Skinner Bethany D, Davies Rebecca J, Weaver Samuel R, Cable N Tim, Lucas Samuel J E, Lucas Rebekah A I
School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.
Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom.
Front Physiol. 2021 Jun 17;12:687591. doi: 10.3389/fphys.2021.687591. eCollection 2021.
Sex differences in cerebrovascular disease rates indicate a possible role for ovarian sex steroid hormones in cerebrovascular function. To synthesise and identify knowledge gaps, a systematic review and meta-analysis was conducted to assess how ovarian sex steroid hormone changes across the lifespan affect cerebrovascular function in women. Three databases (EMBASE, MEDLINE and Web of Science) were systematically searched for studies on adult cerebrovascular function and ovarian sex steroid hormones. Forty-five studies met pre-defined inclusion criteria. Studied hormone groups included hormone replacement therapy (HRT; = 17), pregnancy ( = 12), menstrual cycle ( = 7), menopause ( = 5), oral contraception ( = 2), and ovarian hyperstimulation ( = 2). Outcome measures included pulsatility index (PI), cerebral blood flow/velocity (CBF), resistance index (RI), cerebral autoregulation, and cerebrovascular reactivity. Meta-analysis was carried out on HRT studies. PI significantly decreased [-0.05, 95% CI: (-0.10, -0.01); = 0.01] in post-menopausal women undergoing HRT compared to post-menopausal women who were not, though there was considerable heterogeneity ( = 96.8%). No effects of HRT were seen in CBF ( = 0.24) or RI ( = 0.77). This review indicates that HRT improves PI in post-menopausal women. However, there remains insufficient evidence to determine how changing ovarian sex steroid hormone levels affects cerebrovascular function in women during other hormonal phases (e.g., pregnancy, oral contraception).
脑血管疾病发病率的性别差异表明卵巢性甾体激素在脑血管功能中可能发挥作用。为了综合和识别知识空白，我们进行了一项系统综述和荟萃分析，以评估女性一生中卵巢性甾体激素的变化如何影响脑血管功能。我们系统检索了三个数据库（EMBASE、MEDLINE和Web of Science），以查找关于成人大脑血管功能和卵巢性甾体激素的研究。45项研究符合预先设定的纳入标准。所研究的激素组包括激素替代疗法（HRT；n = 17）、妊娠（n = 12）、月经周期（n = 7）、绝经（n = 5）、口服避孕药（n = 2）和卵巢过度刺激（n = 2）。结局指标包括搏动指数（PI）、脑血流量/速度（CBF）、阻力指数（RI）、脑自动调节和脑血管反应性。对HRT研究进行了荟萃分析。与未接受HRT的绝经后女性相比，接受HRT的绝经后女性的PI显著降低[-0.05，95%CI：（-0.10，-0.01）；P = 0.01]，尽管存在相当大的异质性（I² = 96.8%）。在CBF（P = 0.24）或RI（P = 0.77）方面未观察到HRT的影响。本综述表明，HRT可改善绝经后女性的PI。然而，仍缺乏足够的证据来确定卵巢性甾体激素水平的变化如何影响女性在其他激素阶段（如妊娠、口服避孕药）的脑血管功能。
