Hajat C, Hajat S, Sharma P
Guy's, King's, and St Thomas's School of Medicine, London, UK.
Stroke. 2000 Feb;31(2):410-4. doi: 10.1161/01.str.31.2.410.
The effect of pyrexia on cerebral ischemia has been extensively studied in animals. In humans, however, such studies are small and the results conflicting. We undertook a meta-analysis using all such published studies on the effect of hyperthermia on stroke outcome.
Three databases were searched for all published studies that examined the relationship of raised temperature after stroke onset and eventual outcome. Combined probability values and odds ratios were obtained. A heterogeneity test was performed to ensure that the data were suitable for such an analysis. Morbidity and mortality were used as outcome measures.
Nine studies were identified totaling 3790 patients, providing our study with 99% power to detect a 9% increase in morbidity and 84% power to detect a 1% increase in mortality for the pyrexial group. The combined odds ratio for mortality was 1.19 (95% CI, 0.99 to 1.43). A heterogeneity test was highly nonsignificant (P>0.05) for mortality, suggesting that the data were sufficiently similar to be meta-analyzed. Combined probability values were highly significant for both morbidity (P<0.0001) and mortality (P<0. 00000001).
The results from this meta-analysis suggest that pyrexia after stroke onset is associated with a marked increase in morbidity and mortality. Measures should be taken to combat fever in the clinical setting to prevent stroke progression. The possible benefit of therapeutic hypothermia in the management of acute stroke should be further investigated.
发热对脑缺血的影响已在动物实验中得到广泛研究。然而，在人类中的此类研究规模较小且结果相互矛盾。我们对所有已发表的关于体温过高对卒中结局影响的研究进行了荟萃分析。
检索了三个数据库，以查找所有已发表的研究，这些研究探讨了卒中发作后体温升高与最终结局之间的关系。获得了合并概率值和优势比。进行了异质性检验，以确保数据适合此类分析。将发病率和死亡率用作结局指标。
共确定了9项研究，涉及3790例患者，这使我们的研究有99%的把握检测出发热组发病率增加9%，有84%的把握检测出死亡率增加1%。死亡率的合并优势比为1.19（95%可信区间，0.99至1.43）。死亡率的异质性检验高度无显著性（P>0.05），表明数据足够相似，可以进行荟萃分析。发病率（P<0.0001）和死亡率（P<0.00000001）的合并概率值均高度显著。
该荟萃分析结果表明，卒中发作后的发热与发病率和死亡率的显著增加相关。临床应采取措施控制发热，以防止卒中进展。治疗性低温在急性卒中管理中的潜在益处应进一步研究。
