神经保护剂改善急性缺血性脑卒中神经功能的网状Meta分析  

Network Meta-analysis of neuroprotective agents for improving neurological function in acute cerebral infarction

作　　者：王凯[1,2] 张学琴[1,2] 杨珍珍 王淑梅 WANG Kai;ZHANG Xue-qin;YANG Zhen-zhen;WANG Shu-mei(Department of Pharmacy,The Second Hospital of Hebei Medical University,Shijiazhuang 050000;Hebei Medical University,Shijiazhuang 050000)

机构地区：[1]河北医科大学第二医院药学部,石家庄050000 [2]河北医科大学,石家庄050000

出　　处：《中南药学》2020年第4期685-693,共9页Central South Pharmacy

基　　金：河北省药学会临床药学专项科研项目(编号:YX201505)。

摘　　要：目的评估神经保护剂是否能改善急性缺血性脑卒中的神经功能并对比神经保护剂之间的疗效。方法全面检索依达拉奉、丁苯酞、神经节苷脂、长春西汀、胞磷胆碱等神经保护剂改善急性缺血性脑卒中神经功能的随机对照试验,检索时间为建库至2019年9月,并进行质量评价,采用R3.5.1软件调用GeMtc程序包及JAGS软件对数据进行网状Meta分析。结果共纳入56篇研究,共计5310名患者。网状Meta分析结果显示,依达拉奉与神经节苷脂在7、14、28 d NIHSS评分与14、90 d Barthel指数均显著优于基础治疗或安慰剂(P<0.05),且两者间差异无统计学意义;丁苯酞在短期治疗中(<28 d)对神经功能的改善优于基础治疗(P<0.05),在长期(90 d)治疗中与基础治疗差异无统计学意义,总体丁苯酞氯化钠注射优于丁苯酞软胶囊;长春西汀仅在14 d NIHSS评分方面与基础治疗差异有统计学意义;胞磷胆碱与基础治疗或安慰剂之间差异无统计学意义。结论依达拉奉和神经节苷脂对于急性脑梗死的神经功能改善情况疗效较好;丁苯酞次之;长春西汀和胞磷胆碱疗效不太理想,同时需要高质量头对头的研究对结果进行进一步的验证。Objective To evaluate the effect of neuroprotective agents on patients with acute cerebral infarction and compare the efficacy of neuroprotective agents.Methods Randomized controlled trials of edaravone,butylphthalide,ganglioside,vinpocetine and citicoline,which were published from database foundation to September 2019,were collected from each specified searching platform.The quality of the trials was evaluated and the results of studies were analyzed with R 3.5.1 software,GeMtc package and JAGS software.Results Totally 56 RCTs involving 5310 patients were included.Network Meta-analysis showed edaravone and ganglioside significantly reduced the NIHSS score and improved the Barthel index and efficient as compared with those of the basic treatment or the placebo groups(P<0.05).Significant difference between the butylphthalide and the basic treatment when treatment was<28 d but no significant difference when treatment was longer than 90 d.Only the change of 14 d-NIHSS score showed some difference between vinpocetine and basic treatment.There was no difference between citicoline and basic treatment.Conclusion Edaravone and gangliosides have better effect on the improvement of the neurological function in acute cerebral infarction;butylphthalide has a certain improvement on neurological function;vinpocetine and citicoline are not ideal for acute cerebral infarction.High-quality head-to-head study is needed to further validate the results.

关 键 词：神经保护剂 急性缺血性脑卒中 NIHSS评分 BARTHEL指数 网状Meta分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]