Jashari F, Ibrahimi P, Bajraktari G, Grönlund C, Wester P, Henein M Y
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Biomedical Engineering - Radiation Sciences, Umeå University, Umeå, Sweden.
Eur J Neurol. 2016 Jul;23(7):1241-7. doi: 10.1111/ene.13017. Epub 2016 Apr 23.
Many reports have shown an association between hypoechoic (echolucent) carotid atherosclerotic plaques and unstable features. In this meta-analysis our aim was to determine the role of carotid plaque echogenicity in predicting future cerebrovascular (CV) symptoms.
Electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to September 2015 were systematically searched. Studies with ultrasound-based characterization of carotid artery plaque echogenicity and its association with focal neurological symptoms of vascular origin were eligible for analysis. In the meta-analysis, heterogeneity was measured using I(2) statistics and publication bias was evaluated using the Begg-Mazumdar test. In addition several comparisons between subgroups were performed.
Of 1387 identified reports, eight studies with asymptomatic patients and three studies with symptomatic patients were meta-analyzed. Pooled analysis showed an association between echolucent carotid plaques and future CV events in asymptomatic patients [relative risk 2.72 (95% confidence interval 1.86-3.96)] and recurrent symptoms in symptomatic patients [relative risk 2.97 (95% confidence interval 1.85-4.78)]. The association was preserved for all stenosis degrees in asymptomatic patients, whilst patients with echolucent plaques and severe stenosis were at higher risk of future events. Also, computer-assisted methods for assessment of carotid plaque echogenicity and studies analyzing ultrasound data collected after the year 2000 showed better prediction.
In asymptomatic and symptomatic patients, analysis of carotid plaque echogenicity could identify those at high risk of CV events.
许多报告显示，低回声（无回声）颈动脉粥样硬化斑块与不稳定特征之间存在关联。在这项荟萃分析中，我们的目的是确定颈动脉斑块回声性在预测未来脑血管（CV）症状中的作用。
系统检索截至2015年9月的电子数据库（PubMed、MEDLINE、EMBASE和Cochrane中心注册库）。以超声为基础对颈动脉斑块回声性进行特征描述及其与血管源性局灶性神经症状相关性的研究符合分析条件。在荟萃分析中，使用I²统计量测量异质性，并使用Begg-Mazumdar检验评估发表偏倚。此外，还对亚组之间进行了多项比较。
在1387篇已识别的报告中，对8项无症状患者的研究和3项有症状患者的研究进行了荟萃分析。汇总分析显示，无症状患者中，无回声颈动脉斑块与未来CV事件之间存在关联[相对风险2.72（95%置信区间1.86 - 3.96）]，有症状患者中与复发症状之间存在关联[相对风险2.97（95%置信区间1.85 - 4.78）]。在无症状患者中，这种关联在所有狭窄程度中均存在，而有无回声斑块且严重狭窄的患者未来发生事件的风险更高。此外，计算机辅助评估颈动脉斑块回声性的方法以及分析2000年后收集的超声数据的研究显示出更好的预测效果。
在无症状和有症状患者中，分析颈动脉斑块回声性可以识别出CV事件的高危人群。
