Abstract:Objective To systematically review the influencing factors of malignant cerebral edema in patients with acute cerebral infarction. Methods PubMed, Web of Science, EMbase, the Cochrane Library, CNKI, VIP, and Wanfang Data were searched to collect relevant literatures on influencing factors of malignant cerebral edema in patients with acute cerebral infarction. The retrieval period is from the inception to April 2021. Two reviewers independently screened literatures, extracted data, and assessed the quality of included studies, then, meta analysis was performed by RevMan 5.3 and Stata 15.0 software. Results A total of 18 literatures were included, including 66 792 patients. Meta-analysis results showed baseline National Institute of Health stroke scale (NIHSS) score (OR = 1.15, 95%CI: 1.15-1.16, P < 0.01), history of atrial fibrillation (OR = 2.99, 95%CI:1.53-5.87, P < 0.01), anterior cerebral artery involvement (OR = 5.53, 95%CI: 2.48-12.34, P < 0.01), carotid artery occlusion (OR = 2.12, 95%CI:1.04-4.32, P = 0.04) were the risk factor for malignant cerebral edema after cerebral infarction. Sensitivity analysis showed that successful recanalization was a protective factor (OR = 0.36, 95%CI: 0.20-0.66, P < 0.01), the stability was changed. Egger test results showed no publication bias (P > 0.05). Conclusion Baseline NIHSS score, history of atrial fibrillation, anterior cerebral artery involvement, and carotid artery occlusion are risk factors for malignant cerebral edema after cerebral infarction, which should be paid attention to and timely take corresponding measures in clinical practice. The relationship between successful recanalization and malignant cerebral edema still needs further study.
杨雯 李君卓 刘光维▲. 急性脑梗死患者发生恶性脑水肿影响因素的meta分析[J]. 中国医药导报, 2022, 19(17): 92-95.
YANG Wen LI Junzhuo LIU Guangwei▲. Meta-analysis of influencing factors for malignant cerebral edema in patients with acute cerebral infarction. 中国医药导报, 2022, 19(17): 92-95.
[1] Wu S,Yuan R,Wang Y,et al. Early Prediction of Malignant Brain Edema After Ischemic Stroke [J]. Stroke,2018, 49(12):2918-2927.
[2] Huang X,Yang Q,Shi X,et al. Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke [J]. J Neurointerv Surg,2019,11(10):994-998.
[3] Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses [J]. Eur J Epidemiol,2010,25(9):603-605.
[4] Xu HB,Sun YF,Luo N,et al. Net Water Uptake Calculated in Standardized and Blindly Outlined Regions of the Middle Cerebral Artery Territory Predicts the Development of Malignant Edema in Patients with Acute Large Hemispheric Infarction [J]. Front Neurol,2021,12:645590.
[5] 汪文兵,徐骏峰,黄显军,等.急性大血管闭塞性卒中早期成功再通后恶性脑水肿发生的影响因素分析[J].中华神经科杂志,2020,53(4):274-275.
[6] 戚江丽.急性缺血性脑卒中静脉溶栓后脑水肿相关风险因素的临床研究[D].南昌:南昌大学,2020.
[7] 汪文兵.急性前循环大血管闭塞性卒中患者血管内治疗后早期血脑屏障损伤及其对预后影响的临床研究[D].芜湖:皖南医学院,2020.
[8] Thorén M,Dixit A,Escudero-Martínez I,et al. Effect of Recanalization on Cerebral Edema in Ischemic Stroke Treated with Thrombolysis and/or Endovascular Therapy [J]. Stroke,2020,51(1):216-223.
[9] Sun W,Li G,Song Y,et al. A web based dynamic MANA Nomogram for predicting the malignant cerebral edema in patients with large hemispheric infarction [J]. BMC Neurol,2020,20(1):360.
[10] Du M,Huang X,Li S,et al. A Nomogram Model to Predict Malignant Cerebral Edema in Ischemic Stroke Patients Treated with Endovascular Thrombectomy:An Observational Study [J]. Neuropsychiatr Dis Treat,2020, 16:2913-2920.
[11] Zhang S,Lin L,Zhang R,et al. Absent Contrast Filling of Ipsilateral Superficial Middle Cerebral Vein Predicts Midline Shift in Acute Middle Cerebral Artery Occlusion [J]. Front Neurol,2020,11:570844.
[12] Huang X,Yang Q,Shi X,et al. Predictors of malignant brain edema after mechanical thrombectomy for acute ischemic stroke [J]. J Neurointerv Surg,2019,11(10):994-998.
[13] Kauw F,Bennink E,de Jong H,et al. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction [J]. Stroke,2019,50(6):1437-1443.
[14] Broocks G,Flottmann F,Scheibel A,et al. Quantitative Lesion Water Uptake in Acute Stroke Computed Tomography Is a Predictor of Malignant Infarction [J]. Stroke,2018,49(8):1906-1912.
[15] Thorén M,Azevedo E,Dawson J,et al. Predictors for Cerebral Edema in Acute Ischemic Stroke Treated With Intravenous Thrombolysis [J]. Stroke,2017,48(9):2464-2471.
[16] Jo K,Bajgur SS,Kim H,et al. A simple prediction score system for malignant brain edema progression in large hemispheric infarction [J]. PLoS One,2017,12(2):e171425.
[17] Kim H,Jin ST,Kim YW,et al. Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography [J]. J Clin Neurosci,2015,22(3):554-560.
[18] Shimoyama T,Kimura K,Uemura J,et al. The DASH score:A simple score to assess risk for development of malignant middle cerebral artery infarction [J]. J Neurol Sci,2014,338(1/2):102-106.
[19] 石丹,许岩,杜宇平,等.大脑中动脉供血区大面积脑梗死患者脑疝危险因素的分析[J].中国脑血管病杂志,2011,8(10):522-525.
[20] Thomalla G,Hartmann F,Juettler E,et al. Prediction of Malignant Middle Cerebral Artery Infarction by Magnetic Resonance Imaging Within 6 Hours of Symptom Onset:A Prospective Multicenter Observational Study [J]. Ann Neurol,2010,68(4):435-445.
[21] Moldes O,Sobrino T,Millán M,et al. High serum levels of endothelin-1 predict severe cerebral edema in patients with acute ischemic stroke treated with t-PA [J]. Stroke,2008,39(7):2006-2010.
[22] Cheng Y,Luo J,Lin Y,et al. Impact of hyperglycaemia on complications in patients who had a stroke after thrombolysis [J]. Postgrad Med J,2020,10:postgradmedj-2020-138736.
[23] Tu HT,Campbell BC,Christensen S,et al. Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion,infarct growth,and hemorrhagic transformation [J]. Int J Stroke,2015,10(4):534-540.
[24] Kasner SE,Demchuk AM,Berrouschot J,et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke [J]. Stroke,2001,32(9):2117-2123.
[25] Walcott BP,Miller JC,Kwon CS,et al. Outcomes in severe middle cerebral artery ischemic stroke [J]. Neurocrit Care,2014,21(1):20-26.