From the Institute for Stroke and Dementia Research, University Hospital (M.K.G., M. Duering, M. Dichgans), and Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-Universität LMU, Munich, Germany; Division of Neuroimaging Science (J.M.W.), Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute, University of Edinburgh, UK; Munich Cluster for Systems Neurology (SyNergy) (M. Dichgans); and German Centre for Neurodegenerative Diseases (M. Dichgans), Munich, Germany.
Neurology. 2019 Mar 19;92(12):e1298-e1308. doi: 10.1212/WNL.0000000000007142. Epub 2019 Feb 15.
To investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality.
Following the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle-Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models.
We included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72-2.73), cognitive impairment (RR 2.29, 95% CI 1.48-3.54), functional impairment (RR 2.21, 95% CI 1.83-2.67), any recurrent stroke (RR 1.65, 95% CI 1.36-2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26-2.88), all-cause mortality (RR 1.72, 95% CI 1.47-2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44-2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias.
Presence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.
探讨缺血性脑卒中患者基线时脑白质高信号（WMH）与痴呆、功能障碍、复发性卒中以及死亡的长期风险之间的关系。
根据观察性研究的荟萃分析流行病学和系统评价与荟萃分析的首选报告项目（PROSPERO 方案：CRD42018092857），我们系统地检索了 Medline 和 Scopus 中的队列研究，以调查基线时 MRI 或 CT 评估的 WMH 是否与卒中后 3 个月或更长时间的痴呆、功能障碍、复发性卒中以及死亡相关。我们使用纽卡斯尔-渥太华量表提取数据并评估研究质量。我们使用随机效应模型对 WMH 的存在和严重程度进行了相对风险（RR）的汇总。
我们纳入了 104 项研究，共计 71298 例缺血性卒中患者。基线时存在中度/重度 WMH 与痴呆（RR 2.17，95%置信区间 [CI] 1.72-2.73）、认知障碍（RR 2.29，95% CI 1.48-3.54）、功能障碍（RR 2.21，95% CI 1.83-2.67）、任何复发性卒中（RR 1.65，95% CI 1.36-2.01）、复发性缺血性卒中（RR 1.90，95% CI 1.26-2.88）、全因死亡率（RR 1.72，95% CI 1.47-2.01）和心血管死亡率（RR 2.02，95% CI 1.44-2.83）风险增加相关。WMH 严重程度的关联呈剂量反应模式，并且在 MRI 和 CT 定义的 WMH 中均一致。在调整年龄、卒中严重程度和心血管危险因素、在质量评分高的研究分析中以及在调整发表偏倚的分析中，结果均保持稳定。
WMH 的存在和严重程度与缺血性卒中后痴呆、功能障碍、卒中复发和死亡的风险显著增加相关。WMH 可能有助于临床预后评估和未来临床试验的规划。
