Kermanshah University of Medical Sciences, Kermanshah, Iran.
Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Neurosurg Rev. 2024 Oct 24;47(1):818. doi: 10.1007/s10143-024-03068-7.
This meta-analysis seeks to investigate the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on the recurrence of chronic subdural hematoma (cSDH). Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, this study conducted a comprehensive online search across various databases, including PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, without time restrictions. Two reviewers independently screened titles, abstracts, and full texts based on predetermined criteria, resolving any discrepancies through discussion or consultation with a third reviewer. The quality and risk of bias of the included studies were assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Cochrane's tool for evaluating risk of bias in randomized controlled trials. Six studies aligned with the study objectives were included after a systematic search across 6 databases. The RAAS inhibitors group comprised 404 participants, while the control or placebo group included 1828 participants. Analysis for publication bias using the Egger test indicated no bias in the studies (P = 0.151). The odds ratio for cSDH recurrence with RAAS inhibitor use compared to non-use was reported as OR = 1.06; confidence interval 0.6-1.893, p-value = 0.818, showing no significant association between RAAS inhibitor use and cSDH recurrence. The results suggest no significant link between RAAS inhibitor use and cSDH recurrence. However, due to the limited number and design of studies, as well as the lack of clinical trials, further research is needed to determine the effectiveness of this treatment.
这项荟萃分析旨在探讨肾素-血管紧张素-醛固酮系统（RAAS）抑制剂对慢性硬脑膜下血肿（cSDH）复发的影响。本研究按照系统评价和荟萃分析首选报告项目（PRISMA）声明的指南，在没有时间限制的情况下，全面在线搜索了 PubMed、EMBASE、CINAHL、Web of Science 和 Cochrane 等多个数据库。两名评审员根据预先确定的标准独立筛选标题、摘要和全文，如果有分歧，则通过讨论或咨询第三位评审员解决。使用非随机研究方法学指数（MINORS）和 Cochrane 评估随机对照试验偏倚风险的工具评估纳入研究的质量和偏倚风险。在对 6 个数据库进行系统搜索后，纳入了 6 项符合研究目标的研究。RAAS 抑制剂组包括 404 名参与者，而对照组或安慰剂组包括 1828 名参与者。使用 Egger 检验对发表偏倚进行分析表明，研究中没有偏倚（P = 0.151）。与不使用 RAAS 抑制剂相比，使用 RAAS 抑制剂治疗后 cSDH 复发的优势比（OR）为 1.06；置信区间 0.6-1.893，p 值 = 0.818，表明 RAAS 抑制剂的使用与 cSDH 复发之间没有显著关联。结果表明，RAAS 抑制剂的使用与 cSDH 复发之间没有显著关联。然而，由于研究数量和设计有限，以及缺乏临床试验，需要进一步研究以确定这种治疗的有效性。
