Abstract：
UNASSIGNED: Cerebral small vessel disease (CSVD) causes between 25% and 30% of all ischemic strokes. In acute lacunar ischemic stroke, despite often mild initial symptoms, early neurological deterioration (END) occurs in approximately 15-20% of patients and is associated with poor functional outcome, yet its mechanisms are not well understood.
UNASSIGNED: In this review, we systematically evaluated data on: (1) definitions and incidence of END, (2) mechanisms of small vessel occlusion, (3) predictors and mechanisms of END, and (4) prospects for the prevention or treatment of patients with END.
UNASSIGNED: We identified 67 reports (including 13,407 participants) describing the incidence of END in acute lacunar ischemic stroke. The specified timescale for END varied from <24 h to 3 weeks. The rate of END ranged between 2.3% and 47.5% with a pooled incidence of 23.54% (95% confidence interval (CI) = 21.02-26.05) but heterogeneity was high (I2 = 90.29%). The rates of END defined by National Institutes of Health Stroke Scale (NIHSS) decreases of ⩾1, ⩾2, ⩾3, and 4 points were as follows: 24.17 (21.19-27.16)%, 22.98 (20.48-25.30)%, 23.33 (16.23-30.42)%, and 10.79 (2.09-23.13)%, respectively, with lowest heterogeneity and greatest precision for a cutoff of ⩾2 points. Of the 20/67 studies (30%) reporting associations of END with clinical outcome, 19/20 (95%) reported worse outcomes (usually measured using the modified Rankin score at 90 days or at hospital discharge) in patients with END. In a meta-regression analysis, female sex, hypertension, diabetes, and smoking were associated with END.
UNASSIGNED: END occurs in more than 20% of patients with acute lacunar ischemic stroke and might provide a novel target for clinical trials. A definition of an NIHSS ⩾2 decrease is most used and provides the best between-study homogeneity. END is consistently associated with poor functional outcome. Further research is needed to better identify patients at risk of END, to understand the underlying mechanisms, and to carry out new trials to test potential interventions.
UNASSIGNED: In this review, we systematically evaluated data on: (1) definitions and incidence of END, (2) mechanisms of small vessel occlusion, (3) predictors and mechanisms of END, and (4) prospects for the prevention or treatment of patients with END.
UNASSIGNED: We identified 67 reports (including 13,407 participants) describing the incidence of END in acute lacunar ischemic stroke. The specified timescale for END varied from <24 h to 3 weeks. The rate of END ranged between 2.3% and 47.5% with a pooled incidence of 23.54% (95% confidence interval (CI) = 21.02-26.05) but heterogeneity was high (I2 = 90.29%). The rates of END defined by National Institutes of Health Stroke Scale (NIHSS) decreases of ⩾1, ⩾2, ⩾3, and 4 points were as follows: 24.17 (21.19-27.16)%, 22.98 (20.48-25.30)%, 23.33 (16.23-30.42)%, and 10.79 (2.09-23.13)%, respectively, with lowest heterogeneity and greatest precision for a cutoff of ⩾2 points. Of the 20/67 studies (30%) reporting associations of END with clinical outcome, 19/20 (95%) reported worse outcomes (usually measured using the modified Rankin score at 90 days or at hospital discharge) in patients with END. In a meta-regression analysis, female sex, hypertension, diabetes, and smoking were associated with END.
UNASSIGNED: END occurs in more than 20% of patients with acute lacunar ischemic stroke and might provide a novel target for clinical trials. A definition of an NIHSS ⩾2 decrease is most used and provides the best between-study homogeneity. END is consistently associated with poor functional outcome. Further research is needed to better identify patients at risk of END, to understand the underlying mechanisms, and to carry out new trials to test potential interventions.
摘要：
背景：脑小血管病（CSVD）占所有缺血性卒中的25％至30％。在急性腔隙性缺血性中风中，尽管最初的症状通常很轻微，早期神经系统恶化（END）发生在大约15-20％的患者中，并与不良的功能结局有关。然而，其机制还没有得到很好的理解。
目的：在这篇综述中，我们系统地评估了以下方面的数据：（1）END的定义和发生率；（2）小血管闭塞的机制；（3）END的预测因素和机制；（4）END患者的预防或治疗前景。
结果：我们确定了67份报告（包括13407名参与者）描述了END在急性腔隙性缺血性卒中中的发生率。END的指定时间范围从<24h到3周不等。END的发生率介于2.3％和47.5之间，合并发生率为23.54％（95％CI21.02-26.05％），但异质性很高（I2=90.29％）。NIHSS定义的END下降率≥1，≥2，≥3和4点分别为：24.17（21.19-27.16）％;22.98（20.48-25.30）％;23.33（16.23-30.42）％;和10.79（2.09-23.13）％，分别,对于≥2点的截止值，异质性最低，精度最高。在报告END与临床结果相关的20/67研究（30%）中，19/20（95％）报告了END患者的预后较差（通常在90天或出院时使用改良的Rankin评分进行测量）。在荟萃回归分析中，女性性别，高血压,糖尿病,吸烟,与END相关联。
结论：超过20%的急性腔隙性缺血性卒中患者出现早期神经功能恶化，可能为临床试验提供一个新的目标。NIHSS≥2下降的定义是最常用的，并提供了最佳的研究间同质性。END始终与不良功能结果相关。需要进一步的研究来更好地识别有END风险的患者，了解潜在的机制，并开展新的试验来测试潜在的干预措施。
目的：在这篇综述中，我们系统地评估了以下方面的数据：（1）END的定义和发生率；（2）小血管闭塞的机制；（3）END的预测因素和机制；（4）END患者的预防或治疗前景。
结果：我们确定了67份报告（包括13407名参与者）描述了END在急性腔隙性缺血性卒中中的发生率。END的指定时间范围从<24h到3周不等。END的发生率介于2.3％和47.5之间，合并发生率为23.54％（95％CI21.02-26.05％），但异质性很高（I2=90.29％）。NIHSS定义的END下降率≥1，≥2，≥3和4点分别为：24.17（21.19-27.16）％;22.98（20.48-25.30）％;23.33（16.23-30.42）％;和10.79（2.09-23.13）％，分别,对于≥2点的截止值，异质性最低，精度最高。在报告END与临床结果相关的20/67研究（30%）中，19/20（95％）报告了END患者的预后较差（通常在90天或出院时使用改良的Rankin评分进行测量）。在荟萃回归分析中，女性性别，高血压,糖尿病,吸烟,与END相关联。
结论：超过20%的急性腔隙性缺血性卒中患者出现早期神经功能恶化，可能为临床试验提供一个新的目标。NIHSS≥2下降的定义是最常用的，并提供了最佳的研究间同质性。END始终与不良功能结果相关。需要进一步的研究来更好地识别有END风险的患者，了解潜在的机制，并开展新的试验来测试潜在的干预措施。
