Prevalence for Cerebral Microbleeds in China: a Meta-analysis

doi:10.12114/j.issn.1007-9572.2023.0908

Abstract

Abstract:

Background

Cerebral microbleeds (CMBs) are important diseases that seriously endanger our national health, and their incidence is positively correlated with age. Meanwhile, CMBs are also an independent risk factor for stroke recurrence and induced hemorrhagic stroke. Understanding the current prevalence of CMBs is of great practical significance for promoting healthy aging and strengthening stroke prevention and treatment in China.

Objective

To systematically evaluate the current status of the occurrence of CMBs in China and to provide data support for promoting the process of healthy aging and strengthening the prevention and treatment of stroke in China.

Methods

Literature related to the occurrence of the disease of CMBs in our national population was systematically searched through Chinese and English databases such as CBM, CNKI, Wanfang Data, VIP, PubMed, Embase, and Web of Science, with a timeframe of the establishment of the database until November 2023 for all searches. Two researchers separately performed literature screening, data extraction, and evaluation of the risk of bias in the included literature, and meta-analysis was performed using Stata 16.0 software.

Results

A total of 39 studies were included, with a total of 25 877 study subjects. Meta-analysis showed that the overall incidence of CMBs in China was 25.0% (95%CI=21.0%-29.0%). The results of subgroup analysis showed that the prevalence was 27.0% (95%CI=12.0%-44.0%) for those aged 51-60 years, 23.0% (95%CI=16.0%-30.0%) for those aged 61-70 years, and 27.0% (95%CI=20.0%-35.0%) for those aged 71-80 years; the prevalence was 21.0% (95%CI=15.0%-28.0%) in North China, 26.0% (95%CI=21.0%-33.0%) in East China, 21.0% (95%CI=8.0%-39.0%) in South China, 21.0% (95%CI=16.0%-27.0%) in Central China, 24.0% (95%CI=21.0%-27.0%) in Southwest China and 46.0% (95%CI=41.0%-51.0%) in Northwest China by geographic area; the prevalence of CMBs with a history of hypertension was 19.0% (95%CI=13.0%-26.0%) and without a history of hypertension was 8.0% (95%CI=6.0%-11.0%) ; the prevalence of CMBs with a history of smoking was 9.0% (95%CI=5.0%-14.0%) and without a history of smoking was 16.0% (95%CI=12.0%-21.0%) .

Conclusion

The overall prevalence of CMBs in China is high, with significant differences between different age segments, regions, and provinces. Its prevalence was higher in people of advanced age, males, Northwest China, and nationals with a history of hypertension. Due to the limitations in both quantity and quality of the included studies, further confirmation of this conclusion through additional high-quality research is required.

Key words: Cerebral microbleeds, Prevalence rate, China, Systematic evaluation, Meta-analysis

摘要：

背景

脑微出血（CMBs）是严重危害我国国民健康的重要疾病，其发病率与年龄呈正相关。同时，CMBs也是卒中复发及诱发出血性脑卒中的独立危险因素。了解CMBs的患病现状对于推动我国健康老龄化进程及加强脑卒中防治工作具有重大现实意义。

目的

系统评价我国CMBs发生的现况，为推进我国健康老龄化进程及加强脑卒中防治工作提供数据支撑。

方法

系统检索中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普网（VIP）、PubMed、Embase、Web of Science等数据库中有关我国CMBs患病率的横断面研究，检索时限为建库至2023年11月。2名研究者分别对文献进行筛选、资料提取及纳入文献的偏倚风险评估，并采用Stata 16.0软件进行Meta分析。

结果

共纳入39项研究，25 877例研究对象。Meta分析结果显示：我国CMBs的总体患病率为25.0%（95%CI=21.0%~29.0%）。亚组分析结果显示，51~60、61~70、71~80岁CMBs患病率分别为27.0%（95%CI=12.0%~44.0%）、23.0%（95%CI=16.0%~30.0%）、27.0%（95%CI=20.0%~35.0%）；男、女性CMBs患病率分别为14.0%（95%CI=11.0%~18.0%）、10.0%（95%CI=8.0%~12.0%）；华北、华东、华南、华中、西南、西北地区CMBs患病率分别为21.0%（95%CI=15.0%~28.0%）、26.0%（95%CI=21.0%~33.0%）、21.0%（95%CI=8.0%~39.0%）、21.0%（95%CI=16.0%~27.0%）、24.0%（95%CI=21.0%~27.0%）、46.0%（95%CI=41.0%~51.0%）；有、无高血压病史CMBs患病率分别为19.0%（95%CI=13.0%~26.0%）、8.0%（95%CI=6.0%~11.0%）；有、无吸烟史CMBs患病率分别为9.0%（95%CI=5.0%~14.0%）、16.0%（95%CI=12.0%~21.0%）。

结论

我国CMBs总体患病率较高，不同年龄分段、地域及省份之间存在明显差异。高龄、男性、西北地区以及有高血压病史的人群发病率较高。受纳入研究数量和质量限制，该结论亟待更多高质量研究证实。

关键词: 脑微出血, 患病率, 中国, 系统评价, Meta分析

XIAN Lihong,LI Juan,XUE Chao, et al. Prevalence for Cerebral Microbleeds in China: a Meta-analysis[J]. Chinese General Practice, 2024, 27(20): 2527-2533. DOI: 10.12114/j.issn.1007-9572.2023.0908.
先丽红,李娟,薛超等. 中国人群脑微出血患病率的Meta分析[J]. 中国全科医学, 2024, 27(20): 2527-2533. DOI: 10.12114/j.issn.1007-9572.2023.0908.

Figures/Tables 5

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编号	检索策略
#1	Cerebral microbleeds OR Microbleed OR microhemorrhage OR Cerebral microhemorrhages OR CMBs[Title/Abstract]
#2	Incidence OR Occurrence OR Prevalence OR epidemi^*[Title/Abstract]
#3	Chinese OR China OR HongKong OR TaiWan OR MaCao [Title/Abstract]
#4	#1 AND #2 AND #3

编号	检索策略
#1	Cerebral microbleeds OR Microbleed OR microhemorrhage OR Cerebral microhemorrhages OR CMBs[Title/Abstract]
#2	Incidence OR Occurrence OR Prevalence OR epidemi^*[Title/Abstract]
#3	Chinese OR China OR HongKong OR TaiWan OR MaCao [Title/Abstract]
#4	#1 AND #2 AND #3

第一作者	发表时间（年）	地区	总样本量（例）	男/女（例）	病例数（例）	AHRQ得分（分）
SUN^[8]	2009	广东	998	588/410	273	9
HAN^[9]	2009	北京	247	176/71	72	8
LIU^[10]	2010	北京	447	235/212	95	7
SUN^[11]	2012	北京	436	273/163	202	8
吴小燕^[12]	2013	江苏	248	141/107	122	9
WANG^[13]	2014	广东	348	207/141	160	8
ZHANG^[14]	2014	山东	485	297/188	151	8
毛蓉嫣^[15]	2014	浙江	389	203/186	132	8
叶筱红^[16]	2015	浙江	393	235/158	206	10
苏慧^[17]	2015	山东	524	316/208	111	9
YANG^[18]	2015	北京	1 289	692/597	188	9
YAN^[19]	2015	浙江	333	223/110	133	9
CHUNG^[20]	2016	台湾	401	193/208	47	10
陈后勤^[21]	2017	安徽	308	178/130	116	10
SU^[22]	2107	北京	770	269/501	78	8
CHUNG^[23]	2017	台湾	962	425/537	134	7
马利^[24]	2017	陕西	215	122/93	112	9
HE^[25]	2017	贵州	247	134/113	103	9
HAN^[4]	2018	北京	1 211	453/758	128	8
ZHANG^[26]	2018	广东	1 847	740/1 107	142	8
ZHANG^[27]	2018	山东	983	539/444	215	10
白家赫^[28]	2019	山东	444	216/228	92	9
SU^[29]	2019	北京	1 029	369/660	107	10
张春华^[30]	2020	山东	408	175/233	44	10
ZHU^[31]	2020	江苏	549	250/299	103	10
ZHANG^[32]	2020	江苏	904	404/500	147	8
LI^[33]	2020	上海	792	426/366	231	9
苏宁^[34]	2021	北京	997	346/651	94	8
FAN^[35]	2021	四川	481	—	76	8
SHU^[36]	2021	北京	943	340/603	102	9
LIANG^[37]	2022	山东	300	160/140	110	8
YU^[38]	2022	北京	544	217/327	119	9
吴延佳^[39]	2022	陕西	202	125/77	80	9
MU^[40]	2022	广西	409	184/225	47	8
QIN^[41]	2022	湖北	204	120/84	42	10
CHEN^[42]	2023	北京	755	532/223	286	10
HONG^[43]	2023	福建	522	320/202	212	9
YANG^[44]	2023	浙江	3 063	1 425/1 638	313	9
GUO^[45]	2023	河北	230	160/70	111	9

第一作者	发表时间（年）	地区	总样本量（例）	男/女（例）	病例数（例）	AHRQ得分（分）
SUN^[8]	2009	广东	998	588/410	273	9
HAN^[9]	2009	北京	247	176/71	72	8
LIU^[10]	2010	北京	447	235/212	95	7
SUN^[11]	2012	北京	436	273/163	202	8
吴小燕^[12]	2013	江苏	248	141/107	122	9
WANG^[13]	2014	广东	348	207/141	160	8
ZHANG^[14]	2014	山东	485	297/188	151	8
毛蓉嫣^[15]	2014	浙江	389	203/186	132	8
叶筱红^[16]	2015	浙江	393	235/158	206	10
苏慧^[17]	2015	山东	524	316/208	111	9
YANG^[18]	2015	北京	1 289	692/597	188	9
YAN^[19]	2015	浙江	333	223/110	133	9
CHUNG^[20]	2016	台湾	401	193/208	47	10
陈后勤^[21]	2017	安徽	308	178/130	116	10
SU^[22]	2107	北京	770	269/501	78	8
CHUNG^[23]	2017	台湾	962	425/537	134	7
马利^[24]	2017	陕西	215	122/93	112	9
HE^[25]	2017	贵州	247	134/113	103	9
HAN^[4]	2018	北京	1 211	453/758	128	8
ZHANG^[26]	2018	广东	1 847	740/1 107	142	8
ZHANG^[27]	2018	山东	983	539/444	215	10
白家赫^[28]	2019	山东	444	216/228	92	9
SU^[29]	2019	北京	1 029	369/660	107	10
张春华^[30]	2020	山东	408	175/233	44	10
ZHU^[31]	2020	江苏	549	250/299	103	10
ZHANG^[32]	2020	江苏	904	404/500	147	8
LI^[33]	2020	上海	792	426/366	231	9
苏宁^[34]	2021	北京	997	346/651	94	8
FAN^[35]	2021	四川	481	—	76	8
SHU^[36]	2021	北京	943	340/603	102	9
LIANG^[37]	2022	山东	300	160/140	110	8
YU^[38]	2022	北京	544	217/327	119	9
吴延佳^[39]	2022	陕西	202	125/77	80	9
MU^[40]	2022	广西	409	184/225	47	8
QIN^[41]	2022	湖北	204	120/84	42	10
CHEN^[42]	2023	北京	755	532/223	286	10
HONG^[43]	2023	福建	522	320/202	212	9
YANG^[44]	2023	浙江	3 063	1 425/1 638	313	9
GUO^[45]	2023	河北	230	160/70	111	9

组别	纳入研究数量（篇）	异质性检验		效应模型	患病率（95%CI）
组别	纳入研究数量（篇）	P值	I²值	效应模型	患病率（95%CI）
总患病率	39^{[4,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45]}	<0.001	98.4%	随机	25.0%（21.0%~29.0%）
年龄（岁）
51~60	3^[12,31,32]	<0.001	97.9%	随机	27.0%（12.0%~44.0%）
61~70	12^{[9,10,14,15,17,23,26,29,34,38,43,45]}	<0.001	98.3%	随机	23.0%（16.0%~30.0%）
71~80	8^{[8,18,25,28,33,35,37,42]}	<0.001	97.1%	随机	27.0%（20.0%~35.0%）
性别
男	24^{[8,9,10,12,14,15,17,18,23,25,26,28,29,31,33,34,35,37,38,41,42,43,44,45]}	<0.001	97.6%	随机	14.0%（11.0%~18.0%）
女	24^{[8,9,10,12,14,15,17,18,23,25,26,28,29,31,33,34,35,37,38,41,42,43,44,45]}	<0.001	95.2%	随机	10.0%（8.0%~12.0%）
地理区域
华北地区	12^{[4,9,10,11,18,22,29,34,36,38,42,45]}	<0.001	98.4%	随机	21.0%（15.0%~28.0%）
华东地区	18^{[12,14,15,16,17,19,20,21,23,27,28,30,31,32,33,37,43,44]}	<0.001	98.4%	随机	26.0%（21.0%~33.0%）
华南地区	4^[8,13,26,40]	<0.001	99.2%	随机	21.0%（8.0%~39.0%）
华中地区	1^[41]	<0.001		随机	21.0%（16.0%~27.0%）
西南地区	2^[25,35]	<0.001		随机	24.0%（21.0%~27.0%）
西北地区	2^[24,39]	<0.001		随机	46.0%（41.0%~51.0%）
高血压病史
是	16^{[9,10,12,14,23,24,25,26,29,31,37,38,41,42,43,45]}	<0.001	98.5%	随机	19.0%（13.0%~26.0%）
否	16^{[9,10,12,14,23,24,25,26,29,31,37,38,41,42,43,45]}	<0.001	94.9%	随机	8.0%（6.0%~11.0%）
吸烟史
是	13^{[9,10,12,23,25,26,31,35,37,38,41,43,45]}	<0.001	97.3%	随机	9.0%（5.0%~14.0%）
否	13^{[9,10,12,23,25,26,31,35,37,38,41,43,45]}	<0.001	96.2%	随机	16.0%（12.0%~21.0%）
发表年份（年）
2009—2013	5^{[8,9,10,11,12]}	<0.001	95.9%	随机	34.0%（24.0%~44.0%）
2014—2018	16^{[4,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27]}	<0.001	98.6%	随机	26.0%（19.0%~34.0%）
2019—2023	18^{[28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45]}	<0.001	98.1%	随机	22.0%（16.0%~27.0%）