缺血性卒中后白质病变的严重程度和分布与出血性转化之间的关联：一项系统评价和荟萃分析。
The association between the severity and distribution of white matter lesions and hemorrhagic transformation after ischemic stroke: A systematic review and meta-analysis.
作者信息
Wang Youjie, Bai Xueling, Ye Chen, Yu Yifan, Wu Bo
机构信息
West China School of Medicine, Sichuan University, Chengdu, China.
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Front Aging Neurosci. 2022 Nov 25;14:1053149. doi: 10.3389/fnagi.2022.1053149. eCollection 2022.
BACKGROUND AND PURPOSE
As a part of the natural course of ischemic stroke, hemorrhagic transformation (HT) is a serious complication after reperfusion treatment, which may affect the prognosis of patients with ischemic stroke. White matter lesions (WMLs) refer to focal lesions on neuroimaging and have been suggested to indicate a high risk of HT. This systematic review and meta-analysis aimed to summarize current evidence on the relation between WML and HT.
METHODS
This systematic review was prepared with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for publications on WML and HT in patients with ischemic stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) from eligible studies were combined to quantify the association between the severity of WML and the risk of HT. In addition, the descriptive analysis was adopted to evaluate the influence of different WML distributions on predicting HT.
RESULTS
A total of 2,303 articles were identified after removing duplicates through database searching, and 41 studies were included in our final analysis. The meta-analysis showed that the presence of WML was associated with HT (OR = 1.62, 95%CI 1.08-2.43, = 0.019) and symptomatic intracerebral hemorrhage (sICH) (OR = 1.64, 95%CI 1.17-2.30, = 0.004), and moderate-to-severe WML indicated a high risk of HT (OR = 2.03, 95%CI 1.33-3.12, = 0.001) and sICH (OR = 1.92, 95%CI 1.31-2.81, < 0.001). The dose-response meta-analysis revealed risk effects of increasing the severity of WML on both HT and ICH. In addition, both periventricular WML (PWML) (five of seven articles) and deep WML (DWML) (five of six articles) were shown to be associated with HT.
CONCLUSIONS
White matter lesions are associated with overall HT and sICH in patients with ischemic stroke, and more severe WMLs indicate a high risk of HT and sICH. In addition, both PWML and DWMLs could be risk factors for HT.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42022313467.
背景与目的
作为缺血性卒中自然病程的一部分，出血性转化（HT）是再灌注治疗后的一种严重并发症，可能影响缺血性卒中患者的预后。白质病变（WMLs）是指神经影像学上的局灶性病变，提示HT风险较高。本系统评价和荟萃分析旨在总结目前关于WML与HT关系的证据。
方法
本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南编写。我们在PubMed、Embase、Web of Science和Cochrane图书馆数据库中检索了关于缺血性卒中患者WML和HT的文献。将符合条件的研究中的比值比（OR）和95%置信区间（CIs）合并，以量化WML严重程度与HT风险之间的关联。此外，采用描述性分析来评估不同WML分布对预测HT的影响。
结果
通过数据库检索去除重复文献后，共识别出2303篇文章，最终纳入41项研究进行分析。荟萃分析显示，WML的存在与HT（OR = 1.62，95%CI 1.08 - 2.43，P = 0.019）和症状性脑出血（sICH）（OR = 1.64，95%CI 1.17 - 2.30，P = 0.004）相关，中度至重度WML提示HT（OR = 2.03，95%CI 1.33 - 3.12，P = 0.001）和sICH（OR = 1.92，95%CI 1.31 - 2.81，P < 0.001）风险较高。剂量反应荟萃分析揭示了WML严重程度增加对HT和ICH的风险影响。此外，脑室周围WML（PWML）（7篇文章中的5篇）和深部WML（DWML）（6篇文章中的5篇）均与HT相关。
结论
白质病变与缺血性卒中患者的总体HT和sICH相关，更严重的WML提示HT和sICH风险较高。此外，PWML和DWML均可能是HT的危险因素。
系统评价注册
https://www.crd.york.ac.uk/prospero/，标识符：PROSPERO CRD42022313467。
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