| Objective: Intracerebral hemorrhage(ICH),also known as spontaneous intracerebral hemorrhage,refers to the primary non traumatic brain hemorrhage.It accounts for 17.1%-55.4% of stroke in this country.The annual incidence rate of intracerebral hemorrhage is 60-80/10 million and the mortality rate in the acute stage being 30%-40%.It has the highest mortality rate among acute cerebral vascular disease.Studies on the treatment and prognosis of intracerebral hemorrhage has been lagging behind in ischemic stroke,and as well as lacking effective treatment which is confirmed by Evidence Based Medicine.Previous studies suggest that the injury of neural function after intracerebral hemorrhage is mainly cased by mass effect of hematoma and brain edema;and factors such as the admission Glasgow Coma Scale score(GCS),volume of hemorrhage,bleeding site,and age are closely related with the prognosis of patients,thus surgery and drugs are employed only for the treatment of intracranial hypertension and brain edema.However,now more and more studies have shown that the inflammatory reaction around the brain caused by bleeding is an important factor in aggravating the brain damage.C reactive protein(CRP),which is an acute reactive protein will synthesized in the liver rapidly when the body suffered inflammation,infection or injury.A series of complex injury mechanisms are associated with inflammatory reaction in intracerebral hemorrhage.Many studies have found that the level of CRP in patients with intracerebral hemorrhage changed in some degree and it also played an important role in the prognosis of patients with intracerebral hemorrhage.To assess the prognostic effect of the C-Reactive Protein in patients with intracerebral hemorrhage scientifically,we conducted this study via Evidence Based Medicine,so that we can provide more significant evidence for the further studies.Methods: Through adopting Cochrane systematic review methods,we search the database of PubMed,The Cochrane Library,EMbase,CNKI,WanFang Data,VIP electronically and manually to collect all of the study(up to September 2017)about the prognostic effect of the C-Reactive Protein on intracerebral Hemorrhage.After searching the database completely,two reviewer independently screened the literature according to the inclusion and exclusion criteria,as well as extracting data and assessing the methodological quality of the studies included.The third-party will involve if there is any disagreement.The Newcastle-Ottawa scale was used to evaluate the case control studies,and 5 to 9 stars were high quality.After extraction assessment and quality assessment,the meta-analysis was conducted by RevMan 5.3 soft ware.Results: A total of 2298 patients in 13 cohort studies(6 in English,7 in Chinese)were enrolled.Meta-analysis showed that the level of serum CRP on admission was significantly higher in patients with intracerebral hemorrhage compared with the healthy population [MD = 6.26,95% CI(5.91,6.62),P < 0.00001],and it was also significantly higher in non-survival group compared with survival group in one week,one month,six month,one year(one week: [MD = 3.00,95% CI(1.04,4.96),P = 0.003];one month: [MD = 2.27,95% CI(1.67,2.87),P < 0.00001];six month: [MD = 2.62,95% CI(0.97,4.28),P = 0.002];one year: [MD = 2.09,95% CI(0.92,3.26),P = 0.0005].After summarizing all subgroups,we come to this conclusion as well [MD = 2.31,95% CI(1.82,2.80),P < 0.00001].Elevated serum CRP level on admission was an indication of an unfavorable outcome [MD = 2.86,95% CI(1.38,4.34),P = 0.0001],and the risk of unfavorable outcome in patients with elevated CRP level on admission was 8.12 times higher than that in patients with normal CRP level.Conclusion: Available evidence suggests that the CRP level was elevated in patients with acute intracerebral hemorrhage significantly,and was related to the shortterm prognosis.Further large-scale,multicenter and high-quality research are needed to confirm these results. |
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