Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk Updated meta-analysis
Cerebral microbleeds and postthrombolysis intracerebral hemorrhage risk Updated meta-analysis
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DOI：
10.1212/wnl.0000000000001923
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发表时间：
2015-09-15
期刊：
影响因子：
9.9
通讯作者：
Werring, David J.
中科院分区：
文献类型：
--
作者：
Charidimou, Andreas;Shoamanesh, Ashkan;Werring, David J.
目的：我们进行了系统回顾和荟萃分析，以评估接受溶栓治疗的急性缺血性卒中患者治疗前 MRI 扫描中脑微出血 (CMB) 的存在是否与症状性脑出血 (ICH) 风险增加相关。方法：我们在 PubMed 中搜索相关研究，并使用 Mantel-Haenszel 固定效应法，在接受溶栓治疗的个体中与未接受溶栓治疗的个体中，使用 Mantel-Haenszel 固定效应法计算了症状性 ICH 的汇总比值比 (OR)。治疗前 MRI 扫描的 CMB。为了最大限度地减少潜在偏倚，进行了敏感性分析，包括提供仅接受静脉溶栓治疗的患者数据的研究。结果：荟萃分析中汇集了 10 项符合条件的研究，包括 2,028 名患者。 CMB 的总体患病率为 23.3%。在患有 CMB 的患者中，472 名患者中有 40 名（8.5%；95% CI：6.1%-11.4%）在溶栓后出现有症状的 ICH，而 1,556 名没有 CMB 的患者中有 61 名（3.9%；95% CI：3%-5%）出现症状性脑出血。所有研究中 ICH 的汇总 OR 为 2.26（95% CI：1.46-3.49；p < 0.0001）。八项研究，包括 1,704 名患者（n = 401 名接受 CMB 治疗的患者），提供了仅接受静脉溶栓治疗的患者的数据；存在 CMB 和出现症状性 ICH 的 OR 为 2.87（95% CI：1.76-4.69；p < 0.0001）。 结论：我们对现有已发表数据的荟萃分析表明，CMB 患者急性缺血性卒中溶栓后出现症状性 ICH 的风险增加。然而，我们不能完全排除偏见或混杂因素，因此我们的结果应被视为假设生成。根据现有证据，检测 CMB 不应妨碍溶栓治疗。需要进一步分析，考虑 CMB 数量和位置，以及功能结果的测量。Neurology (R) 2015；85:927-934
Objective:We performed a systematic review and meta-analysis to assess whether the presence of cerebral microbleeds (CMBs) on pretreatment MRI scans of patients with acute ischemic stroke treated with thrombolysis is associated with an increased risk of symptomatic intracerebral hemorrhage (ICH).Methods:We searched PubMed for relevant studies and calculated pooled odds ratios (ORs) for symptomatic ICH, using the Mantel-Haenszel fixed-effects method, among individuals with vs without CMBs on pretreatment MRI scans. To minimize potential bias, sensitivity analysis was performed including studies providing data on patients treated only with IV thrombolysis.Results:Ten eligible studies including 2,028 patients were pooled in meta-analysis. The overall prevalence of CMBs was 23.3%. Among patients with CMBs, 40 of 472 (8.5%; 95% confidence interval [CI]: 6.1%-11.4%) experienced a symptomatic ICH after thrombolysis compared with 61 of 1,556 patients (3.9%; 95% CI: 3%-5%) without CMBs. The pooled OR of ICH across all studies was 2.26 (95% CI: 1.46-3.49; p < 0.0001). Eight studies, including 1,704 patients (n = 401 with CMBs), provided data on patients treated with IV thrombolysis only; OR for the presence of CMBs and the development of symptomatic ICH was 2.87 (95% CI: 1.76-4.69; p < 0.0001).Conclusions:Our meta-analysis of the available published data demonstrates an increased risk of symptomatic ICH after thrombolysis for acute ischemic stroke in patients with CMBs. However, we cannot fully exclude bias or confounding, so our results should be considered hypothesis-generating. Detecting CMBs should not prevent thrombolytic treatment based on present evidence. Further analyses, taking into account CMB number and location, as well as measures of functional outcome, are needed.Neurology (R) 2015;85:927-934