背景:脑小血管病(cSVD)是缺血性卒中和痴呆的主要因素。然而,cSVD的血管病变仍无定论。本系统综述和荟萃分析的目的是描述cSVD和脑血管反应性(CVR)之间的关系。大脑自动调节,和动脉僵硬度(AS)。
结果:MEDLINE,WebofScience,和Embase从开始到2023年9月进行了研究报告CVR,大脑自动调节,或AS与cSVD的放射标记有关。数据在预定义的表中提取,reviewed,并使用逆方差随机效应模型进行荟萃分析,以确定合并比值比(ORs)。共确定了1611项研究;142项纳入了系统评价,其中60人有可用于荟萃分析的数据.系统评价显示,CVR,大脑自动调节,和AS始终与cSVD相关(80.4%,78.6%,85.4%的研究,分别)。7项研究的荟萃分析(536名参与者,32.9%的女性)发现CVR受损和cSVD之间存在边缘性关联(OR,2.26[95%CI,0.99-5.14];P=0.05)。在37项研究中(27952名参与者,53.0%女性)增加AS,每SD,与cSVD相关(或,1.24[95%CI,1.15-1.33];P<0.01)。经合并症校正的元回归占AS模型方差的三分之一(R2=29.4%,主持人=0.02)。AS研究的亚组分析表明与白质高信号(OR,1.42[95%CI,1.18-1.70];P<0.01)。
结论:本系统综述和荟萃分析的共同发现表明cSVD与CVR受损和AS升高之间存在关联。然而,对血管僵硬度和调节功能作为cSVD可能危险因素的纵向研究仍有必要.
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]; P=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]; P<0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (R2=29.4%, Pmoderators=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; P<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.