Gao Peng, Chen Zuo-quan, Bao Yu-hai, Jiao Li-qun, Ling Feng
389 Xincun Rd, Putuo District, Shanghai 200065, China.
Stroke. 2007 Aug;38(8):2382-90. doi: 10.1161/STROKEAHA.107.482760. Epub 2007 Jun 28.
We sought to investigate the association between carotid intraplaque hemorrhage (IPH) and ipsilateral symptoms of cerebral ischemia.
A search was performed for clinical observational studies comparing the incidence of IPH between symptomatic and asymptomatic patients. Odds ratios (ORs) for IPH as a factor in the pathogenesis of neurologic events were calculated and combined by a meta-analysis. Interstudy heterogeneity, estimated effects, and methodologic quality of the studies were assessed.
Thirty-one studies were included for analysis. The reported ORs varied widely. Overall, the incidence of IPH in the symptomatic groups was significantly higher than in the asymptomatic group. However, there was an apparent trend for heterogeneity (P<0.00001) between studies. The random-effects summary estimator of ORs was 2.25 (95% CI, 1.57 to 3.22; P<0.00001). To identify potential sources of heterogeneity, subgroup analyses were performed. The pooled ORs varied greatly by stratification. Major heterogeneity was found among studies with low quality, microscopic methods of examination, significant effects, small sizes, early publication, and unequal severity of carotid stenosis in both groups. Large, recent, macroscopic, or high-quality studies, as well as studies with equal degrees of stenosis, tended to yield insignificant associations. The methods in defining and evaluating hemorrhage were very heterogeneous. Characterizations of the age, size, number, and location of hemorrhages were poorly reported and highly variable. In addition, a lack of control of confounders and selection bias were frequently identified among studies.
Statistical inferences have suggested a plausible role in the production of cerebral ischemia; however, reliable interpretation was strongly undermined by poor methodologic quality, substantial heterogeneity, and suspicious publication bias. To preciously estimate the underlying correlation, a well-designed study with uniformity in definition and evaluation for IPH might be warranted.
我们试图研究颈动脉斑块内出血（IPH）与同侧脑缺血症状之间的关联。
进行一项临床观察性研究的检索，比较有症状和无症状患者中IPH的发生率。计算IPH作为神经事件发病机制因素的比值比（OR），并通过荟萃分析进行合并。评估研究间的异质性、估计效应和研究的方法学质量。
纳入31项研究进行分析。报告的OR差异很大。总体而言，有症状组中IPH的发生率显著高于无症状组。然而，研究之间存在明显的异质性趋势（P<0.00001）。OR的随机效应汇总估计值为2.25（95%CI，1.57至3.22；P<0.00001）。为了确定潜在的异质性来源，进行了亚组分析。合并的OR按分层差异很大。在质量低、微观检查方法、显著效应、样本量小、发表早以及两组颈动脉狭窄严重程度不等的研究中发现了主要的异质性。大型、近期、宏观或高质量的研究，以及狭窄程度相等的研究，往往得出不显著的关联。定义和评估出血的方法非常不一致。关于出血的年龄、大小、数量和位置的描述报告不佳且差异很大。此外，研究中经常发现缺乏对混杂因素的控制和选择偏倚。
统计推断表明在脑缺血的发生中可能有一定作用；然而，方法学质量差、实质性异质性和可疑的发表偏倚严重削弱了可靠的解释。为了准确估计潜在的相关性，可能需要进行一项在IPH定义和评估方面具有一致性的精心设计的研究。
