Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis.
Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis.
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DOI：
10.1212/wnl.0000000000003605
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发表时间：
2017-02-14
期刊：
影响因子：
9.9
通讯作者：
Werring DJ
中科院分区：
文献类型：
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作者：
Kongbunkiat K;Wilson D;Kasemsap N;Tiamkao S;Jichi F;Palumbo V;Hill MD;Buchan AM;Jung S;Mattle HP;Henninger N;Werring DJ
对已发表的研究进行系统回顾和汇总荟萃分析，以评估溶栓（静脉溶栓或动脉溶栓）治疗前神经影像学上出现白质变是否与症状性脑出血（sICH）风险增加或功能预后不良相关。我们纳入了接受静脉溶栓或动脉溶栓治疗的急性缺血性卒中患者的研究，这些研究通过预处理神经影像学（CT或MRI）评估功能结局（3个月改良Rankin量表[mRS]）或sICH与白化病的关系。我们使用随机效应模型来计算有与无白质病变（使用任何评分量表）和无至轻度白质病变与中度至重度白质病变（使用Van Swieten或Fazekas Schmidt量表）的sICH和不良功能结局（mRS≥2）的总相对风险（RR）。我们确定了15项研究（总n = 6,967）。对于siich结果，RR为1.65 (n = 5,551； 95%可信区间[CI] 1.26-2.16, p = 0.001)，任何白质病变的绝对风险（AR）比无白质病变增加2.5%。相对危险度为2.4 (n = 4,192; 95% CI 1.83-3.14, p = 0.001)，中度至重度白质变与无至轻度白质变的AR增加6.2%。功能不良；RR为1.30 (n = 3401； 95% CI为1.19-1.42,p = 0.001)，任何白质病变的AR比无白质病变的AR增加15.4%。RR为1.31 (n = 3,659; 95% CI 1.22-1.42, p = 0.001)，中度至重度白质病变的AR比无至轻度白质病变增加17.5%。任何分析均未发现统计异质性。急性缺血性卒中静脉溶栓或动脉溶栓后，白质病变的存在和严重程度始终与sICH风险增加和功能预后不良相关。
To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome. We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI). We used random-effects models to calculate pooled relative risks (RR) of sICH and poor functional outcome (mRS ≥ 2) for any vs no leukoaraiosis (using any rating scale) and for no to mild vs moderate to severe leukoaraiosis (using the Van Swieten or Fazekas Schmidt scale). We identified 15 studies (total n = 6,967). For sICH outcome, the RR was 1.65 (n = 5,551; 95% confidence interval [CI] 1.26–2.16, p = 0.001) with an absolute risk (AR) increase of 2.5% for any leukoaraiosis vs none. The RR was 2.4 (n = 4,192; 95% CI 1.83–3.14, p = 0.001) with an AR increase of 6.2% for moderate to severe vs no to mild leukoaraiosis. For poor functional outcome; the RR was 1.30 (n = 3,401; 95% CI 1.19–1.42, p = 0.001) with an AR increase of 15.4% for any leukoaraiosis vs none. The RR was 1.31 (n = 3,659; 95% CI 1.22–1.42, p = 0.001) with an AR increase of 17.5% for moderate to severe vs no to mild leukoaraiosis. No statistical heterogeneity was noted for any of the analyses. Leukoaraiosis presence and severity are consistently associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke.