (3): 1023.Jain K.K. The Handbook of Biomarkers. N.Y.: Humana Press, 2010; p. 492.Путилина М.В. Практическая эндотелиология. Что необходимо знать врачу-клиницисту о диагностике и коррекции дисфункции эндотелия. Справочник поликлинического врача. 2017; 3: 70-7.Калын Я.Б. Психическое здоровье населения пожилого и старческого возраста (клинико-эпидемиологическое исследование). Автореф. дис. … д-ра мед. наук. М., 2001.Путилина М.В. Тревожно-депрессивные расстройства и инсульт. Возможные этиологические и патогенетические корреляции. Журн. неврологии и психиатрии им. С.С.Корсакова. 2014; 114 (6): 86-93.Меркин А.Г., Кажин В.А., Комаров А.Н. и др. Профилактика цереброваскулярных заболеваний и когнитивных расстройств в психиатрической и неврологической практике (обзор литературы). Неврология, нейропсихиатрия, психосоматика. 2016; 8 (3): 95-100. https: //doi.org/10.14412/2074-2711-2016-3-95-100Wardlaw J.M, Smith C, Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurology 2013; 12 (5): 483-97. DOI: 10.1016/S1474-4422 (13)70060-7Taylor W.D, Aizenstein H.J, Alexopoulos G.S. The vascular depression hypothesis: mechanisms linking vascular disease with depression. Mol Psychiatry 2013; 18 (9): 963-74. DOI: 10.1038/mp.2013.20Cheng W, Rolls E.T, Qiu J et al. Medial reward and lateral non-reward orbitofrontal cortex circuits change in opposite directions in depression. Brain 2016; 139: 3296-309. https: //doi.org/10.1093/brain/aww255Табеева Г.Р. Когнитивные и некогнитивные расстройства у пациентов пожилого возраста, ассоциированные со стрессом. Неврология, нейропсихиатрия, психосоматика. 2015; 1: 87-93.Prins N.D, Van Dijk E.J, Den Heijer T. Cerebral small-vessel disease and decline in information processing speed, executive function and memory. Brain 2005; 128 (9): 2034-41. DOI: 10.1093/brain/awh553Mazzoni M, Ferroni L, Lombardi L. Mini-Mental State Examination (MMSE): sensitivity in an Italian sample of patients with dementia. Ital J Neuro Sci 1992; 13: 323. https: //doi.org/10.1007/BF02223097Poggesi, A, Gouw A, van der Flier W. Neurological abnormalities predict disability: the LADIS (Leukoaraiosis And DISability) study. J Neurol 2014; 261: 1160. https: //doi.org/10.1007/s00415-014-7332-9Дамулин И.В., Екушева Е.В. Деменция вследствие поражения мелких церебральных сосудов: современные представления о патогенезе и терапии. Неврология, нейропсихиатрия, психосоматика. 2014; 6 (4): 94-100. https://doi.org/10.14412/2074-2711-2014-4-94-100Lanfranconi S, Markus H.S. COL4A1 mutations as a monogenic cause of cerebral small vessel disease: a systematic review. Stroke 2010; 41 (8): e513-e518. https: //doi.org/10.1161/STROKEAHA.110.581918Tojima M, Saito S, Yamamoto Y et al. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy with a Novel NOTCH3 Cys323Trp Mutation Presenting Border-Zone Infarcts: A Case Report and Literature Review. J Stroke Cerebrovasc Dis 2016; 25 (8): e128-30. DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.013Maeda S, Nakayama H, Isaka K. Familial unusual encephalopathy of Binswanger's type without hypertension. Folia Psychiatr Neurol Jpn 1976; 30: 165-77.Fukutake T, Hirayama K. Familial young-adult-onset arteriosclerotic leukoencephalopathy with alopecia and lumbago without arterialhypertension. Eur Neurol 1995; 35: 69-79.Winkler D. Hereditary systemic angiopathy (HSA) with cerebral calcifications, retinopthy, progressive nephropathy, and hepatopathy. J Neurol 2008; 255: 77-8. https: //doi.org/10.1007/s10072-014-1944-9Alamowitch S, Plaisier E, Favrole P. Cerebrovascular disease related to COL4A1 mutations in HANAC syndrome. Neurology 2009; 73 (22): 1873-82.Lanfranconi S, Markus HS. COL4A1 mutations as a monogenic cause of cerebral small vessel disease: A systemic review. Stroke 2010; 41: 513-8. DOI: 10.1161/strokeaha.110.581918Politei JM, Bouhassira D et al. Pain in Fabry Disease: Practical Recommendations for Diagnosis and Treatment. CNS Neurosci Ther 2016; 22 (7): 568-76. DOI: 10.1111/cns.12542Lavallee P.C, Labreuche J, Faille D et al. Circulating markers of endothelial dysfunction and platelet activation in patients with severe symptomatic cerebral small vessel disease. Cerebrovasc Dis 2013; 36: 131-8. DOI: 10.1159/000353671Philip B.M, Wardlaw J.M. Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions. Int J Stroke 2015; 10. Issue 4: 469-78. DOI: 10.1111/ijs.12466Blanco-Rojas L, Arboix A, Canovas D et al. Cognitive profile in patients with a first-ever lacunar infarct with and without silent lacunes: a comparative study. BMC Neurol 2013; 13: 203. DOI: 10.1186/1471-2377-13-203Путилина М.В. Эндотелий - мишень для новых терапевтических стратегий при сосудистых заболеваниях головного мозга. Журн. неврологии и психиатрии им. С.С.Корсакова. 2017; 10: 89-97. https: //doi.org/10.17116/jnevro2017117101Benavente O.R, Coffey C.S, Conwit R et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet 2013; 382: 507-15. DOI: 10.1016/S0140-6736 (13)60852-1Davidai G, Cotton D, Gorelick P et al. Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke: a post hoc analysis. Eur J Neurol 2014; 21: 1311-7. DOI: 10.1111/ene.12484Barzegar A. Proton-Coupled Electron-Transfer Mechanism for the Radical Scavenging Activity of Cardiovascular Drug Dipyridamole. PLoS ONE 2012; 7 (6): e39660. DOI: 10.1371/journal.pone.0039660): 764-9Aktas B, Utz A, Hoenig-Liedl P. Dipyridamole enhances NO/cGMP-mediated vasodilator-stimulated phosphoprotein phosphorylation and signaling in human platelets: in vitro and in vivo/ex vivo studies. Stroke 2003; 34 (3): 764-9.Танашян М.М., Домашенко М.А. Применение курантила при хроническом цереброваскулярном заболевании. Атмосфера. Нервные болезни. 2005; 3: 8-11.Arvin A, Campadelli Fiume G, Mocarski E et al. Human Herpesviruses: Biology, Therapy and Immunoprophylaxis. Cambridge University Press, 2007; p. 1432.Карева Е.Н. Особенности фармакологического действия и применения дипиридамола в профилактике и лечении вирусных инфекций. Consilium Medicum. 2016; 18 (12): 80-7Davidai G, Cotton D, Gorelick P. Dipyridamole-induced headache and lower recurrence risk in secondary prevention of ischaemic stroke: a post hoc analysis. Eur J Neurol 2014; 21: 1311-7. DOI: 10.1111/ene.12484Есин Р.Г., Есин О.Р., Хайруллин И.Х. Болезнь мелких сосудов: патогенетические подтипы, возможные лечебные стратегии. Consilum Mediсum. 2016; 18 (2): 104-8.