非中风成人颈动脉内膜厚度与白质高密度之间的关系:系统性综述

Syeda Humayra, N. Yahya, Chai Jia Ning, Mohd Asyiq Al-Fard bin Mohd Raffali, I. A. Mir, Abdul Latiff Mohamed, H. A. Manan
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摘要

文献表明,颈动脉粥样硬化(CAS)与脑白质改变之间存在共同的病理生理基础。然而,颈动脉内膜厚度(CIMT)与脑白质高密度(WMH)之间的关系尚未有确切报道。本系统性综述探讨并报告了无症状/非中风成人的颈动脉内膜厚度(CIMT)与白质增厚(WMH)之间的关系。在 255 项潜在结果中,对 32 项研究进行了严格的评估筛选,最终纳入了 10 篇文章,包括 5116 名年龄在 36-71 岁之间的患者(女性 = 60.2%;男性 = 39.8%)。根据纽卡斯尔-渥太华量表标准,纳入的研究均获得了较高的质量评级(6-9)。定性综述显示,50%的研究中,CIMT增大与WMH负荷增加之间存在明显的平行关系。此外,与 CIMT-WMH 相关的重要风险因素包括年龄偏大、高血压、抑郁、偏头痛、西班牙裔和绝经后妇女的载脂蛋白 E(ɛ4)。总体而言,累积的证据显示,在无症状的中老年非卒中成人中,CIMT 与 WMH 的关系是一致的,这表明 CAS 可能会导致大脑中病理性高密度白质的进展。然而,在没有中风的情况下,要推断 CIMT 与 WMH 之间的合理关系,还需要进一步的研究。
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Relationship between carotid intima-media thickness and white matter hyperintensities in non-stroke adults: a systematic review
Literature suggests a common pathophysiological ground between carotid atherosclerosis (CAS) and white matter alterations in the brain. However, the association between carotid intima-media thickness (CIMT) and white matter hyperintensities (WMH) has not been conclusively reported. The current systematic review explores and reports the relationship between CIMT and WMH among asymptomatic/non-stroke adults.A recent literature search on PubMed, SCOPUS, and Web of Science databases was conducted in compliance with the PRISMA protocol. The pre-defined Population-Intervention-Comparison-Outcome-Study (PICOS) criteria included observational studies investigating the CIMT-WMH association among non-stroke adults undergoing magnetic resonance imaging and carotid ultrasound.Out of 255 potential results, 32 studies were critically assessed for selection, and finally, 10 articles were included, comprising 5,116 patients (females = 60.2%; males = 39.8%) aged between 36–71 years. The included studies earned high quality ratings (6–9) based on the Newcastle-Ottawa-Scale criteria. Qualitative synthesis showed a significantly parallel relationship between increased CIMT and greater WMH burden in 50% of the studies. In addition, significant risk factors related to the CIMT-WMH association included older age, hypertension, depression, migraine, Hispanic ethnicity, and apolipoprotein E (ɛ4) in postmenopausal women.Overall, the cumulative evidence showed a consistent CIMT-WMH association in asymptomatic middle-aged and older non-stroke adults, indicating that CAS may contribute to the progression of pathologically hyperintense white matter in the brain. However, further research is warranted to infer the plausible relationship between CIMT and WMH in the absence of stroke.
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