脊髓损伤后周围血管功能障碍：一项系统评价和荟萃分析。
Peripheral Vascular Dysfunction Following Spinal Cord Injury: A Systematic Review and Meta-Analysis.
作者信息
Thordarson Thomas, Miller Tiev, Calderón-Juárez Martín, Hosseinzadeh Ali, Malik Raza, Sachdeva Rahul, Krassioukov Andrei V
机构信息
International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada.
出版信息
Top Spinal Cord Inj Rehabil. 2025 Spring;31(2):88-103. doi: 10.46292/sci24-00036. Epub 2025 Jun 19.
BACKGROUND
Spinal cord injury (SCI) has been shown to impact vascular function and increase the risk of cardiovascular disease (CVD). However, data are limited regarding prognostic factors for identifying subclinical CVD risk in individuals with SCI.
OBJECTIVES
To identify maladaptive structural and functional changes to central and peripheral vasculature resulting from SCI and to assess the effect of SCI on these parameters relative to able-bodied comparators.
METHODS
This review was prospectively registered. A systematic search was performed using PRISMA guidelines. Bias was assessed using the ROBINS-I and AHRQ tools. Studies reporting structural or functional changes to vasculature following SCI were included. Data on participant and injury characteristics, outcomes, and assessments used were extracted. Meta-analyses were conducted for adequately powered subgroups based on outcome type, measurement site, and level of injury.
RESULTS
A total of 49 studies involving 1026 individuals with SCI and 941 able-bodied comparators were included. Most studies described injury level and severity using standardized impairment classifications. Subgroup analyses showed significantly reduced arterial diameter, compliance, endothelial function, blood flow volume, and high-density lipoprotein (HDL) cholesterol concentration among people with SCI compared to controls. Intima-media thickness, arterial stiffness, shear rate, and blood glucose and triglyceride concentrations were significantly greater for people with SCI compared to controls. Additional subgroup analyses were underpowered.
CONCLUSION
This review synthesizes the current literature reporting central and peripheral vasculature outcomes in people with SCI and able-bodied controls. Between-group differences were observed for several structural and functional vascular outcomes, which suggests that SCI has a significant impact on multiple subclinical CVD risk factors.
背景
脊髓损伤（SCI）已被证明会影响血管功能并增加心血管疾病（CVD）的风险。然而，关于识别脊髓损伤个体亚临床心血管疾病风险的预后因素的数据有限。
目的
确定脊髓损伤导致的中枢和外周血管适应性结构和功能变化，并评估脊髓损伤相对于健全对照者对这些参数的影响。
方法
本综述进行了前瞻性注册。使用PRISMA指南进行系统检索。使用ROBINS-I和AHRQ工具评估偏倚。纳入报告脊髓损伤后血管结构或功能变化的研究。提取有关参与者和损伤特征、结局及所用评估方法的数据。根据结局类型、测量部位和损伤水平对有足够样本量的亚组进行荟萃分析。
结果
共纳入49项研究，涉及1026例脊髓损伤个体和941例健全对照者。大多数研究使用标准化损伤分类描述损伤水平和严重程度。亚组分析显示，与对照组相比，脊髓损伤患者的动脉直径、顺应性、内皮功能、血流量和高密度脂蛋白（HDL）胆固醇浓度显著降低。与对照组相比，脊髓损伤患者的内膜中层厚度、动脉僵硬度、剪切率以及血糖和甘油三酯浓度显著更高。其他亚组分析样本量不足。
结论
本综述综合了当前关于脊髓损伤患者和健全对照者中枢和外周血管结局的文献。在几个血管结构和功能结局方面观察到组间差异，这表明脊髓损伤对多个亚临床心血管疾病风险因素有显著影响。
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