脑白质疏松与卒中复发相关性的meta分析

Association between leukoaraiosis and stroke recurrence:A meta-analysis

目的系统评价脑白质疏松在卒中复发风险预测中的价值。方法计算机检索PubMed、Web of science、Embase及维普、中国生物医学文献数据库、中国知网等数据库截止2019年3月15日收录的关于脑白质疏松及卒中复发关系的文献。提取资料进行质量评价并进行meta分析,利用Begg's漏斗图和Egger's检验评估发表偏倚。结果最终纳入33篇文献,共34444例。meta分析显示,当结局指标为任何类型复发性卒中时,中重度组与轻度或无组比较(RR=1.71,95%CI:1.44~2.04),I2=55.69%;有脑白质疏松组与无脑白质疏松组比较(RR=1.79,95%CI:1.43~2.25),I2=56.26%;连续性分析组(RR=1.81,95%CI:1.47~2.23),I2=34.63%。当结局指标为缺血性卒中时,中重度组与轻度或无脑白质疏松组比较(RR=1.82,95%CI:1.36~2.42),I2=48.43%;有脑白质疏松组与无脑白质疏松组比较(RR=2.13,95%CI:1.37~3.32),I2=70.64%;连续性分析组(RR=2.01,95%CI:1.13~3.58),I2=69.78%。亚组分析结果显示脑白质疏松对于远期复发性卒中的预测价值更高。通过Begg's漏斗图和Egger's检验,仅当结局指标为任何类型复发性卒中时,中重度组与轻度或无脑白质疏松组比较有显著性发表偏倚,经剪补法校正后仍提示相关性。结论脑白质疏松对于复发性卒中具有预测价值。

Objective To systematically evaluate the value of leukoaraiosis in predicting the risk of stroke recurrence.Methods PubMed,Web of Science,Embase,VIP,CBM,and CNKI were searched for the studies on the association between leukoaraiosis and stroke recurrence published up to March 15,2019.Related data were extracted for quality assessment and meta-analysis,and Begg's funnel plots and the Egger's test were used to evaluate publication bias.Results A total of 33 studies with 34444 subjects were included.The meta-analysis showed that when the outcome measure was any type of recurrent stroke,there was a significant difference in the risk of recurrence between the moderate/severe group and the mild/no group(risk ratio[RR]=1.71,95%confidence interval[CI]:1.44-2.04),with an I2 value of 55.69%,and there was also a significant difference in such risk between the leukoaraiosis group and the non-leukoaraiosis group(RR=1.79,95%CI:1.43-2.25),with an I2 value of 56.26%;the risk of recurrence was observed in the continuity analysis group(RR=1.81,95%CI:1.47-2.23),with an I2 value of 34.63%.When the outcome measure was ischemic stroke,there was a significant difference in the risk of recurrence between the moderate/severe group and the mild/no group(RR=1.82,95%CI:1.36-2.42),with an I2 value of 48.43%,and there was also a significant difference in such risk between the leukoaraiosis group and the non-leukoaraiosis group(RR=2.13,95%CI:1.37-3.32),with an I2 value of 70.64%;the risk of recurrence was observed in the continuity analysis group(RR=2.01,95%CI:1.13-3.58),with an I2 value of 69.78%.The subgroup analysis showed that leukoaraiosis had a higher predictive value for long-term recurrent stroke.The Begg's funnel plots and the Egger's test showed that when the outcome measure was any type of recurrent stroke,the moderate/severe group had significantly greater publication bias than the mild/no group and the non-leukoaraiosis group,and correlation was still observed after correction by the"trim and fill"method.Conclusions Leukoaraiosis has a certain value in predicting recurrent stroke.