血管内治疗的缺血性脑卒中患者的预处理脑微出血和颅内出血：系统评价和荟萃分析。
Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis.
机构信息
Cerebrovascular Disease Center, Department of Neurology, People's Hospital, China Medical University, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People's Republic of China.
出版信息
J Neurol. 2020 May;267(5):1227-1232. doi: 10.1007/s00415-019-09210-6. Epub 2019 Jan 28.
BACKGROUND AND PURPOSE
Predicting the risk of intracranial hemorrhage (ICH) is an important aspect for improving the efficacy and safety of endovascular therapy (EVT). We intended to perform a systematic review and meta-analysis to show whether pre-treatment cerebral microbleeds (CMBs) were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT.
METHODS
We searched PubMed, EMBASE, Web of Science and Cochrane Library from their dates of inception to December 18, 2018, and also manually searched reference lists of relevant articles. Cumulative prevalence of CMBs and ICH was calculated. Relative risk and 95% confidence interval (CI) were calculated for the incidence of ICH in patients with CMBs versus those without after EVT.
RESULTS
Four studies involving 598 patients were included. The pooled prevalence of CMBs was 18% (95% CI 15-21%) and the pooled prevalence of ≥ 5 CMBs was 1% (95% CI 0-2%). The pooled incidence of ICH was 29% (95% CI 8-49%) in all patients, 25% (95% CI 5-45%) in those with CMBs and 29% (95% CI 8-50%) in those without CMBs. The pooled relative risk of ICH was 0.90 (95% CI 0.65-1.25, P = 0.528; I = 0%, P = 0.949) in patients with CMBs versus those without CMBs.
CONCLUSIONS
There is no evidence that pre-treatment CMBs were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT.
背景与目的
预测颅内出血（ICH）的风险是提高血管内治疗（EVT）疗效和安全性的重要方面。我们旨在进行系统评价和荟萃分析，以表明接受 EVT 的缺血性脑卒中患者中，治疗前脑微出血（CMB）是否与ICH 发生率增加相关。
方法
我们检索了 PubMed、EMBASE、Web of Science 和 Cochrane Library 自成立日期至 2018 年 12 月 18 日的数据，并手动检索了相关文章的参考文献列表。计算 CMB 和 ICH 的累积患病率。计算 EVT 后 CMB 患者与无 CMB 患者 ICH 发生率的相对风险和 95%置信区间（CI）。
结果
共有 4 项研究纳入 598 例患者。CMB 的总体患病率为 18%（95%CI 15-21%），≥5 个 CMB 的总体患病率为 1%（95%CI 0-2%）。所有患者的 ICH 总发生率为 29%（95%CI 8-49%），CMB 患者为 25%（95%CI 5-45%），无 CMB 患者为 29%（95%CI 8-50%）。CMB 患者与无 CMB 患者相比，ICH 的相对风险为 0.90（95%CI 0.65-1.25，P=0.528；I=0%，P=0.949）。
结论
没有证据表明接受 EVT 的缺血性脑卒中患者治疗前的 CMB 与 ICH 发生率增加相关。
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