脑微出血对急性脑梗死患者溶栓治疗后出血转化及功能预后的影响:一项Meta分析

Effect of Cerebral Microbleeds on Hemorrhagic Transformation and Function Prognosis in Patients with Cerebral Infarction after Thrombolysis: a Meta-analysis

目的:评价脑微出血(CMBs)与急性脑梗死患者溶栓治疗后出血转化(HT)及功能预后的相关性。方法:对Pub Med、Elsevier、中国知网、万方、维普等文献数据库进行检索。应用Rev Man5.2软件进行Meta分析。结果:共纳入8篇研究,共计1 583例患者。Meta分析结果显示:CMBs(+)组的HT、症状性出血(s ICH)的发生率均高于CMBs(-)组,差异有统计学意义(P=0.03;P=0.01)。CMBs(+)组3个月时良好的神经功能结局发生率低于CMBs(-)组,有显著性差异(P=0.0002)。根据微出血数目进行严重程度分级,发现HT和s ICH发生风险随着CMBs数量的增加而升高。合并有CMBs>10个的急性脑梗死患者溶栓治疗后HT和s ICH发生风险高于CMBs≤10个的患者,差异有统计学意义(P=0.03;P=0.04)。结论:合并CMBs的急性脑梗死患者溶栓治疗后发生HT和预后不良的风险升高。

Objective： To evaluate the effects of cerebral microbleeds （CMBs） on hemorrhage transformation （HT） and function prognosis in patients with acute cerebral infarction after thrombolytic therapy. Methods： PubMed, El-sevier, CNKI, Wanfang and Weipu Databases were searched. Statistical analyses were performed by RevMan 5.2 software. Results： Eight studies （1 583 patients） were analyzed. Meta-analysis revealed the presence of microbleeds as an increased risk of HT and sICH （P=0.03;P=0.01）. However, Meta-analysis of neurological functional outcome at three months revealed the presence of CMBs as a negative factor of favorable outcome （P=0.0002）. When the cases with CMBs were classified into different groups depending on the number, the risk of HT and sICH increased with the number of CMBs. Patients with more than 10 CMBs showed an increased risk of HT and sICH when com-pared to those with less than 10 CMBs （P=0.03;P=0.04）. Conclusion： There is an increased risk of HT and poor prognosis following thrombolysis for acute cerebral infarction patients with CMBs.