PDF(Pubmed)
Abstract：
UNASSIGNED: The optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients.
UNASSIGNED: We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors\' institutional series of 24 patients were also included and reviewed in the analysis.
UNASSIGNED: A total of 19 East Asian studies involving 1,571 patients as well as our institution\'s retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients\' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively).
UNASSIGNED: The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.
UNASSIGNED: We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors\' institutional series of 24 patients were also included and reviewed in the analysis.
UNASSIGNED: A total of 19 East Asian studies involving 1,571 patients as well as our institution\'s retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients\' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively).
UNASSIGNED: The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.
摘要：
■出血性烟雾病（HMMD）的最佳治疗方法仍然是争论的话题，特别是关于血运重建与保守治疗的比较疗效。我们的研究,其中包括单中心病例系列和荟萃分析的系统综述，旨在确定手术血运重建是否与术后再出血的显著减少相关，缺血事件，与保守治疗相比，东亚HMMD患者的死亡率。
■我们通过搜索PubMed，谷歌学者，万方医学在线(WMO)，和中国国家知识基础设施(CNKI)。手术血运重建和保守治疗的结果，包括再出血,缺血事件和死亡率，进行了比较。作者的机构系列24名患者也被纳入分析，并在分析中进行了回顾。
■本研究共纳入19项东亚研究，涉及1,571名患者，以及本机构对24名患者的回顾性研究。在仅成人患者的研究中，那些接受血运重建的患者的再出血率明显较低，缺血事件，与接受保守治疗的患者相比，死亡率(13.1%(46/352)vs.32.4%（82/253），P<0.00001;4.0%(5/124)vs.14.9%（18/121），P=0.007；3.3%(5/153)与12.6%（12/95），分别为P=0.01)。在成人/儿科患者研究中，类似的再出血统计结果，缺血事件，和死亡率已经获得(70/588(11.9%)vs.103/402（25.6%），在随机或固定效应模型中，P=0.003或<0.0001，分别为14/296（4.7%）与26/183（14.2%），P=0.001；和4.6％（15/328）与18.7%（23/123），分别为P=0.0001)。
■当前的单中心病例系列和系统评价与荟萃分析的研究表明，外科血运重建，包括直接,间接，两者的结合，显著减少再出血,缺血事件，东亚地区HMMD患者的死亡率。需要更多精心设计的研究来进一步证实这些发现。
■我们通过搜索PubMed，谷歌学者，万方医学在线(WMO)，和中国国家知识基础设施(CNKI)。手术血运重建和保守治疗的结果，包括再出血,缺血事件和死亡率，进行了比较。作者的机构系列24名患者也被纳入分析，并在分析中进行了回顾。
■本研究共纳入19项东亚研究，涉及1,571名患者，以及本机构对24名患者的回顾性研究。在仅成人患者的研究中，那些接受血运重建的患者的再出血率明显较低，缺血事件，与接受保守治疗的患者相比，死亡率(13.1%(46/352)vs.32.4%（82/253），P<0.00001;4.0%(5/124)vs.14.9%（18/121），P=0.007；3.3%(5/153)与12.6%（12/95），分别为P=0.01)。在成人/儿科患者研究中，类似的再出血统计结果，缺血事件，和死亡率已经获得(70/588(11.9%)vs.103/402（25.6%），在随机或固定效应模型中，P=0.003或<0.0001，分别为14/296（4.7%）与26/183（14.2%），P=0.001；和4.6％（15/328）与18.7%（23/123），分别为P=0.0001)。
■当前的单中心病例系列和系统评价与荟萃分析的研究表明，外科血运重建，包括直接,间接，两者的结合，显著减少再出血,缺血事件，东亚地区HMMD患者的死亡率。需要更多精心设计的研究来进一步证实这些发现。
