目的：脑小血管病（CSVD）是导致卒中及认知障碍的重要病因，其发生发展与地域环境及血管危险因素密切相关。高原地区长期低氧环境可能通过血流动力学改变影响CSVD 病理进程，而平原地区人群的高血压等代谢风险更为突出。本研究旨在对比高原与平原地区CSVD 患者影像标志物分布差异，明确两地危险因素特征，并进一步探讨平原地区CSVD 总负荷与认知功能损害的关联，为不同地域CSVD 的精准防治提供依据。方法：纳入高原地区（西藏，n = 131）和平原地区（北京协和医院，n = 183）CSVD 患者，所有患者均接受头颅MRI检查（3.0T），评估白质高信号（WMH，采用Fazekas 量表分级）、腔隙性梗死（LI）、微出血（CMB）及血管周围间隙扩大（EPVS）脑小血管病标记物。认知功能通过MMSE 及MoCA 量化。采用多因素Logistic 回归分析两地CSVD 高负荷（总评分≥ 1 分）的独立危险因素，并通过斯皮尔曼相关性检验探究平原地区影像标志物严重程度与认知评分的关联。

结果：高原地区CSVD 患者以白质高信号为主（95.4%），但平原地区白质高信号严重程度更高（Fazekas ≥ 2 级：74.3% vs. 47.3%）。高血压（OR = 12.88, 95% CI5.05–32.86）和年龄增长（≥ 70岁：OR = 10.41）是CSVD 高负荷的独立危险因素。而性别、吸烟、饮酒、高脂血症不存在统计学差异。平原地区认知评分与白质高信号（MoCA: R = -0.199, p = 0.041）及微出血显著负相关（p < 0.01），而与LI, CMB及EPVS 无明显相关。

结论：无论是在高原地区还是平原地区，高血压和年龄都是CSVD 的核心危险因素；白质高信号是CSVD 最常见的影像标志物，其严重程度与认知功能下降密切相关。

Objective: Cerebral small vessel disease (CSVD) is a critical etiology of stroke and cognitive impairment, with its development closely linked to geographical environments and vascular risk factors. Chronic hypoxic conditions in high-altitude regions may influence CSVD pathology through hemodynamic changes, while metabolic risks such as hypertension are more prominent in plain areas. This study aimed to compare the distribution of imaging markers in CSVD patients between high-altitude and plain regions, identify region-specific risk factors, and investigate the association between total CSVD burden and cognitive dysfunction in plain areas, thereby providing evidence for targeted prevention and treatment strategies.

Methods: A total of 131 CSVD patients from a high-altitude region (Tibet) and 183 patients from a plain region (Peking Union Medical College Hospital, Beijing) were enrolled. All participants underwent 3.0T brain MRI to assess CSVD markers: white matter hyperintensity (WMH, graded by Fazekas scale), lacunar infarction (LI), cerebral microbleeds (CMB), and enlarged perivascular spaces (EPVS). Cognitive function was assessed through two widely recognized assessment tools: MMSE and MoCA. Multivariate logistic regression analysis was performed to identify independent risk factors for high CSVD burden (total score ≥ 1), and Spearman’s correlation analysis was used to explore associations between imaging markers and cognitive scores in the plain cohort.

Results: WMH was the most prevalent marker in high-altitude patients (95.4%), but plain patients exhibited higher WMH severity (Fazekas grade ≥ 2: 74.3% vs. 47.3%, p < 0.01). Hypertension (OR = 12.88, 95% CI 5.05–32.86) and advanced age (≥ 70 years: OR = 10.41) were independent risk factors for high CSVD burden, while gender, smoking, alcohol consumption, and hyperlipidemia showed no significant associations. In plain regions, cognitive scores (MoCA: R = -0.199, p = 0.041) were negatively correlated with WMH severity and CMB burden (p < 0.01), but not with LI, CMB, or EPVS.

Conclusion: Hypertension and aging are core risk factors for CSVD in both high-altitude and plain regions. WMH is the most common imaging marker, and its severity is closely associated with cognitive decline. These findings highlight the need for region-specific interventions to mitigate CSVD progression and related cognitive impairment.