Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian 116033, China.
Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian 116033, China.
Int J Surg. 2019 Sep;69:68-76. doi: 10.1016/j.ijsu.2019.07.023. Epub 2019 Jul 26.
Many risk factors are associated with the growth of unruptured intracranial aneurysm; however, the effects of these risk factors on intracranial aneurysm growth remain poorly understood. Here, we performed a meta-analysis to evaluate the effects of these risk factors on intracranial aneurysm growth, incorporating different data types to provide comprehensive estimates of individual effects.
We searched the Cochrane Library, PubMed, Embase, and Web of Science for cohort studies analyzing risk factors for aneurysm growth prior to January 10, 2019. The hazard ratio (HR) and odds ratio (OR) with its 95% confidence interval (CI) were calculated to assess the effect of individual risk factors on intracranial aneurysm growth. Both univariate analysis (UVA) and multivariate analysis (MVA) were performed. Two reviewers independently assessed the quality of the trials and the associated data. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2.
We included 23 studies (N = 7208 participants) in this meta-analysis. A total of 944 patients (13.1%) experienced intracranial aneurysm growth during their follow-up times. Aneurysm size and smoking may have significant effects on the growth of intracranial aneurysm, with pooled ORs of 2.73 (95% CI 2.21-3.36; P < 0.00001) and 1.45 (95% CI 1.07-1.98; P = 0.02) respectively. However, our results indicated that subarachnoid hemorrhage (SAH) had a negative effect on the growth of intracranial aneurysm (OR 0.64; 95% CI 0.48-0.86; P = 0.003). Other risk factors such as irregular shape of intracranial aneurysm, female sex, and multiple aneurysms were inconsistent across studies due to differences in data types and effect estimates.
Our meta-analysis identified aneurysm size and smoking as independent risk factors for the growth of intracranial aneurysm, while prior SAH had a negative effect on the growth of intracranial aneurysm. The roles of other risk factors for intracranial aneurysm growth were inconsistent, with further research necessary to assess fully the roles of these factors in disease outcomes.
许多风险因素与未破裂颅内动脉瘤的生长有关；然而，这些风险因素对颅内动脉瘤生长的影响仍知之甚少。在这里，我们进行了一项荟萃分析，以评估这些风险因素对颅内动脉瘤生长的影响，结合不同的数据类型，提供对个体影响的综合估计。
我们在 Cochrane 图书馆、PubMed、Embase 和 Web of Science 中搜索了截至 2019 年 1 月 10 日分析动脉瘤生长前风险因素的队列研究。使用风险比（HR）和优势比（OR）及其 95%置信区间（CI）来评估单个风险因素对颅内动脉瘤生长的影响。进行了单变量分析（UVA）和多变量分析（MVA）。两位审查员独立评估了试验的质量和相关数据。所有统计分析均使用 Review Manager 5.2 提供的标准统计程序进行。
我们的荟萃分析纳入了 23 项研究（N=7208 名参与者）。共有 944 名患者（13.1%）在随访期间经历了颅内动脉瘤生长。动脉瘤大小和吸烟可能对颅内动脉瘤的生长有显著影响，汇总 OR 分别为 2.73（95%CI 2.21-3.36；P<0.00001）和 1.45（95%CI 1.07-1.98；P=0.02）。然而，我们的结果表明蛛网膜下腔出血（SAH）对颅内动脉瘤的生长有负面影响（OR 0.64；95%CI 0.48-0.86；P=0.003）。其他风险因素，如颅内动脉瘤的不规则形状、女性和多个动脉瘤，由于数据类型和效应估计的差异，在研究中不一致。
我们的荟萃分析确定了动脉瘤大小和吸烟是颅内动脉瘤生长的独立危险因素，而既往的蛛网膜下腔出血对颅内动脉瘤的生长有负面影响。其他颅内动脉瘤生长风险因素的作用不一致，需要进一步研究以充分评估这些因素在疾病结局中的作用。
