The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis.
The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis.
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DOI：
10.1136/bmj.c3666
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发表时间：
2010-07-26
期刊：
影响因子：
--
通讯作者：
Markus HS
中科院分区：
文献类型：
--
作者：
Debette S;Markus HS
目的回顾白色高信号与卒中、认知能力下降、痴呆和死亡风险相关的证据。设计系统综述和荟萃分析。数据来源PubMed，1966年至2009年11月23日。研究选择前瞻性纵向研究，使用磁共振成像，并评估白色高信号对卒中、认知能力下降、痴呆和死亡风险的影响，对于荟萃分析，研究提供了白色高信号分类测量的风险估计，评估这些病变对卒中、痴呆和死亡风险的影响。数据提取研究人群、随访持续时间、测量白色高信号的方法、结局定义以及测量白色高信号与结局的相关性。数据综合46项纵向研究评估了白色高信号与卒中（n=12）、认知能力下降（n=19）、痴呆（n=17）和死亡（n=10）风险的相关性。22项研究可纳入荟萃分析（9项中风，9项痴呆，8项死亡）。白色高信号与卒中（风险比3.3，95%置信区间2.6 - 4.4）、痴呆（1.9，1.3 - 2.8）和死亡（2.0，1.6 - 2.7）风险增加相关。白色高信号与整体认知能力、执行功能和处理速度的快速下降也有关联。结论：白色高信号可预测卒中、痴呆和死亡的风险增加。因此，白色高信号表明，作为诊断研究的一部分时，脑血管事件的风险增加，并支持其作为一个中间标记物在研究环境中使用。他们的发现应该会促使对中风和痴呆的危险因素进行详细的筛查。
Objectives To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death. Design Systematic review and meta-analysis. Data sources PubMed from 1966 to 23 November 2009. Study selection Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta-analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death. Data extraction Population studied, duration of follow-up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome. Data synthesis 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta-analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested. Conclusion White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.
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