Jackson C A, Sudlow C L M
Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Bramwell Dott Building, Edinburgh EH4 2XU, UK.
J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1244-52. doi: 10.1136/jnnp.2006.089292. Epub 2006 May 11.
To determine whether evidence from observational studies supports the widely held belief that hypertension is more commonly a risk factor for deep than for lobar supratentorial intracerebral haemorrhage.
Studies comparing the frequency of hypertension as a risk factor for deep versus lobar supratentorial intracerebral haemorrhage, excluding haemorrhages with identified secondary causes, were identified and subjected to a meta-analysis. The effects of predefined methodological quality criteria on the results were assessed and other sources of bias were considered.
The pooled result from all 28 included studies (about 4000 patients) found hypertension to be about twice as common in patients with deep as in those with lobar haemorrhage (odds ratio (OR) 2.10, 95% confidence interval (95% CI) 1.82 to 2.42), but there was significant heterogeneity between studies. The pooled OR was less extreme for studies that used a pre-stroke definition of hypertension, were population based or included first-ever strokes only. In the three studies meeting all criteria (601 patients), deep haemorrhage was associated with a smaller, statistically significant excess of hypertension (OR 1.50, 95% CI 1.09 to 2.07). The OR for studies confined to younger patients seemed to be more extreme (12.32, 95% CI 6.13 to 24.77), but none of these studies fulfilled our methodological quality criteria. Additional, unquantified sources of bias included uncertainty about whether those doctors reporting brain scans were blind to hypertension status, uncertain reliability of the classification of haemorrhage location and variable rates of investigation for secondary causes.
An excess of hypertension was found in patients with deep versus lobar intracerebral haemorrhages without an identified secondary cause, but this may be due to residual, unquantified methodological biases.
确定观察性研究的证据是否支持广泛持有的观点，即高血压作为幕上脑内出血的危险因素，在深部出血中比在脑叶出血中更常见。
检索比较高血压作为幕上深部脑内出血与脑叶出血危险因素的频率的研究，排除有明确继发原因的出血，进行荟萃分析。评估预定义的方法学质量标准对结果的影响，并考虑其他偏倚来源。
纳入的所有28项研究（约4000例患者）的汇总结果显示，深部出血患者中高血压的发生率约为脑叶出血患者的两倍（优势比（OR）2.10，95%置信区间（95%CI）1.82至2.42），但研究间存在显著异质性。对于采用卒中前高血压定义、基于人群或仅纳入首次卒中的研究，汇总的OR值不那么极端。在符合所有标准的三项研究（601例患者）中，深部出血与高血压的统计学显著过量相关，程度较小（OR 1.50，95%CI 1.09至2.07）。限于年轻患者的研究的OR值似乎更极端（12.32，95%CI 6.13至24.77），但这些研究均未满足我们的方法学质量标准。其他未量化的偏倚来源包括报告脑部扫描的医生是否对高血压状态不知情、出血部位分类的可靠性不确定以及继发原因的调查率不同。
在无明确继发原因的幕上深部与脑叶脑内出血患者中发现高血压过量，但这可能归因于残留的、未量化的方法学偏倚。
