Department of Kinesiology Kansas State University Manhattan KS USA.
Department of Biostatistics, St. Jude Children's Research Hospital Memphis TN USA.
J Am Heart Assoc. 2023 Dec 5;12(23):e032616. doi: 10.1161/JAHA.123.032616. Epub 2023 Nov 28.
Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta-analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS).
MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta-analyses performed using inverse-variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta-analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta-analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99-5.14]; =0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15-1.33]; <0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (=29.4%, =0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; <0.01).
The collective findings of the present systematic review and meta-analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.
脑小血管病（cSVD）是缺血性卒中和痴呆的主要致病因素。然而，cSVD 的血管病理学仍不明确。本系统评价和荟萃分析的目的是描述 cSVD 与脑血管反应性（CVR）、脑自动调节和动脉僵硬度（AS）之间的关联。
从 MEDLINE、Web of Science 和 Embase 数据库中检索了截至 2023 年 9 月与 cSVD 的放射学标志物相关的 CVR、脑自动调节和 AS 的研究。使用逆方差随机效应模型提取预定义表格中的数据进行荟萃分析，以确定汇总优势比（OR）。共确定了 1611 项研究；142 项被纳入系统评价，其中 60 项有可供 meta 分析的数据。系统评价显示，CVR、脑自动调节和 AS 与 cSVD 均具有一致性关联（分别有 80.4%、78.6%和 85.4%的研究）。7 项研究（536 名参与者，32.9%为女性）的 meta 分析显示，CVR 受损与 cSVD 之间存在边缘关联（OR，2.26 [95%CI，0.99-5.14]；=0.05）。37 项研究（27952 名参与者，53.0%为女性）中，AS 每增加 1 个标准差，与 cSVD 相关（OR，1.24 [95%CI，1.15-1.33]；<0.01）。对共病进行调整的 meta 回归解释了 AS 模型变异的三分之一（=29.4%，=0.02）。AS 研究的亚组分析表明，AS 与脑白质高信号（OR，1.42 [95%CI，1.18-1.70]；<0.01）相关。
本系统评价和荟萃分析的综合结果表明，cSVD 与 CVR 受损和 AS 升高之间存在关联。然而，仍需要对血管僵硬和调节功能作为 cSVD 潜在风险因素进行纵向研究。
