Table_1_Relationship between carotid intima-media thickness and white matter hyperintensities in non-stroke adults: a systematic review.docx

IntroductionLiterature suggests a common pathophysiological ground between carotid atherosclerosis (CAS) and white matter alterations in the brain. However, the association between carotid intima-media thickness (CIMT) and white matter hyperintensities (WMH) has not been conclusively reported. The current systematic review explores and reports the relationship between CIMT and WMH among asymptomatic/non-stroke adults.
MethodsA recent literature search on PubMed, SCOPUS, and Web of Science databases was conducted in compliance with the PRISMA protocol. The pre-defined Population-Intervention-Comparison-Outcome-Study (PICOS) criteria included observational studies investigating the CIMT-WMH association among non-stroke adults undergoing magnetic resonance imaging and carotid ultrasound.
ResultsOut of 255 potential results, 32 studies were critically assessed for selection, and finally, 10 articles were included, comprising 5,116 patients (females = 60.2%; males = 39.8%) aged between 36–71 years. The included studies earned high quality ratings (6–9) based on the Newcastle-Ottawa-Scale criteria. Qualitative synthesis showed a significantly parallel relationship between increased CIMT and greater WMH burden in 50% of the studies. In addition, significant risk factors related to the CIMT-WMH association included older age, hypertension, depression, migraine, Hispanic ethnicity, and apolipoprotein E (ɛ4) in postmenopausal women.
ConclusionOverall, the cumulative evidence showed a consistent CIMT-WMH association in asymptomatic middle-aged and older non-stroke adults, indicating that CAS may contribute to the progression of pathologically hyperintense white matter in the brain. However, further research is warranted to infer the plausible relationship between CIMT and WMH in the absence of stroke.

引言 现有文献表明，颈动脉粥样硬化（carotid atherosclerosis, CAS）与脑白质病变存在共同的病理生理学基础。然而，颈动脉内膜中层厚度（carotid intima-media thickness, CIMT）与脑白质高信号（white matter hyperintensities, WMH）之间的关联尚未得到明确证实。本项系统综述旨在探讨并报告无症状/非卒中成人中CIMT与WMH的相关性。

方法 本研究遵循PRISMA规范，近期在PubMed、SCOPUS及Web of Science数据库中开展了文献检索。预先设定的人群-干预-比较-结局-研究设计（Population-Intervention-Comparison-Outcome-Study, PICOS）标准纳入了针对接受磁共振成像与颈动脉超声检查的非卒中成人、探讨CIMT与WMH关联的观察性研究。

结果 在255篇潜在候选文献中，对32项研究进行了严格的筛选评估，最终纳入10篇文献，共包含5116名受试者（女性占60.2%，男性占39.8%），年龄区间为36~71岁。根据纽卡斯尔-渥太华量表（Newcastle-Ottawa-Scale）标准，纳入研究的质量评级均较高（6~9分）。定性综合分析显示，50%的研究表明CIMT升高与WMH负荷增加呈显著正相关。此外，与CIMT-WMH关联相关的显著危险因素包括：高龄、高血压、抑郁、偏头痛、西班牙裔种族，以及绝经后女性的载脂蛋白E（apolipoprotein E, APOE）ε4等位基因。

结论 总体而言，累积证据表明，在无症状的中老年非卒中成人中，CIMT与WMH之间存在一致的关联，提示CAS可能参与了脑病理性白质高信号的进展过程。然而，仍需开展进一步研究以明确无卒中状态下CIMT与WMH之间的潜在关联。