Wong George Kwok Chu, Teoh Jeremy, Chan Emily Kit Ying, Ng Stephanie Chi Ping, Poon Wai Sang
Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Br J Neurosurg. 2013 Feb;27(1):34-9. doi: 10.3109/02688697.2012.709559. Epub 2012 Aug 21.
It has been theorised that the relationship between smaller body size and smaller ruptured intracranial aneurysms in Asians indirectly supports the treatment of small, unruptured intracranial aneurysms. There has also been uncertainty regarding whether the progress that has been made in neuroimaging allows for better detection of smaller ruptured intracranial saccular aneurysms. Therefore, we conducted this systemic review of ruptured intracranial saccular aneurysm sizes according to region and time.
Computerised MEDLINE and PubMed searches of the literature for population-based studies of ruptured intracranial saccular aneurysms were carried out from 1 January 1980 to 1 March 2011. Statistical analyses were generated using SPSS for Windows, Version 15.0 (SPSS Inc., Chicago, IL) and Comprehensive MetaAnalysis 2.0 for Windows (Biostat, Englewood, NJ). The results of the meta-analyses are presented with 95% confidence intervals (CIs).
Six eligible population- or hospital-based studies were analysed. The percentage of ruptured intracranial aneurysms measuring less than 5 mm was 28.4% (95% CI: 18.1% to 41.6%, I(2) = 98%). The percentage of ruptured intracranial aneurysms measuring less than 10 mm was 76.7% (95% CI: 69.2% to 82.9%, I2 = 89%). A higher proportion of patients with ruptured intracranial aneurysms of less than 5 mm was found in Asia compared to other regions. Similarly, a higher proportion of patients with ruptured intracranial aneurysms of less than 10 mm was found in Asia compared to other regions.
The present findings suggest that ruptured intracranial aneurysms are smaller in Asians and should be confirmed in future prospective international multi-centre registries to assess ethnicity. Whether these findings support treating smaller unruptured intracranial aneurysms in Asians should be investigated.
从理论上来说，亚洲人群中较小的体型与较小的破裂颅内动脉瘤之间的关系间接支持了对小型未破裂颅内动脉瘤的治疗。关于神经影像学取得的进展是否能够更好地检测出较小的破裂颅内囊状动脉瘤，也一直存在不确定性。因此，我们针对破裂颅内囊状动脉瘤的大小，按区域和时间进行了这项系统评价。
利用计算机对MEDLINE和PubMed数据库进行检索，查找1980年1月1日至2011年3月1日期间基于人群的破裂颅内囊状动脉瘤研究文献。使用SPSS for Windows 15.0版软件（SPSS公司，伊利诺伊州芝加哥）以及Comprehensive MetaAnalysis 2.0 for Windows软件（Biostat公司，新泽西州恩格尔伍德）进行统计分析。荟萃分析结果以95%置信区间（CI）呈现。
分析了6项符合条件的基于人群或医院的研究。直径小于5mm的破裂颅内动脉瘤的比例为28.4%（95%CI：18.1%至41.6%，I² = 98%）。直径小于10mm的破裂颅内动脉瘤的比例为76.7%（95%CI：69.2%至82.9%，I² = 89%）。与其他地区相比，亚洲地区直径小于5mm的破裂颅内动脉瘤患者比例更高。同样，与其他地区相比，亚洲地区直径小于10mm的破裂颅内动脉瘤患者比例更高。
目前的研究结果表明，亚洲人的破裂颅内动脉瘤较小，这一点应在未来前瞻性国际多中心登记研究中得到证实，以评估种族因素。这些研究结果是否支持对亚洲人较小的未破裂颅内动脉瘤进行治疗，还有待研究。
