Table_3_A Systematic Review and Meta-Analysis Examining Whether Changing Ovarian Sex Steroid Hormone Levels Influence Cerebrovascular Function.DOCX

Sex differences in cerebrovascular disease rates indicate a possible role for ovarian sex steroid hormones in cerebrovascular function. To synthesise and identify knowledge gaps, a systematic review and meta-analysis was conducted to assess how ovarian sex steroid hormone changes across the lifespan affect cerebrovascular function in women. Three databases (EMBASE, MEDLINE and Web of Science) were systematically searched for studies on adult cerebrovascular function and ovarian sex steroid hormones. Forty-five studies met pre-defined inclusion criteria. Studied hormone groups included hormone replacement therapy (HRT; n = 17), pregnancy (n = 12), menstrual cycle (n = 7), menopause (n = 5), oral contraception (n = 2), and ovarian hyperstimulation (n = 2). Outcome measures included pulsatility index (PI), cerebral blood flow/velocity (CBF), resistance index (RI), cerebral autoregulation, and cerebrovascular reactivity. Meta-analysis was carried out on HRT studies. PI significantly decreased [−0.05, 95% CI: (−0.10, −0.01); p = 0.01] in post-menopausal women undergoing HRT compared to post-menopausal women who were not, though there was considerable heterogeneity (I2 = 96.8%). No effects of HRT were seen in CBF (p = 0.24) or RI (p = 0.77). This review indicates that HRT improves PI in post-menopausal women. However, there remains insufficient evidence to determine how changing ovarian sex steroid hormone levels affects cerebrovascular function in women during other hormonal phases (e.g., pregnancy, oral contraception).

脑血管疾病发病率的性别差异提示卵巢性激素可能在脑血管功能调控中发挥潜在作用。为系统整合现有研究并明确尚存的知识空白，本研究开展了一项系统综述与荟萃分析，旨在评估全生命周期内卵巢性激素的动态变化对女性脑血管功能的影响。本研究系统检索了EMBASE、MEDLINE与Web of Science三个数据库，筛选针对成人脑血管功能与卵巢性激素的相关研究，最终共有45项研究符合预先设定的纳入标准。所纳入研究涉及的激素相关组别包括：激素替代疗法（hormone replacement therapy, HRT，n=17）、妊娠（n=12）、月经周期（n=7）、绝经（n=5）、口服避孕药（n=2）以及卵巢过度刺激（n=2）。结局测量指标包括搏动指数（pulsatility index, PI）、脑血流量/脑血流速度（cerebral blood flow/velocity, CBF）、阻力指数（resistance index, RI）、脑自动调节功能以及脑血管反应性。针对激素替代疗法相关研究开展了荟萃分析，结果显示，与未接受激素替代疗法的绝经后女性相比，接受激素替代疗法的绝经后女性搏动指数显著降低[−0.05, 95%CI: (−0.10, −0.01); p=0.01]，但研究间存在显著异质性（I²=96.8%）；而激素替代疗法对脑血流量（p=0.24）或阻力指数（p=0.77）无显著影响。本综述表明，激素替代疗法可改善绝经后女性的搏动指数水平。然而，目前仍缺乏足够证据明确其他激素变化阶段（如妊娠、口服避孕药使用期间）卵巢性激素水平的改变对女性脑血管功能的具体影响。