房颤对脑卒中溶栓预后影响的系统评价  

Effect of Atrial Fibrillation on Prognosis of Stroke Patients Receiving Thrombolysis:A Meta-analysis

作　　者：郭江[1] 陈宁[1] 郭建[1] 周沐科[1] 何俐[1] 

机构地区：[1]四川大学华西医院神经内科,成都610041

出　　处：《中国循证医学杂志》2015年第3期320-326,共7页Chinese Journal of Evidence-based Medicine

基　　金：四川省科技支撑计划(编号:2009SZ0155;2011SZ0146)

摘　　要：目的系统评价伴房颤的卒中患者是否在使用溶栓治疗后比无房颤的患者预后更差。方法计算机检索MEDLINE、The Cochrane Library(2014年第3期)和EMbase,查找伴房颤的卒中患者使用静脉溶栓后与无房颤的患者预后比较的队列研究,检索时限均为从建库至2014年3月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入9个队列研究,共计6 313例患者。Meta分析结果显示:1房颤会显著增加缺血性卒中患者溶栓后出血[OR=1.51,95%CI(1.15,1.99),P=0.003]和病死率[OR=1.90,95%CI(1.29,2.80),P=0.001];2伴房颤的卒中患者溶栓后早期[OR=0.74,95%CI(0.60,0.90),P=0.002]和晚期[OR=0.50,95%CI(0.39,0.64),P<0.000 01]改善低于无房颤患者。结论房颤可能是缺血性卒中患者溶栓后不良预后的危险因素。受限于纳入研究的质量和数量,上述结论尚有赖于进一步开展更多大样本、多中心、高质量的临床研究加以验证。Objective To evaluate whether atrial fibrillation could predict poor outcomes in stroke patients receiving thrombolysis by meta-analysis. Methods We searched MEDLINE,the Cochrane Library and EMbase databases for cohort studies concerning the effect of atrial ribrillation on prognosis of stroke patients receiving thrombolysis up to March 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed methodological quality of included studies. Then,meta-analysis was performed using Rev Man 5.2 software. Results A total of nine retrospective cohort studies involving 6 313 patients were included. The results of meta-analysis showed that： atrial fibrillation could increase the risk of symptomatic intracerebral hemorrhage（OR=1.51,95%CI 1.15 to 1.99,P=0.003） and mortality（OR=1.90,95%CI 1.29 to 2.80,P=0.001） of ischemic stroke patients receiving thrombolysis; the early improvement rate（OR=0.74,95%CI 0.60 to 0.90,P=0.002） and later improvement rate（OR=0.50,95%CI 0.39 to 0.64,P〈0.000 01） of the atrial fibrillation group were lower than that of the non-atrial fibrillation group. Conclusion Atrial fibrillation could be a risk factor of poor outcome in ischemic stroke patients receiving thrombolysis. Due to the limitation of quantity and quality of the included studies,large-scale,multi-central and high quality clinical studies are needed.

关 键 词：房颤 溶栓 卒中 系统评价 META分析 队列研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]