Lee Si Un, Hong Eun Pyo, Kim Bong Jun, Kim Sung-Eun, Jeon Jin Pyeong
Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul, Korea.
Department of Medical Genetics, Hallym University College of Medicine, Chuncheon, Korea.
World Neurosurg. 2018 Jul;115:e558-e569. doi: 10.1016/j.wneu.2018.04.096. Epub 2018 Apr 22.
To report clinical outcomes of delayed cerebral ischemia (DCI) and vasospasm in angiogram-negative subarachnoid hemorrhage (SAH) according to hemorrhage patterns, perimesencephalic hemorrhage (PMH) and non-PMH.
Online databases from January 1990 to December 2017 were systematically reviewed. A fixed-effects model was used to control heterogeneity. To resolve publication bias, the trim and fill method was used to estimate number of missing studies and adjusted odds ratio (OR). Subgroup analysis of data from studies that defined angiogram-negative subarachnoid hemorrhage by angiography repeated at least twice or computed tomography angiography was performed.
Among 24 studies including 2083 patients, 23/985 patients (2.3%) with PMH and 144/1098 patients (13.1%) with non-PMH had DCI, indicating that patients with PMH experienced significantly lower DCI than patients with non-PMH (OR = 0.219; 95% confidence interval [CI], 0.144-0.334). Regarding vasospasm, 99/773 patients (12.8%) with PMH and 231/922 patients (25.1%) with non-PMH exhibited vasospasm, indicating that patients with PMH experienced significantly lower vasospasm than patients with non-PMH (OR = 0.445; 95% CI, 0.337-0.589). Funnel plots show asymmetry indicating possible publication bias. After trimming 10 studies for DCI and 7 for vasospasm, the adjusted ORs remained significant between PMH and lower risks of DCI and vasospasm. Subgroup analysis of 789 patients in 8 studies showed a lower risk of DCI (OR = 0.268; 95% CI, 0.151-0.473) and vasospasm (OR = 0.346; 95% CI, 0.221-0.538) in patients with PMH.
PMH showed a significantly lower risk of DCI and vasospasm than non-PMH. Clinical outcomes of angiogram-negative subarachnoid hemorrhage, based on meta-analysis of individual patient data, need to be investigated.
根据出血模式，即中脑周围出血（PMH）和非PMH，报告血管造影阴性蛛网膜下腔出血（SAH）中迟发性脑缺血（DCI）和血管痉挛的临床结果。
系统回顾了1990年1月至2017年12月的在线数据库。采用固定效应模型控制异质性。为解决发表偏倚问题，采用修剪填充法估计缺失研究的数量和调整后的比值比（OR）。对通过至少重复两次血管造影或计算机断层血管造影定义血管造影阴性蛛网膜下腔出血的研究数据进行亚组分析。
在包括2083例患者的24项研究中，23/985例（2.3%）PMH患者和144/1098例（13.1%）非PMH患者发生DCI，表明PMH患者发生DCI的比例显著低于非PMH患者（OR = 0.219；95%置信区间[CI]，0.144 - 0.334）。关于血管痉挛，99/773例（12.8%）PMH患者和231/922例（25.1%）非PMH患者出现血管痉挛，表明PMH患者发生血管痉挛的比例显著低于非PMH患者（OR = 0.445；95% CI，0.337 - 0.589）。漏斗图显示不对称，表明可能存在发表偏倚。在对DCI修剪10项研究和对血管痉挛修剪7项研究后，PMH与较低的DCI和血管痉挛风险之间调整后的OR仍然显著。对8项研究中789例患者的亚组分析显示，PMH患者发生DCI（OR = 0.268；95% CI，0.151 - 0.473）和血管痉挛（OR = 0.346；95% CI，0.221 - 0.538）的风险较低。
与非PMH相比，PMH发生DCI和血管痉挛的风险显著较低。基于个体患者数据的荟萃分析，需要对血管造影阴性蛛网膜下腔出血的临床结果进行研究。
