颅内和颅外动脉粥样硬化与白质高信号之间的关联：一项系统评价和荟萃分析。

Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis.

作者信息

Zhang Wenyuan, Fu Fangwang, Zhan Zhenxiang

机构信息

Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China.

Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.

出版信息

Front Aging Neurosci. 2024 Jan 8;15:1240509. doi: 10.3389/fnagi.2023.1240509. eCollection 2023.

BACKGROUND

White matter hyperintensities (WMHs) are key neuroimaging markers of cerebral small vessel diseases. This study aimed to investigate whether intracranial and extracranial atherosclerotic stenosis is associated with WMHs.

METHODS

Following a previously registered protocol (PROSPERO protocol: CRD42023407465), PubMed, Web of Science, and Embase were systematically searched for relevant literature published until March 2023. Cross-sectional studies examining the association between intracranial and extracranial atherosclerotic stenosis and WMHs were included. Random effects models were used to calculate the pooled estimates.

RESULTS

Twenty-one eligible studies, including 10,841 participants, were identified. Intracranial and extracranial atherosclerotic stenosis was associated with an increased risk of WMHs (OR 1.80, 95% CI 1.25-2.57, = 75%) and increased WMH volumes (SMD 0.40, 95% CI 0.18-0.63, = 63%). Heterogeneity resulted from the WMHs rating method and the location. Extracranial atherosclerotic stenosis (ECAS) was significantly associated with WMHs (OR 2.10, 95% CI 1.22-3.62, = 71%), but intracranial atherosclerotic stenosis (ICAS) was insignificantly associated with WMHs (OR 1.75, 95% CI 0.97-3.15, = 84%). The association was stable in the subgroup analysis based on WMHs location, which included deep WMHs and periventricular WMHs.

CONCLUSION

Intracranial and extracranial atherosclerotic stenosis is associated with WMHs. This association is significant in ECAS, but attenuated in ICAS.

背景

脑白质高信号（WMHs）是脑小血管疾病的关键神经影像学标志物。本研究旨在探讨颅内和颅外动脉粥样硬化狭窄是否与脑白质高信号相关。

方法

按照先前注册的方案（PROSPERO方案：CRD42023407465），系统检索了PubMed、Web of Science和Embase数据库中截至2023年3月发表的相关文献。纳入了研究颅内和颅外动脉粥样硬化狭窄与脑白质高信号之间关联的横断面研究。采用随机效应模型计算合并估计值。

结果

共纳入21项符合条件的研究，包括10841名参与者。颅内和颅外动脉粥样硬化狭窄与脑白质高信号风险增加相关（比值比1.80，95%置信区间1.25 - 2.57，I² = 75%），且与脑白质高信号体积增加相关（标准化均数差0.40，95%置信区间0.18 - 0.63，I² = 63%）。异质性源于脑白质高信号的评分方法和部位。颅外动脉粥样硬化狭窄（ECAS）与脑白质高信号显著相关（比值比2.10，95%置信区间1.22 - 3.62，I² = 71%），但颅内动脉粥样硬化狭窄（ICAS）与脑白质高信号的关联不显著（比值比1.75，95%置信区间0.97 - 3.15，I² = 84%）。在基于脑白质高信号部位的亚组分析中，该关联是稳定的，脑白质高信号部位包括深部脑白质高信号和脑室周围脑白质高信号。