Neurovascular Unit Dysfunction and Cerebral Small Vessel Disease in Parkinson Disease: A Systematic Review and a Meta Analysis.

Cerebral small vessel disease (CSVD) burden reflects neurovascular dysfunction in the form of white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMB), and enlarged perivascular spaces (ePVS).

脑小血管病（CSVD）的负担反映了以白质高信号（WMH）、腔隙、脑微出血（CMB）和扩大血管周围空间（ePVS）形式出现的神经血管功能障碍。

In PD cohorts, CSVD burden correlates with worse motor and gait scores.

在帕金森病（PD）队列中，脑小血管病（CSVD）负担与较差的运动和步态评分相关。

The aim of the study was to explore whether patients with PD exhibit greater CSVD burden than healthy controls (HC).

该研究的目的是探讨帕金森病（PD）患者是否比健康对照者（HC）表现出更大的脑小血管病（CSVD）负担。

Methods

We conducted a PRISMA-conformant systematic reviewand meta-analysisof studies including adults with idiopathic PD and a HC group that presented data comparing CSVD burden in these 2 groups.

我们进行了一项符合PRISMA标准的系统评价和荟萃分析，研究对象为成年特发性帕金森病患者和健康对照组，并比较了这两组的脑小血管疾病负担数据。

Six databases (MEDLINE, Embase, CINAHL Plus, CENTRAL, Scopus, and Web of Science) were searched on May 14 and 15, 2024.

在2024年5月14日和15日，我们搜索了六个数据库（MEDLINE、Embase、CINAHL Plus、CENTRAL、Scopus和Web of Science）。

Two reviewers independently screened records, extracted data, and assessed risk of bias, with discrepancies resolved by consensus.

两位审查员独立筛选记录、提取数据并评估偏倚风险，意见不一致时通过共识解决。

Continuous outcomes were pooled as standardized mean differences (SMD); dichotomous outcomes as odds ratios (ORs).

连续性结果以标准化均数差（SMD）合并；二分类结果以比值比（ORs）合并。

We evaluated small-study effects for pooled analyses with 10 or more studies using funnel plots and Egger regression test.

我们使用漏斗图和Egger回归检验评估了包含10个或更多研究的汇总分析中的小样本研究效应。

Results

We examined 13,403 records.

我们审查了13,403条记录。

Forty-six studies (45 cross-sectional) met inclusion criteria, totaling 3,817 PD and 2,593 HC (mean ages: 66.9 and 66.5, respectively).

共有46项研究（45项横断面研究）符合纳入标准，总计包括3,817名帕金森病患者和2,593名健康对照者（平均年龄分别为66.9岁和66.5岁）。

WMH volume (k = 21) was higher in PD (SMD 0.36, 95% CI 0.11-0.62).

帕金森病患者的脑白质高信号体积（k=21）更高（标准化均数差SMD为0.36，95%置信区间为0.11-0.62）。

Visual ratings also indicated higher WMH in PD: global (k = 14) SMD 0.27 (95% CI 0.08-0.46); periventricular (k = 11) SMD 0.32 (95% CI 0.12-0.51); deep (k = 8) SMD 0.20 (95% CI 0.09-0.31).

视觉评分也显示帕金森病患者的脑白质高信号更高：全脑（k = 14）标准化平均差异（SMD）为0.27（95%置信区间0.08-0.46）；脑室周围（k = 11）SMD为0.32（95%置信区间0.12-0.51）；深部（k = 8）SMD为0.20（95%置信区间0.09-0.31）。

Differences in CMB (k = 6; OR 1.18, 95% CI 0.57-2.42) and lacunes (k = 4; OR 1.48, 95% CI 0.58-3.78) were not significant. ePVS results were heterogeneous but trended toward greater burden in PD, most notably in the midbrain (k = 3; SMD 1.80, 0.15-3.44).

微出血（k = 6；比值比OR 1.18，95%置信区间0.57-2.42）和腔隙性梗死（k = 4；OR 1.48，95%置信区间0.58-3.78）的差异不显著。ePVS结果异质性较大，但倾向于帕金森病患者负担更重，尤其是在中脑（k = 3；SMD 1.80，95%置信区间0.15-3.44）。

Overall evidence quality was rated as low, reflecting the observational nature of the included studies.

综合证据质量被评为低，反映了纳入研究的观察性质。

Discussion

Our analysis showed PD to be associated with greater WMH burden and increased midbrain ePVS.

我们的分析显示，帕金森病（PD）与更大的脑白质高信号（WMH）负担和中脑表观血管周围间隙（ePVS）增加有关。

Pooled differences in CMB and lacunes were not significant.

合并的微出血（CMB）和腔隙性梗死（lacunes）的差异无统计学意义。

Substantial heterogeneity and cross-sectional designs limit certainty; standardized imaging and prospective cohorts are needed to define mechanisms and clinical implications.

显著的异质性和横断面设计限制了确定性；需要标准化的影像学和前瞻性队列研究来确定机制和临床意义。