From the Department of Neurology and Neurosurgery (W.M.T.J., G.J.E.R., A.A., C.J.M.K.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht Brain Center, Utrecht University; and Department of Neurology (K.W., F.-E.d.L., C.J.M.K.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
Neurology. 2020 Sep 29;95(13):e1807-e1818. doi: 10.1212/WNL.0000000000010418. Epub 2020 Jul 20.
To conduct a systematic review and meta-analysis of studies reporting on risk factors according to location of the intracerebral hemorrhage.
We searched PubMed and Embase for cohort and case-control studies reporting ≥100 patients with spontaneous intracerebral hemorrhage that specified the location of the hematoma and reported associations with risk factors published until June 27, 2019. Two authors independently extracted data on risk factors. Estimates were pooled with the generic variance-based random-effects method.
After screening 10,013 articles, we included 42 studies totaling 26,174 patients with intracerebral hemorrhage (9,141 lobar and 17,033 nonlobar). Risk factors for nonlobar intracerebral hemorrhage were hypertension (risk ratio [RR] 4.25, 95% confidence interval [CI] 3.05-5.91, = 92%), diabetes mellitus (RR 1.35, 95% CI 1.11-1.64, = 37%), male sex (RR 1.63, 95% CI 1.25-2.14, = 61%), alcohol overuse (RR 1.48, 95% CI 1.21-1.81, = 19%), underweight (RR 2.12, 95% CI 1.12-4.01, = 31%), and being a Black (RR 2.83, 95% CI 1.02-7.84, = 96%) or Hispanic (RR 2.95, 95% CI 1.69-5.14, = 71%) participant compared with being a White participant. Hypertension, but not any of the other risk factors, was also a risk factor for lobar intracerebral hemorrhage (RR 1.83, 95% CI 1.39-2.42, = 76%). Smoking, hypercholesterolemia, and obesity were associated with neither nonlobar nor lobar intracerebral hemorrhage.
Hypertension is a risk factor for both nonlobar and lobar intracerebral hemorrhage, although with double the effect for nonlobar intracerebral hemorrhage. Diabetes mellitus, male sex, alcohol overuse, underweight, and being a Black or Hispanic person are risk factors for nonlobar intracerebral hemorrhage only. Hence, the term hypertensive intracerebral hemorrhage for nonlobar intracerebral hemorrhage is not appropriate.
根据脑出血的位置，对报告风险因素的研究进行系统回顾和荟萃分析。
我们在 PubMed 和 Embase 中检索了报告≥ 100 例自发性脑出血患者的队列研究和病例对照研究，这些患者明确了血肿的位置，并报告了截至 2019 年 6 月 27 日与风险因素相关的研究。两位作者独立提取风险因素的数据。使用通用方差随机效应方法对估计值进行汇总。
在筛选了 10013 篇文章后，我们纳入了 42 项研究，共计 26174 例脑出血患者（9141 例脑叶和 17033 例非脑叶）。非脑叶脑出血的风险因素包括高血压（风险比[RR] 4.25，95%置信区间[CI] 3.05-5.91， = 92%）、糖尿病（RR 1.35，95% CI 1.11-1.64， = 37%）、男性（RR 1.63，95% CI 1.25-2.14， = 61%）、酗酒（RR 1.48，95% CI 1.21-1.81， = 19%）、体重过轻（RR 2.12，95% CI 1.12-4.01， = 31%）和黑人（RR 2.83，95% CI 1.02-7.84， = 96%）或西班牙裔（RR 2.95，95% CI 1.69-5.14， = 71%）参与者比白人参与者（RR 1.35，95% CI 1.11-1.64， = 37%）。高血压是脑叶出血的危险因素（RR 1.83，95% CI 1.39-2.42， = 76%），但不是其他任何风险因素。吸烟、高胆固醇血症和肥胖与非脑叶和脑叶脑出血均无关。
高血压是脑叶和非脑叶脑出血的危险因素，尽管非脑叶脑出血的风险是脑叶脑出血的两倍。糖尿病、男性、酗酒、体重过轻和黑人和西班牙裔是脑叶脑出血的非脑叶脑出血的危险因素。因此，非脑叶脑出血术语“高血压性脑出血”并不合适。
