无症状且血流动力学稳定的烟雾病的临床及影像学病程：一项系统评价与荟萃分析
Clinical and radiological course of asymptomatic and hemodynamically stable moyamoya disease: a systematic review and meta-analysis.
作者信息
Chen Yang, Zhou Zixuan, Qin Bingyang, Liang Yan, Li Peize, Li Ziao, Chen Yu, Li Ren, Yang Biao, Wang Xiaogang, Wu Yongqiang, Guo Xiaolong, Zhang Huidong, Guo Geng
机构信息
Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, China.
Cerebrovascular Disease Center, First Hospital of Shanxi Medical University, Taiyuan, China.
出版信息
Front Neurol. 2025 Jul 8;16:1626817. doi: 10.3389/fneur.2025.1626817. eCollection 2025.
BACKGROUND
Moyamoya disease (MMD) is an idiopathic, chronic intracranial vascular stenosis and occlusion disease. However, there is currently a lack of comprehensive analysis on the clinical and radiological course of asymptomatic MMD (AMMD) and hemodynamically stable MMD (HSMMD).
DATA SOURCE
We conducted a comprehensive literature search using major bibliographic indexing databases, including Embase, Medline, PubMed, Web of Science, and Cochrane Library.
METHODS
This systematic review was conducted based on the PRISMA guidelines. The quality of the included studies was accessed using the Methodological Index for Non-Randomized Studies (MINORS). Effect sizes were pooled with a random-effects model. Heterogeneity between studies was estimated via the I test. Publication bias was assessed with Egger's test. The registration code is CRD42023444432.
RESULT
A total of seven AMMD studies were included in a meta-analysis, involving 393 patients and 649 hemispheres. Three HSMMD studies were all from the same institution. The pooled rate for clinical progression, hemorrhagic stroke, ischemic stroke, transient ischemic attack (TIA), and radiological progress of conservative group was 10% (95% CI 4.9-15.1%), 3.8% (95% CI 0.4-7.2%), 0.7% (95% CI 0-2.3%), 3.6% (95% CI 0.6-6.6%), and 15.6% (95% CI 10.2-22.1%), respectively. The pooled rate for stroke, TIA, and radiological progress of the surgical group was 3.7% (95% CI 0-10.8%), 0.2% (95% CI 0-3.0%), and 4.8% (95% CI 0-10.5%), respectively. Revascularization did not show a protective effect on TIA and radiological progression for AMMD.
CONCLUSION
AMMD and HSMMD present a concerning risk of clinical and radiological progression over a follow-up period of more than 2 years. Further high-quality studies are needed to optimize treatment strategies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444432, CRD42023444432.
背景
烟雾病（MMD）是一种特发性慢性颅内血管狭窄和闭塞性疾病。然而，目前缺乏对无症状烟雾病（AMMD）和血流动力学稳定型烟雾病（HSMMD）的临床和影像学病程的综合分析。
数据来源
我们使用主要的文献索引数据库进行了全面的文献检索，包括Embase、Medline、PubMed、科学网和考克兰图书馆。
方法
本系统评价按照PRISMA指南进行。使用非随机研究方法学指数（MINORS）评估纳入研究的质量。效应量采用随机效应模型合并。通过I检验估计研究间的异质性。用Egger检验评估发表偏倚。注册码为CRD42023444432。
结果
一项荟萃分析共纳入7项AMMD研究，涉及393例患者和649个半球。3项HSMMD研究均来自同一机构。保守治疗组临床进展、出血性卒中、缺血性卒中、短暂性脑缺血发作（TIA）和影像学进展的合并发生率分别为10%（95%CI 4.9 - 15.1%）、3.8%（95%CI 0.4 - 7.2%）、0.7%（95%CI 0 - 2.3%）、3.6%（95%CI 0.6 - 6.6%）和15.6%（95%CI 10.2 - 22.1%）。手术治疗组卒中、TIA和影像学进展的合并发生率分别为3.7%（95%CI 0 - 10.8%）、0.2%（95%CI 0 - 3.0%）和4.8%（95%CI 0 - 10.5%）。血运重建对AMMD的TIA和影像学进展未显示出保护作用。
结论
在超过2年的随访期内，AMMD和HSMMD存在临床和影像学进展的风险，令人担忧。需要进一步开展高质量研究以优化治疗策略。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444432，CRD42023444432。
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