Ya Xiaolong, Zhang Chaoqi, Zhang Shuo, Zhang Qian, Cao Yong, Wang Shuo, Zhao Jizong
Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Beijing Neurosurgery Research Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Mar 26;12:625087. doi: 10.3389/fneur.2021.625087. eCollection 2021.
Delayed cerebral ischemia (DCI) is the main cause of death and disability after intracranial aneurysm rupture. Previous studies have shown that smoking can lead to DCI after intracranial aneurysm rupture. However, some recent studies have shown that nicotine, as the main ingredient of tobacco, can cause cerebral vasodilation. This view has led to a debate about the relationship between smoking and DCI. This study aims to determine the relationship between smoking and DCI. A systematic literature search was performed according to PRISMA guidelines. The Cochrane Library, Web of Science, PubMed, and Embase online databases were searched for studies published up to September 2020. All studies related to smoking and DCI were included in the analysis. The R and RevMan software were used for data analysis, and random or fixed model analysis was selected depending on the degree of heterogeneity. Publication bias was examined by using the Begg-Mazumdar test and using contour-enhanced funnel plots with trim method. A total of eight original articles (12 cohorts) with 10,722 patients were included in this meta-analysis. There were statistically significant higher rates of DCI in the smoking group than in the non-smoking group (RR = 1.16, 95%CI: 1.05-1.27). After heterogeneity among cohorts was removed by sensitivity analysis, there was still a statistically significant difference in the incidence of DCI between the smoking and non-smoking groups (RR = 1.13, 95%CI: 1.07-1.20). Although the effects of nicotine as the main component of tobacco are unclear in terms of cerebral vessels, the present study suggests that smoking is a risk factor for DCI in patients with ruptured aneurysm.
迟发性脑缺血（DCI）是颅内动脉瘤破裂后死亡和致残的主要原因。以往研究表明，吸烟可导致颅内动脉瘤破裂后发生DCI。然而，最近一些研究表明，尼古丁作为烟草的主要成分，可引起脑血管扩张。这一观点引发了关于吸烟与DCI之间关系的争论。本研究旨在确定吸烟与DCI之间的关系。根据PRISMA指南进行了系统的文献检索。在Cochrane图书馆、科学网、PubMed和Embase在线数据库中检索截至2020年9月发表的研究。所有与吸烟和DCI相关的研究均纳入分析。使用R和RevMan软件进行数据分析，并根据异质性程度选择随机或固定模型分析。采用Begg-Mazumdar检验和带修剪法的等高线增强漏斗图检验发表偏倚。本荟萃分析共纳入8篇原始文章（12个队列），涉及10722例患者。吸烟组的DCI发生率在统计学上显著高于非吸烟组（RR = 1.16，95%CI：1.05 - 1.27）。通过敏感性分析消除队列间的异质性后，吸烟组和非吸烟组之间DCI的发生率仍存在统计学显著差异（RR = 1.13，95%CI：1.07 - 1.20）。尽管尼古丁作为烟草主要成分对脑血管的影响尚不清楚，但本研究表明，吸烟是动脉瘤破裂患者发生DCI的一个危险因素。
