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性别是否可预测动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）和脑积水？系统评价和荟萃分析。

Is sex a predictor for delayed cerebral ischaemia (DCI) and hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH)? A systematic review and meta-analysis.

机构信息

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.

NeuroInterventional Radiology, Monash Health, Melbourne, VIC, Australia.

出版信息

Acta Neurochir (Wien). 2023 Jan;165(1):199-210. doi: 10.1007/s00701-022-05399-0. Epub 2022 Nov 4.

DOI:10.1007/s00701-022-05399-0
PMID:36333624
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9840585/
Abstract

OBJECTIVES

DCI and hydrocephalus are the most common complications that predict poor outcomes after aSAH. The relationship between sex, DCI and hydrocephalus are not well established; thus, we aimed to examine sex differences in DCI and hydrocephalus following aSAH in a systematic review and meta-analysis.

METHODS

A systematic search was conducted using the PubMed, Scopus and Medline databases from inception to August 2022 to identify cohort, case control, case series and clinical studies reporting sex and DCI, acute and chronic shunt-dependent hydrocephalus (SDHC). Random-effects meta-analysis was used to pool estimates for available studies.

RESULTS

There were 56 studies with crude estimates for DCI and meta-analysis showed that women had a greater risk for DCI than men (OR 1.24, 95% CI 1.11-1.39). The meta-analysis for adjusted estimates for 9 studies also showed an association between sex and DCI (OR 1.61, 95% CI 1.27-2.05). For acute hydrocephalus, only 9 studies were included, and meta-analysis of unadjusted estimates showed no association with sex (OR 0.95, 95%CI 0.78-1.16). For SDHC, a meta-analysis of crude estimates from 53 studies showed that women had a somewhat greater risk of developing chronic hydrocephalus compared to men (OR 1.14, 95% CI 0.99-1.31). In meta-analysis for adjusted estimates from 5 studies, no association of sex with SDHC was observed (OR 0.87, 95% CI 0.57-1.33).

CONCLUSIONS

Female sex is associated with the development of DCI; however, an association between sex and hydrocephalus was not detected. Strategies to target females to reduce the development of DCI may decrease overall morbidity and mortality after aSAH.

摘要

目的

迟发性脑缺血（DCI）和脑积水是蛛网膜下腔出血（aSAH）后预测不良预后的最常见并发症。性别与 DCI 和脑积水之间的关系尚未明确；因此，我们旨在通过系统评价和荟萃分析检查 aSAH 后 DCI 和脑积水的性别差异。

方法

从开始到 2022 年 8 月，使用 PubMed、Scopus 和 Medline 数据库进行系统搜索，以确定报告性别和 DCI、急性和慢性分流依赖性脑积水（SDHC）的队列、病例对照、病例系列和临床研究。使用随机效应荟萃分析汇总可用研究的估计值。

结果

共有 56 项研究提供了 DCI 的原始估计值，荟萃分析表明，女性发生 DCI 的风险高于男性（OR 1.24，95%CI 1.11-1.39）。对 9 项研究的调整估计值的荟萃分析也显示了性别与 DCI 之间的关联（OR 1.61，95%CI 1.27-2.05）。对于急性脑积水，仅纳入了 9 项研究，对未调整估计值的荟萃分析显示性别与脑积水无关联（OR 0.95，95%CI 0.78-1.16）。对于 SDHC，对 53 项研究的原始估计值进行荟萃分析显示，与男性相比，女性发生慢性脑积水的风险略高（OR 1.14，95%CI 0.99-1.31）。对 5 项研究的调整估计值进行荟萃分析，未观察到性别与 SDHC 之间存在关联（OR 0.87，95%CI 0.57-1.33）。

结论

女性性别与 DCI 的发生有关；然而，未检测到性别与脑积水之间的关联。针对女性的策略以减少 DCI 的发生可能会降低 aSAH 后的总体发病率和死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/636ae7bc2cc7/701_2022_5399_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/8a595dae83dc/701_2022_5399_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/636ae7bc2cc7/701_2022_5399_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/8a595dae83dc/701_2022_5399_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/3f1f2c020746/701_2022_5399_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/805556c8f679/701_2022_5399_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/9d278e9c454a/701_2022_5399_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4bfc/9840585/636ae7bc2cc7/701_2022_5399_Fig7_HTML.jpg

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