脑梗死后出血转化不同亚型与预后关系的系统评价

摘要/Abstract

摘要：

目的了解脑梗死后出血转化不同亚型对脑梗死患者预后的影响，为临床出血转化患者的恰当处理提供依据帮助改善患者预后。方法计算机检索PubMed（1966年1月1日至2014年7月1日）、EMbase（1966年1月1日至2014年7月1日）、中国生物医学文献数据库（Chinese Biological Medical Database，CBM）（1978年1月1日至2014年7月1日）、维普中文科技期刊数据库（VIP Database for Chinese Technical Periodicals，VIP）（1989年1月1日至2014年7 月1日）、中国知网（China National Knowledge Infrastructure，CNKI）（1980年1月1日至2014年7月1日），全面收集出血转化与脑梗死预后关系的临床研究，共1 601篇。由2名评价者独立进行文献筛选，使用 Newcastle-Ottawa量表（Newcastle-Ottawa Scale，NOS）对文献进行质量评价。结果共纳入10篇文献，共50 186例脑梗死患者，其中发生出血转化者4 492例，梗死后出血转化发生率8.9%。纳入研究的方法学质量较高。3篇文献对无症状出血转化的预后进行了比较，其中1篇文献指出无症状出血转化将使患者最终预后变差，另外2篇文献均指出无症状出血转化不会对患者长期预后造成不良影响。3篇文献对梗死后出血转化进行了影像分型，指出血肿形成（parenchymal hematoma，PH）2型（PH-2）预后较差，PH-1存有争议。其中1篇文献对远隔部位血肿形成（remote parenchymal hematoma，PHr）的相关预后展开分析，指出PHr预后较差，PH中有PHr则预后更差。结论出血转化不同亚型对患者的最终结局会造成不同影响，无症状出血转化可能影响患者长期预后，但具体预后与其影像分型有关，如为PH-2型则预后较差。影像分型PH-2会影响患者最终预后。 PHr亦会影响患者最终预后，但关于PHr的具体机制仍不清楚。

文章导读： 本文研究显示出血转化对预后的影响与其具体类型相关，既往认为不影响预后的无症状出血转化应引起足够重视。

关键词: 脑梗死; 出血转化; 亚型; 预后

Abstract:

Objective To systematically assess the association between clinical outcome and hemorrhagic transformation(HT) after acute cerebral infarction. Methods Such databases as PubMed, Cochrane Library, EMbase, China National Knowledge Infrastructure(CNKI), Chinese Biological Medical Database(CBM), and Database for Chinese Technical Periodicals(VIP) were searched for cohort study and case-control study on the association between clinical outcome and HT (up to July, 2014). Two researchers selected studies and extracted data independently using a designed extraction form. Results Ten studies involving 50 186 patients were included. The 4 492 patients have hemorrhagic transformation. The result of analysis showed that whether asymptomatic hemorrhage influenced the prognosis is not clear, but symptomatic hemorrhage secondary to ischemic stroke implies a clear causal relationship between clinical deterioration and HT. As the type of HT, parenchymal hematoma (PH)-2 was negative predictor of outcome. Conclusion Different types of HT indicates different prognosis, symptomatic hemorrhagepredicates worsened outcome, but the outcome influenced by asymptomatic hemorrhage is still not clear.

Key words: Cerebral infarction; Hemorrhagic transformation; Subtype; Clinical outcome

陈艳超，雷春艳，刘鸣. 脑梗死后出血转化不同亚型与预后关系的系统评价[J]. 中国卒中杂志, 2015, 10(10): 827-834.

CHEN Yan-Chao, LEI Chun-Yan, LIU Ming. Association between Clinical Outcome and Hemorrhagic Transformation after Acute Cerebral Infarction: a System Review[J]. Chinese Journal of Stroke, 2015, 10(10): 827-834.

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