与 COVID-19 相关的缺血性脑卒中：系统评价和荟萃分析。

BACKGROUND: Coronavirus disease 2019 (COVID-19), a contagious infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread across the world. Apart from respiratory complications, an increasing number of patients with ischemic stroke have been reporting. OBJECTIVE: This systematic review and meta-analysis aims to explore the characteristics of ischemic stroke after SARS-CoV-2 infection, and provides valuable reference materials for subsequent clinical treatment. MATERIALS AND METHODS: PubMed, Web of Science, and Ovid-Embase databases were searched up to 24th March 2021. We utilized the search strategy of medical subject headings combined with entry terms to search all related literatures. All studies identified with the electronic and manual searches were listed by citation, title, authors, and abstract. Only studies involving patients with COVID-19-related stroke were eligible. The references of included studies were also manually screened. RESULTS: The meta-analysis was conducted following the PRISMA and MOOSE reporting guidelines. Bias risk was assessed using the Newcastle-Ottawa Scale (NOS). Ten articles, including 26,691 participants and 280 patients with ischemic stroke and COVID-19, were selected. The pooled prevalence of ischemic stroke in COVID-19 was 2% (95% CI 1-2%; p < 0.01). The pooled proportions of hypertension, hyperlipidemia and diabetes in COVID-19-related ischemic stroke was 66% (95% CI 51-81%; p < 0.01), 48% (95% CI 19-76%; p < 0.01) and 40% (95% CI 29-51%; p < 0.01), respectively. Notably, the pooled proportions of female was 36% (95% CI 21-50%; p < 0.01) in patients with COVID-19 and stroke. In addition, in TOAST classification, cryptogenic stroke subtype was associated with a high trend, and its pooled proportion was 35% (95% CI 12-59%; p < 0.01). CONCLUSION: Ischemic stroke caused by COVID-19 has its own unique clinical features. Although common high-risk factors can also be observed, its importance may have changed. The major inflammatory storm of COVID-19 is more likely to occur in male patients. The increase in the proportion of cryptogenic stroke has also made stroke related to COVID-19 complicated.

背景：由严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 引起的传染性疾病 2019 年冠状病毒病 (COVID-19) 已在全球范围内传播。除了呼吸道并发症外，越来越多的缺血性脑卒中患者也有报道。

目的：本系统评价和荟萃分析旨在探讨 SARS-CoV-2 感染后缺血性脑卒中的特征，并为后续临床治疗提供有价值的参考资料。

材料和方法：检索 PubMed、Web of Science 和 Ovid-Embase 数据库，截至 2021 年 3 月 24 日。我们使用主题词与主题词结合词的检索策略来搜索所有相关文献。通过引文、标题、作者和摘要列出电子和手动搜索中识别的所有相关研究。只有涉及 COVID-19 相关脑卒中患者的研究才符合入选标准。还对手册筛选出的纳入研究的参考文献进行了筛选。

结果：按照 PRISMA 和 MOOSE 报告指南进行荟萃分析。使用纽卡斯尔-渥太华量表 (NOS) 评估偏倚风险。选择了 10 篇文章，包括 26691 名参与者和 280 名 COVID-19 相关缺血性脑卒中患者。COVID-19 患者缺血性脑卒中的总患病率为 2%（95%CI 1-2%；p<0.01）。COVID-19 相关缺血性脑卒中患者中高血压、高血脂和糖尿病的比例分别为 66%（95%CI 51-81%；p<0.01）、48%（95%CI 19-76%；p<0.01）和 40%（95%CI 29-51%；p<0.01）。值得注意的是，COVID-19 合并脑卒中患者中女性的比例为 36%（95%CI 21-50%；p<0.01）。此外，在 TOAST 分类中，隐源性卒中亚型与高趋势相关，其比例为 35%（95%CI 12-59%；p<0.01）。

结论：COVID-19 引起的缺血性脑卒中具有其独特的临床特征。虽然也可以观察到常见的高危因素，但它们的重要性可能已经发生了变化。COVID-19 的主要炎症风暴更可能发生在男性患者中。隐源性卒中比例的增加也使与 COVID-19 相关的卒中变得复杂。