阿加曲班联合阿替普酶治疗急性缺血性脑卒中的疗效和安全性的Meta分析  

作　　者：庄鸣阳 李全福 丁阳阳 陈益 蒋旭宏 

机构地区：[1]浙江中医药大学第一临床医学院,310053

出　　处：《浙江临床医学》2021年第11期1654-1657,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY223)。

摘　　要：目的系统评价阿加曲班联合阿替普酶(r-tPA)治疗急性缺血性脑卒中的疗效和安全性。方法﹑计算机检PubMed、the Cochrane Library、Embase、Medline、Web of Science、中国知网、万方数据库、维普数据库。检索所有阿加曲班治疗急性缺血性脑卒中患者的临床随机对照实验文献。根据Cochrane系统评价手册对纳入文献的质量进行评价,采用RevMan5.3进行Meta分析。结果纳入以有效率、神经功能缺损评分、血液流变学指标、出血不良事件为评价标准的文献13篇,观察组病例638例,对照组病例612例。Meta分析结果显示;有效率RR 1.21,95%(1.14,1.28);NIHSS MD-1.72,95%CI(-1.92,-1.53);BI SMD 1.32,95%.CI(1.14,1.50);mRS评分MD-1.71,95%CI(-1.95,-1.48);全血黏度MD-0.48,95%CI(-0.58,-0.39)红细胞聚集指数MD-1.02,95%CI(-1.14,-0.89);CRP MD-3.78,95%C1(-4.27,-3.30);Hey MD-4.11,95%CI(-4.84,-3.38),差异均有统计学意义(P<0.05)。不良事件RR 0.87,95%(0.52,1.46),两组治疗的出血事件差异无统计学意义(P-=0.60)。结论阿加曲班联合r-tPA对急性缺血性脑卒中患者能降低患者神经损害,不增加患者症状性脑出血风险。Objective To systematically evaluate the efficacy and the safety of argatrohan combined with alteplase in the treatment of acute ischemic stroke.Methods Computerize examination of PubMed,the Cochrane Library,Embase,Medline,Web of Science,CNKI,Wanfang database,and VIP database.Retrieve all the clinical randomized controlled trials literature of argatrohan in the treatment of patients with acute ischemic stroke.The quality of the included literature was evaluated according to the Cochrane Systematic Review Manual,and RevMan5.3 was used for Meta analysis.Results A total of 13 literatures were included with evaluation criteria such as effective rate,neurological deficit score,hemorheological indicators,and bleeding adverse events.There were 638 cases in the observation group and 612 c«ises in the control group.Meta analysis Results show:effective rate RR=1.21,95%=[1.14,1.28];NIHSS MD=-1.72,95%CI=[-1.92,-1.53];BI SMD=1.32,95%CI=[1.14,1.50];mRS score MD=-1.71,95%CI=[-1.95,-1.48];Whole blood viscosity MD=-0.48,95%CI=[-0.58,-0.39];Red blood cell aggregation index MD=-1.02,95%CI[-1.14,-0.89];CRPMD=-3.78,95%C1=[-4.27,-3.30];Hey MD=-4.11,95%CI[-4.84,-3.38],all statistica significance.Adverse events RR=0.87,95%=[0.52,1.46],there was no difference in bleeding events between the two treatment groups(P=0.60).Conclusion Argatrohan combined with r-tPA can reduce neurological damage in patients with acute ischemic stroke without incre«ising the risk of symptomatic cerebral hemorrhage.

关 键 词：阿加曲班 R-TPA 急性缺血性脑卒中 随机对照实验 META分析 

分 类 号：R74[医药卫生—神经病学与精神病学]