摘要
目的系统评价静脉溶栓治疗轻型卒中的疗效和安全性。方法检索PubMed、Embase、Cochrane和Web of Science数据库,检索时限是从收录开始至2019年7月。应用RevMan V 5.3软件对纳入的文献进行Meta分析。结果共有8篇文献被纳入最终研究,其中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓组1 202例,非溶栓组1 434例。Meta分析结果显示,患者良好功能结局与rt-PA静脉溶栓显著相关(OR=1.44, 95%CI:1.21~1.71,P<0.001),但存在中度异质性[Chi2=13.49,df=7(P=0.060),I2=48%]。亚组分析后发现,异质性的主要来源是地区。与非溶栓组相比,rt-PA溶栓组出现症状性颅内出血(sICH)的比例明显增高(OR=14.40, 95%CI:2.62~79.26,P=0.002,I2=0%),但两组的病死率并无显著性差异(OR=0.97, 95%CI:0.54~1.76,P=0.920,I2=0%)。结论轻型卒中患者能从静脉溶栓中获益。虽然rt-PA静脉溶栓增加了sICH的风险,但不影响患者的病死率。
Objective To evaluate the efficacy and safety of intravenous thrombolysis for minor ischemic stroke(MIS). Methods Papers were searched in PubMed, Embase, Cochrane and Web of Science from inception to July 2019. A meta-analysis was performed among studies that met the inclusion criteria with RevMan V 5.3. Results Totally 8 studies were included, with 1 202 patients in the recombinant tissue plasminogen activator(rt-PA) group and 1 434 patients in the non-IV-rtPA group. Meta-analysis showed that excellent functional outcome was associated with rt-PA treatment and reached statistical significance(OR=1.44, 95%CI: 1.21-1.71, P<0.001), but moderate level of heterogeneity existed[Chi^2=13.49, df=7(P=0.060), I^2=48%]. After undertaking subgroup-analysis, we found that region was a significant moderator. The rate of symptomatic intracranial haemorrhage(sICH) was significantly higher in IV-rtPA group compared with that in non-IV-rtPA group(OR=14.40, 95%CI: 2.62-79.26, P=0.002, I^2=0%), but there was no significant difference in mortality between the two groups(OR=0.97, 95%CI: 0.54-1.76, P=0.920, I^2=0%). Conclusions Patients with MIS can benefit from intravenous thrombolysis. Although IV-rtPA can increase the risk of sICH, it has no influence on the mortality.
作者
陈艳
李仕文
赵珊珊
CHEN Yan;LI Shi-wen;ZHAO Shan-shan(Department of Neurology,the First Haspital of China Medical Lininersity,Shenyang 110000,China)
出处
《临床神经病学杂志》
CAS
2020年第5期328-333,共6页
Journal of Clinical Neurology
基金
国家自然科学基金青年基金(81401002)。
关键词
轻型卒中
重组组织型纤溶酶原激活剂
功能结局
病死率
症状性颅内出血
minor ischemic stroke
recombinant tissue plasminogen activator
functional outcome
mortality
symptomatic intracranial haemorrhage
