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颈动脉斑块内出血与临床症状相关性的系统评价
引用本文:高鹏,陈左权,鲍遇海,焦力群,张鸿祺,凌锋. 颈动脉斑块内出血与临床症状相关性的系统评价[J]. 中国脑血管病杂志, 2007, 4(8): 363-369
作者姓名:高鹏  陈左权  鲍遇海  焦力群  张鸿祺  凌锋
作者单位:1. 200065,上海,同济大学附属同济医院神经外科
2. 首都医科大学宣武医院神经外科
摘    要:目的研究颈动脉斑块内出血(intra-plaque hemorrhage,IPH)与同侧脑缺血症状的相关性。方法从PubMed数据库中检索1979年1月—2006年9月同侧脑缺血与IPH相关性研究的英文文献,通过比较这些文献研究中有症状与无症状人群IPH的发生率,阐明IPH在脑缺血发生机制中的作用。采用Meta分析方法,对各个研究的数据进行整合和分析,并对效应值(优势比,OR)和研究间异质性进行评价。结果共31项研究被纳入此项Meta分析。各项研究间OR值变异很大。总体上,有症状组IPH发生率(46.6%)显著高于无症状组(36.0%),随机效应模型下OR值为2.25(95%CI:1.57~3.22,P<0.000 01)。但同质性分析提示,各项研究间存在高度异质性(P<0.000 01)。亚组分析发现,采用显微镜检方法定义IPH的研究、阳性结果、小样本研究、早期发表的研究(1995年之前),及有症状组和无症状组间颈动脉狭窄程度不等的研究,均存在高度异质性。大样本、近期发表(1995年以后)、采用大体形态学观察方法定义IPH、两组颈动脉狭窄程度相等的研究,未发现同侧脑缺血发生与IPH有相关性。此外,研究中定义和评价IPH的方法变异很大。IPH时程、大小、数目和位置等研究报道较少,且变异亦很大。有些研究未控制混淆因子和选择偏倚。结论尽管统计学结果提示,IPH参与脑缺血的发生机制,但由于研究中存在高度异质性和潜在发表偏倚,统计学结果可信度受到质疑,不能完全准确地评价IPH在脑缺血症状发生中的作用。为了准确评价IPH在脑缺血发生中的机制,尚需要进行大样本、前瞻性、设计严密、统一IPH定义和评价方法的研究。

关 键 词:颈动脉狭窄  斑块内出血  Meta分析  医学信息学
修稿时间:2007-04-04

A systematic review of carotid intraplaque hemorrhage associated with ipsilateral neurologic symptoms
GAO Peng,CHEN Zuo-quan,BAO Yu-hai,JIAO Li-qun,ZHANG Hong-qi,LING Feng. A systematic review of carotid intraplaque hemorrhage associated with ipsilateral neurologic symptoms[J]. Chinese Journal of Cerebrovascular Diseases, 2007, 4(8): 363-369
Authors:GAO Peng  CHEN Zuo-quan  BAO Yu-hai  JIAO Li-qun  ZHANG Hong-qi  LING Feng
Affiliation:Department of Neurosurgery, Tongji Hospital of Tongji University, Shanghai 200065, China
Abstract:Objective To study the correlations between carotid intra-plaque hemorrhage(IPH) and ipsilateral cerebral ischemie symptoms.Methods The English references on the correlations between ipsilateral cerebral ischemia and IPH were retrieved from PubMed database from January 1979 to September 2006.By comparing the incidence of IPH between symptomatic and asymptomatic populations in the literatures,the effect in the mechanism of IPH in cerebral ischemia was elucidated.All the study data were integrated and analyzed by meta-analysis,and the effect size(odds ratio,OR) and heterogeneity between the studies were assessed.Results There were 31 studies altogether were included in the systematic review.The variation of OR values was great among all the studies.Overall,the incidence of IPH in symptomatic group(46.6%) was significantly higher than that in asymptomatic group(36.0%).The OR value was 2.25 under the random effect model(95% CI,1.57 to 3.22,P<0.000 01).However,the analysis of homogeneity indicated that there was high heterogeneity between all the studies(P<0.000 01).Subgroup analyses found that the studies of IPH,positive result,small sample and early published studies(before 1995) defined by the method of microscopic examination,as well as the studies of unequal carotid stenosis between the symptomatic and asymptomatic groups had high heterogeneity.The large sample,recently published studies(after 1995),IPH defined by the method of gross morphology,and the studies of equal carotid stenosis between the two groups did not find correlations between the occurrence of ipsilateral cerebral ischemia and IPH.In addition,the methods in defining and evaluating IPH in the studies varied significantly.IPH time course,size,number,and location were rarely reported,and their variations were great.Some studies did not control the confounders and selection bias.Conclusions Although the statistical results suggested that IPH participated in the mechanism of cerebral ischemia,the reliability of the statistic results was challenged because of the high heterogeneity and potential publication bias,and they could not accurately evaluate the effect of IPH in the development of cerebral ischemia.In order to accurately evaluate the mechanism of IPH in the occurrence of cerebral ischemia,the large-sample,prospective,well-designed studies,and unified IPH definition and evaluating methods are needed.
Keywords:Carotid stenosis  Intra-plaque hemorrhage  Meta analysis  Medical informatics
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