脑小血管病患者认知障碍危险因素的Meta分析

Risk Factors for Cognitive Impairment in Patients with Cerebral Small Vessel Disease:a Meta-analysis

背景脑小血管病(CSVD)具有起病隐匿、早期症状不典型、易被忽视等特征,一旦进展为血管性认知障碍(VCI)将不可逆转。因此,识别CSVD患者认知障碍的危险因素并尽早防治或可降低VCI发生风险。目的系统评价CSVD患者认知障碍的危险因素,以期为CSVD患者认知障碍风险预测模型建立提供参考依据。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库公开发表的探讨CSVD进展为认知障碍影响因素的病例对照研究或队列研究,检索时限为建库至2021-02-28。由两名研究员独立完成文献筛选、方法学质量评价及资料提取,应用Stata 13.1和RevMan 5.3软件进行Meta分析。结果本Meta分析最终纳入47篇文献,共8218例患者。本Meta分析仅合并纳入文献数≥5条的危险因素,结果显示,受教育程度低[OR=0.78,95%CI(0.66,0.92)]、吸烟[OR=1.88,95%CI(1.33,2.65)]、高血压[OR=1.48,95%CI(1.24,1.77)]、高脂血症[OR=1.97,95%CI(1.46,2.66)]、同型半胱氨酸(Hcy)[OR=1.22,95%CI(1.13,1.31)]、CSVD核磁总负荷评分[OR=3.02,95%CI(1.79,5.08)]、脑白质高信号(WMH)评分[OR=1.99,95%CI(1.50,2.64)]、腔隙性脑梗死(LI)病灶计数[OR=2.19,95%CI(1.82,2.64)]是CSVD患者认知障碍的危险因素(P<0.05)。结论现有证据表明,受教育程度低、吸烟、高血压、高脂血症、Hcy、CSVD核磁总负荷评分、WMH评分、LI病灶计数是识别和预测CSVD患者认知障碍首要考虑的危险因素,临床上针对伴有上述危险因素的CSVD患者应加强管理,以降低CSVD进展为认知障碍的风险。

Background Cerebral small vessel disease(CSVD)is characterized by insidious onset,atypical early symptoms,and easy to be neglected,and once it progresses to vascular cognitive impairment(VCI),and it will be irreversible.Therefore,early identification and prevention of risk factors of cognitive impairment in patients with CSVD may reduce the risk of VCI.Objective To systematically evaluate the risk factors for cognitive impairment in patients with CSVD,and to provide a basis for establishing a risk prediction model for cognitive impairment in patients with CSVD.Methods PubMed,Embase,Web of Science,Cochrane Library,CNKI,WanFang,VIP,and CBM databases were searched for literature on risk factors for cognitive impairment in patients with CSVD,with a search time frame from the date of database creation to February 28,2021.Two researchers independently performed literatures screening,quality evaluation,and data extraction,and Stata 13.1/RevMan 5.3 software were used for Meta-analysis.Results A total of 47 literatures with 9539 study subjects were included.In this study,only the risk factors of more than 5 articles included were merged for analysis,Meta-analysis results showed that low level of education[OR=0.78,95%CI(0.66,0.92)],smoking[OR=1.88,95%CI(1.33,2.65)],hypertension[OR=1.48,95%CI(1.24,1.77)],hyperlipidemia[OR=1.97,95%CI(1.46,2.66)],homocysteine(Hcy)[OR=1.22,95%CI(1.13,1.31)],CSVD total nuclear magnetic load score[OR=3.02,95%CI(1.79,5.08)],white matter hyperintensity(WMH)score[OR=1.99,95%CI(1.50,2.64)],lacunar infarction(LI)lesion count[OR=2.19,95%CI(1.82,2.64)]were risk fators for cognitive impairment in patients with CSVD(P<0.05).Conclusion Current evidence suggests that low level of education,smoking,hypertension,hyperlipidemia,Hcy,CSVD total nuclear magnetic load score,WMH score,and LI lesion count are the primary risk factors considered to identify and predict cognitive impairment in CSVD patients.The management of CSVD patients with the above risk factors should be strengthened,and then reduce the risk of CSVD developing into cognitive impairment.