脑小血管病患者影像学改变与阿尔茨海默病危险因素的Meta分析  

Imaging changes in cerebral small vessel disease and risk factors of Alzheimer’s disease: Meta-analysis

作　　者：林昕 王海姣[1] 朱丽娜[1] 储珊珊 王雪萍 刘凌[1] LIN Xin;WANG Hai-jiao;ZHU Li-na;CHU Shan-shan;WANG Xue-ping;LIU Ling(Department of Neurology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院神经内科

出　　处：《中国现代神经疾病杂志》2019年第7期474-480,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的评价脑小血管病患者影像学改变与阿尔茨海默病的发生风险。方法以Alzheimer’s disease,cerebral small vessel disease,white matter lesion,cerebral microbleeds,lacunar infarction等英文词汇计算机检索1980年1月1日至2019年4月1日美国国立医学图书馆生物医学信息检索系统(PubMed)、荷兰医学文摘(EMBASE/SCOPUS)和Cochrane图书馆数据库收录的关于脑小血管病与阿尔茨海默病相关危险因素的队列研究和病例对照研究,并查阅纳入研究的参考文献补充可能遗漏的相关临床研究。以Newcastle-Ottawa量表和Stata 15.1统计软件进行文献质量评价和Meta分析。结果共获得1452篇文献,经剔除重复和不符合纳入标准者,最终纳入11项高质量临床研究计12 882例研究对象。Meta分析显示,脑白质病变(RR=1.152,95%CI:1.007~1.317;P=0.039)和脑微出血(RR=1.659,95%CI:1.085~2.537;P=0.019)可增加罹患阿尔茨海默病的风险,腔隙性梗死不增加阿尔茨海默病的发生风险(RR=1.298,95%CI:0.785~2.147;P=0.309)。结论影像学提示脑白质病变和脑微出血的慢性脑小血管病患者发生阿尔茨海默病的风险增加,脑小血管病可能在一定程度上参与阿尔茨海默病的发生与发展,故对表现有脑小血管病征象的患者应注重阿尔茨海默病的一级预防。Objective To evaluate the imaging changes in patients with cerebral small vessel disease(cSVD)and the risk factors of Alzheimer’s disease(AD).Methods Retrieve relevant retrospective case analysis and observational studies that about cSVD and the risk factors of AD from online database(January 1,1980-April 1,2019)as PubMed,EMBASE/SCOPUS and Cochrane Library with key words:Alzheimer’s disease,cerebral small vessel disease,white matter lesion,cerebral microbleeds,lacunar infarction.Selection of studies was performed according to pre-designed inclusion and exclusion criteria.Quality of studies was evaluated by using Newcastle-Ottawa Scale(NOS).All data were pooled by Stata15.1 software for Meta-analysis.Results A total of 1452 articles were enrolled,from which 11 studies with NOS score ≥ 5 were chosen after excluding duplicates and those not meeting the inclusion criteria.A total of 12 882 patients were included.Meta-analysis showed that white matter lesion(RR= 1.152,95%CI:1.007-1.317;P = 0.039)and cerebral microbleeds(RR = 1.659,95%CI:1.085-2.537;P = 0.019)increased the risk of AD;lacunar infarc did not increase the risk of AD(RR= 1.298,95%CI:0.785-2.147;P=0.309).Conclusions The risk of Alzheimer’s disease is increased in patients with white matter lesion and cerebral microbleeds.The cerebral small vessel disease may be involved in the occurrence of some Alzheimer’s disease.When patients have the imaging changes of white matter lesion and cerebral microbleeds,should be paid on primary prevention of Alzheimer’s disease.

关 键 词：大脑小血管疾病 阿尔茨海默病 磁共振成像 META分析 

分 类 号：R743[医药卫生—神经病学与精神病学] R749.16[医药卫生—临床医学]