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动静脉畸形相关出血后脑血管痉挛的危险因素:一项系统评价和荟萃分析

Risk factors for cerebral vasospasm following arteriovenous malformation-related hemorrhage: a systematic review and meta-analysis.

作者信息

Rakowski Maurycy, Koc Natalia Anna, Pettersson Samuel D, Zieliński Piotr

机构信息

Department of Neurosurgery, Medical University of Gdańsk, Gdańsk, Poland.

Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

出版信息

Neurosurg Rev. 2025 Jul 2;48(1):540. doi: 10.1007/s10143-025-03684-x.

Abstract

Cerebral vasospasm (CVS) is a severe complication associated with significant morbidity and in-hospital mortality. While well characterized in aSAH, its occurrence following AVM-related hemorrhage remains less understood. To address this gap, a meta-analysis adhering to PRISMA guidelines was conducted, with two independent authors searching PubMed, Scopus, and Web of Science from inception to July 2024, seeking studies on CVS risk factors following AVM-related hemorrhage. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Dichotomous variables were pooled into an overriding odds ratio (OR) with a 95% confidence interval (CI), while continuous variables were analyzed using the mean difference (MD) with a 95% CI, both using a random-effects model. Out of 2360 screened articles, 4 studies met the inclusion criteria, totaling 7483 AVM-related hemorrhage patients, 958 of whom developed CVS. All studies were rated high quality, according to NOS. A total of 10 extractable demographic, behavioral, clinical, and radiographic variables reported in the literature were assessed. The following CVS risk factors were statistically significant: younger age (MD = -4.99; 95% CI [-9.40 to -0.57]; p = 0.03), female sex (OR = 1.72; 95% CI [1.50-1.98]; p < 0.00001), and intraventricular hemorrhage (OR = 1.24; 95% CI [1.04-1.48]; p = 0.02). Subarachnoid hemorrhage was close to significance (OR = 1.17; 95% CI [1.00-1.36]; p = 0.05). This is the first systematic review and meta-analysis to identify risk factors for CVS in the context of AVM-related hemorrhage. The presented findings may aid clinicians in recognizing high-risk individuals. Further research is warranted to develop a reliable risk scoring system that can predict AVM-associated CVS in clinical settings and to further explore the differences between CVS following aSAH and AVM-related hemorrhage.

摘要

脑血管痉挛(CVS)是一种严重的并发症,具有较高的发病率和院内死亡率。虽然在动脉瘤性蛛网膜下腔出血(aSAH)中对其特征已有充分了解,但在动静脉畸形(AVM)相关出血后其发生情况仍了解较少。为填补这一空白,我们按照PRISMA指南进行了一项荟萃分析,由两位独立作者检索了从数据库建立至2024年7月的PubMed、Scopus和Web of Science数据库,以查找关于AVM相关出血后CVS危险因素的研究。使用纽卡斯尔-渥太华量表(NOS)评估研究质量。二分变量汇总为总体优势比(OR)及95%置信区间(CI),连续变量则使用平均差(MD)及95%CI进行分析,均采用随机效应模型。在筛选的2360篇文章中,有4项研究符合纳入标准,共计7483例AVM相关出血患者,其中958例发生了CVS。根据NOS,所有研究均被评为高质量。我们评估了文献中报告的总共10个可提取的人口统计学、行为学、临床和影像学变量。以下CVS危险因素具有统计学意义:年龄较小(MD = -4.99;95%CI [-9.40至-0.57];p = 0.03)、女性(OR = 1.72;95%CI [1.50 - 1.98];p < 0.00001)和脑室内出血(OR = 1.24;95%CI [1.04 - 1.48];p = 0.02)。蛛网膜下腔出血接近显著水平(OR = 1.17;95%CI [1.00 - 1.36];p = 0.05)。这是第一项在AVM相关出血背景下识别CVS危险因素的系统评价和荟萃分析。所呈现的研究结果可能有助于临床医生识别高危个体。有必要进一步开展研究,以开发一种可靠的风险评分系统,能够在临床环境中预测AVM相关的CVS,并进一步探索aSAH后CVS与AVM相关出血后CVS之间的差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4954/12222334/b7a5b866644a/10143_2025_3684_Fig1_HTML.jpg

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