Bartek Jiri, Sjåvik Kristin, Schaible Samuel, Gulati Sasha, Solheim Ole, Förander Petter, Jakola Asgeir Store
Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway.
World Neurosurg. 2018 May;113:e555-e560. doi: 10.1016/j.wneu.2018.02.094. Epub 2018 Feb 23.
To investigate the role of angiotensin converting enzyme (ACE) inhibitors in the recurrence of chronic subdural hematoma (cSDH) after burr hole surgery.
A retrospective review was conducted of a Scandinavian multicenter, population-based cohort of 1252 adults with cSDH who underwent with burr hole surgery between January 1, 2005, and December 31, 2010. The risk of cSDH recurrence was assessed in users of ACE inhibitors, users of angiotensin II receptor blockers (ARBs), and those without ACE inhibitor treatment (no ACE inhibitor group) using univariable and multivariable regression analyses.
The cohort included 98 (7.8%) ACE inhibitor users and 63 (5%) ARB-only users. The recurrence rate was 16.3% (n = 16) in the ACE inhibitor group, compared with 13.3% (n = 153) in the no ACE inhibitor group (P = 0.39) and 14.3% (n = 9) in the ARB group (P = 0.73). When comparing groups, age (P = 0.01), Charlson Comorbidity Index (P = 0.01), use of platelet inhibitors (P = 0.001) and use of anticoagulants (P = 0.01) differed between the ACE inhibitor and no ACE inhibitor groups. Only age differed significantly between the ACE inhibitor and ARB groups (P = 0.03). In the analyses adjusted for differences in baseline characteristics, ACE inhibitor treatment did not influence the risk of recurrence (odds ratio, 1.2; 95% confidence interval, 0.7-2.2; P = 0.46).
In this population-based study, the use of ACE inhibitors was not associated with the risk of recurrence following burr hole surgery for cSDH.
探讨血管紧张素转换酶（ACE）抑制剂在慢性硬膜下血肿（cSDH）钻孔手术后复发中的作用。
对2005年1月1日至2010年12月31日期间在斯堪的纳维亚多中心进行钻孔手术的1252例成年cSDH患者的人群队列进行回顾性研究。使用单变量和多变量回归分析评估ACE抑制剂使用者、血管紧张素II受体阻滞剂（ARB）使用者以及未接受ACE抑制剂治疗者（无ACE抑制剂组）发生cSDH复发的风险。
该队列包括98例（7.8%）ACE抑制剂使用者和63例（5%）仅使用ARB者。ACE抑制剂组的复发率为16.3%（n = 16），无ACE抑制剂组为13.3%（n = 153）（P = 0.39），ARB组为14.3%（n = 9）（P = 0.73）。在比较各组时，ACE抑制剂组和无ACE抑制剂组之间在年龄（P = 0.01）、Charlson合并症指数（P = 0.01）、血小板抑制剂的使用（P = 0.001）和抗凝剂的使用（P = 0.01）方面存在差异。ACE抑制剂组和ARB组之间仅年龄差异有统计学意义（P = 0.03）。在对基线特征差异进行校正的分析中，ACE抑制剂治疗不影响复发风险（比值比，1.2；95%置信区间，0.7 - 2.2；P = 0.46）。
在这项基于人群的研究中，使用ACE抑制剂与cSDH钻孔手术后的复发风险无关。
