背景:本荟萃分析旨在探讨血管周围间隙(PVS)负荷与缺血性卒中和短暂性脑缺血发作(TIA)患者未来卒中事件和死亡风险的关系。
方法:我们系统地搜索了PubMed,Embase和Cochrane数据库从成立到2023年12月31日。我们纳入了符合条件的研究,这些研究报告了对未来颅内出血(ICH)的校正估计效果,缺血性卒中和TIA患者基线PVS负荷的缺血性卒中和死亡率.使用固定效应(FE)模型的逆方差方法和随机效应(RE)模型的受限最大似然(REML)方法对数据进行汇总。
结果:13项观察性研究(5项前瞻性,8个回顾性)包括在内,包括20256名患者。与基底神经节(BG)的0-10个PVS相比,较高的BG-PVS负担(>10)与未来颅内出血的风险增加显着相关(调整后的风险比[aHR]2.79,95%置信区间[CI]1.16-6.73,RE模型;aHR2.14,95CI1.34-3.41,FE模型;I2=64%,来自四项研究的n=17084)随访至少一年。再灌注治疗后7天内,10BG-PVS与颅内出血之间没有显着关联(校正比值比[aOR]1.69,95CI0.74-3.88,RE模型;aOR1.43,95CI0.89-2.88,FE模型;I2=67%,来自四项研究的n=1176)。我们没有检测到复发性缺血性卒中的显著关联,BG-PVS负担的死亡率或残疾。半卵中心PVS(CSO-PVS)和增加CSO-PVS负荷均与未来脑出血或缺血性卒中复发的风险无显著关联。
结论:目前的证据表明,更高的BG-PVS负荷可能与缺血性卒中和TIA患者未来颅内出血的风险增加有关。PROSPERO注册号:CRD42021232713,网址:https://www.crd.约克。AC.uk/prospro/display_record.php?ID=CRD42021232713。
BACKGROUND: This meta-analysis aimed to explore the association of perivascular spaces (PVS) burden with the risks of future stroke events and mortality in patients with ischemic stroke and transient ischemic attack (TIA).
METHODS: We systematically searched PubMed, Embase, and Cochrane database from inception to December 31, 2023. We included eligible studies that reported adjusted estimated effects for future intracranial hemorrhage (ICH), ischemic stroke, and mortality with baseline PVS burden in patients with ischemic stroke and TIA. Data were pooled using an inverse-variance method for the fixed effects (FE) model and a restricted maximum likelihood method for the random effects (RE) model.
RESULTS: Thirteen observational studies (5 prospective, 8 retrospective) were included, comprising 20,256 patients. Compared to 0-10 PVS at basal ganglia (BG-PVS), a higher burden (>10) of BG-PVS was significantly associated with an increased risk of future ICH (adjusted hazards ratio [aHR] 2.79, 95% confidence interval [CI]: 1.16-6.73, RE model; aHR 2.14, 95% CI: 1.34-3.41, FE model; I2 = 64%, n = 17,084 from four studies) followed up for at least 1 year. There was no significant association between >10 BG-PVS and ICH within 7 days after reperfusion therapy (adjusted odds ratio [aOR] 1.69, 95% CI: 0.74-3.88, RE model; aOR 1.43, 95% CI: 0.89-2.88, FE model; I2 = 67%, n = 1,176 from four studies). We did not detect a significant association of recurrent ischemic stroke, mortality, or disability with BG-PVS burden. Neither >10 PVS at centrum semiovale (CSO-PVS) nor increasing CSO-PVS burden was significantly associated with the risk of future intracranial hemorrhage or ischemic stroke recurrence.
CONCLUSIONS: Current evidence suggests that a higher BG-PVS burden may be associated with an increased risk of future ICH in patients with ischemic stroke and TIA.