Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K.
UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, 47 Little France Crescent, Edinburgh EH16 4TJ, U.K.
Clin Sci (Lond). 2018 Jan 16;132(1):157-171. doi: 10.1042/CS20171280.
Growing evidence suggests that increased intracranial pulsatility is associated with cerebral small vessel disease (SVD). We systematically reviewed papers that assessed intracranial pulsatility in subjects with SVD. We included 27 cross-sectional studies (=3356): 20 used Doppler ultrasound and 7 used phase-contrast MRI. Most studies measured pulsatility in the internal carotid or middle cerebral arteries (ICA, MCA), whereas few assessed veins or cerebrospinal fluid (CSF). Methods to reduce bias and risk factor adjustment were poorly reported. Substantial variation between studies in assessment of SVD and of pulsatility indices precluded a formal meta-analysis. Eight studies compared pulsatility by SVD severity (=26-159, median = 74.5): arterial pulsatility index was generally higher in more severe SVD (e.g. MCA: standardized mean difference = 3.24, 95% confidence interval [2.40, 4.07]), although most did not match for age. Seventeen studies (=9-700; median = 110) performed regression or correlation analysis, of which most showed that increased pulsatility was associated with SVD after adjustment for age. In conclusion, most studies support a cross-sectional association between higher pulsatility in large intracranial arteries and SVD. Future studies should minimize bias, adjust for potential confounders, include pulsatility in veins and CSF, and examine longitudinal relationship between pulsatility and SVD. Agreement on reliable measures of intracranial pulsatility would be helpful.
越来越多的证据表明，颅内脉动增加与脑小血管疾病（SVD）有关。我们系统地回顾了评估 SVD 患者颅内脉动的论文。我们纳入了 27 项横断面研究（=3356 例）：20 项使用了多普勒超声，7 项使用了相位对比 MRI。大多数研究测量了颈内或大脑中动脉（ICA、MCA）的脉动，而很少评估静脉或脑脊液（CSF）。关于减少偏倚和危险因素调整的方法报告得很差。由于评估 SVD 和脉动指数的研究之间存在很大差异，因此无法进行正式的荟萃分析。八项研究比较了 SVD 严重程度（=26-159，中位数=74.5）的脉动（例如 MCA：标准化均数差=3.24，95%置信区间[2.40，4.07]），尽管大多数研究没有匹配年龄。十七项研究（=9-700；中位数=110）进行了回归或相关性分析，其中大多数表明，在调整年龄后，脉动增加与 SVD 有关。总之，大多数研究支持颅内大动脉脉动增加与 SVD 之间的横断面关联。未来的研究应尽量减少偏倚，调整潜在的混杂因素，包括静脉和 CSF 的脉动，并检查脉动与 SVD 之间的纵向关系。对可靠的颅内脉动测量达成一致将是有益的。
