估算肾小球滤过率下降与急性缺血性卒中患者静脉溶栓后结局相关性研究的meta分析  

The relationship of decreased estimated glomerular filtration rate and outcome of patients with acute ischemic stroke after intravenous thrombolysis:A meta-analysis

作　　者：裴洪菲 佟旭 于萍[5] 曹亦宾[1] 郑华光[4,6] 王伊龙 王拥军[4,6] 刘静 PEI Hongfei;TONG Xu;YU Ping(Department of Neurology,Tangshan Gongren Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市工人医院神经内科,河北唐山063000 [2]首都医科大学附属北京市神经外科研究所,北京100050 [3]首都医科大学附属北京天坛医院介入神经病学科,北京100050 [4]国家神经系统疾病临床医学研究中心,北京100050 [5]河北医科大学第二医院神经内科,河北石家庄050000 [6]首都医科大学附属北京天坛医院神经病学中心,北京100050

出　　处：《中风与神经疾病杂志》2019年第5期388-394,共7页Journal of Apoplexy and Nervous Diseases

基　　金：“十一五”国家科技支撑计划(2006BAI01A11);“十二五”国家科技支撑计划(2011BAI08B02);2016年北京市科学技术委员会“首都临床特色应用研究”专项课题(Z161100000516079);河北省卫计委2017年度医学科学研究青年科技课题(20170097);河北省卫计委2018年度医学科学研究重点课题计划项目(20181258和20181264)

摘　　要：目的探讨估算肾小球滤过率(estimated glomerular filtration rate,eGFR)与急性缺血性卒中患者阿替普酶静脉溶栓后结局的相关性。方法利用计算机检索PubMed、EMbase、Cochrane Library(2017年第11期)和WebofScience数据库,查找关于肾功能障碍对缺血性卒中患者静脉溶栓结局预测价值的研究,检索时限均为从建库至2017年11月。由2位评价者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质量后,采用Stata14.0软件进行meta分析,从而比较eGFR下降组与eGFR正常组患者行阿替普酶静脉溶栓后发生症状性脑出血、所有脑出血、90d内死亡、90d良好预后情况的差异。结果最终纳入13项研究,共计56280例患者,eGFR正常组患者16608例(占29.5%),eGFR下降组患者共39672例(占70.5%)。Meta分析结果显示:与eGFR正常组患者相比,eGFR下降组患者溶栓后发生症状性脑出血(OR=1.76,95%CI=1.44~2.16,P<0.001)、所有脑出血(OR=1.60,95%CI=1.38~1.87,P<0.001)以及90d内死亡(OR=2.77,95%CI=2.22~3.45,P<0.001)的风险增高,并且eGFR下降组患者90d预后良好(OR=0.64,95%CI=0.57~0.71,P<0.001)的比例降低。结论与eGFR正常的卒中患者相比,eGFR下降的卒中患者在接受阿替普酶静脉溶栓治疗后发生脑出血、死亡的风险增高,90d预后良好的比例降低。Objective We aimed to systematically review the relationship of decreased estimated glomerular filtration rate(eGFR) and outcome of patients with acute ischemic stroke(AIS) after intravenous thrombolysis(IVT) with alteplase.Methods Literature search was carried out in PubMed,EMbase,Cochrane Library(Issue 11,2017) and Web of Science up to November 2017 for the studies on the effect of renal dysfunction in outcome of patients with acute ischemic stroke after IVT.Two reviewers independently screened literature according to inclusion and exclusion criteria,extracted data,and assessed methodological quality of included studies.Then meta-analysis was performed by using Stata14.0.Results A total of 13 studies were finally included involving 56 280 cases,16 608 patients(29.5%) in the normal eGFR group,and 39 672 patients(70.5%) in the decreased eGFR group.The results of meta-analysis showed that,as compared with patients in normal eGFR group,patients in decreased eGFR group had not only higher rates of symptomatic intracranial hemorrhage(odds ratio[ OR ]=1.76,95%confidenceinterval[CI]=1.44~2.16,P<0.001),any intracranial hemorrhage(OR =1.60,95% CI =1.38~1.87,P<0.001) and 90 day mortality(OR =2.77,95% CI =2.22~3.45,P<0.001),but also lower proportions of favorable outcome at discharge or 90 days(OR =0.64,95% CI =0.57~0.71,P<0.001).Conclusion Our study suggests that decreased eGFR may not only increase the risks of symptomatic intracranial hemorrhage,any intracranial hemorrhage and 90-day mortality,but also increase the chance of favorable outcome at discharge or 90 days in AIS patients after IVT with alteplase.

关 键 词：卒中 肾小球滤过率 血栓溶解疗法 组织型纤溶酶原激活物 META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]