颈动脉高分辨磁共振血管壁成像对缺血性脑卒中发生及复发诊断价值的Meta分析

Meta analysis of the diagnostic value of carotid artery high-resolution magnetic resonance vessel wall imaging in the occurrence and recurrence of ischemic stroke

目的 基于Meta分析颈动脉高分辨磁共振血管壁成像对缺血性脑卒中发生及复发的诊断价值。材料与方法 检索Web of Science、Embase、The Cochrane Library、Medline、PubMed、中国知网、万方、维普数据库中发表的高分辨磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging, HR-VWI)评估缺血性脑卒中发生及复发的相关研究,检索时间为建库至2024年2月。根据纳入和排除标准筛选文献。使用固定效应模型计算和合并不同颈动脉易损斑块特征的比值比(odds ratio, OR)或风险比(hazard ratio, HR),以Stata 17.0和RevMan 5.6进行Meta分析。结果 17篇文章符合纳入标准。在8项回顾性研究中,斑块内出血(OR=1.92,95%CI:1.46~2.52)、斑块富含脂质的坏死核(OR=2.78,95%CI:1.84~4.18)、斑块钙化(OR=1.26,95%CI:0.99~1.61)、斑块纤维帽破裂(OR=1.64,95%CI:1.06~2.52)与缺血性脑卒中发生显著相关;在9项前瞻性研究中,斑块内出血(HR=6.88,95%CI:4.46~10.61)、斑块富含脂质的坏死核(HR=1.78,95%CI:0.87~3.65)、斑块纤维帽破裂(HR=3.01,95%CI:1.53~5.93)与缺血性脑卒中复发显著相关。结论 HR-VWI可以准确评估颈动脉斑块成分特征,这些特征与缺血性脑卒中发生及复发有显著相关性。由于缺乏原始研究,未来需要对颈动脉斑块进行大样本量的队列研究,通过对颈动脉粥样硬化斑块特征的评估,进一步提供缺血性脑卒中发生及复发的早期精准预测和临床治疗指导。

Objective:To analyze the diagnostic value of high-resolution magnetic resonance vascular wall imaging(HR-VWI)of the carotid artery for the occurrence and recurrence of ischemic stroke based on Meta.Materials and Methods:Retrieve relevant studies on HR-VWI assessment of ischemic stroke occurrence and recurrence published in Web of Science,Embase,The Cochrane Library,Medline,PubMed,China National Knowledge Network,Wanfang,and VIP database,with a search period from database establishment to February 2024.Select literature based on inclusion and exclusion criteria.Use a fixed effects model to calculate and combine the odds ratio(OR)or hazard ratio(HR)of different vulnerable carotid plaque features,and conduct meta-analysis using Stata 17.0 and RevMan 5.6.Results:Seventeen articles met the inclusion criteria.In 8 retrospective studies,intraplaque hemorrhage(OR=1.92,95%CI:1.46-2.52),lipid-rich necrotic nucleus(OR=2.78,95%CI:1.84-4.18),plaque calcification(OR=1.26,95%CI:0.99-1.61)and fibrous cap rupture(OR=1.64,95%CI:1.06-2.52)were significantly associated with ischemic stroke.In nine prospective studies,intraplaque hemorrhage(HR=6.88,95%CI:4.46-10.61),lipid-rich necrotic nucleus(HR=1.78,95%CI:0.87-3.65),fibrous cap rupture(HR=3.01,95%CI:1.53-5.93)were significantly associated with ischemic stroke recurrence.Conclusions:HR-VWI can accurately evaluate the characteristics of carotid artery plaque components,which are significantly related with the occurrence and recurrence of ischemic stroke.Due to the lack of original research,a large sample size cohort study of carotid plaque is needed in the future to further provide timely accurate prediction of the occurrence and recurrence of ischemic stroke and guide clinical treatment by assessing the characteristics of carotid atherosclerotic plaque.