单独静脉输注阿替普酶与联合阿加曲班对急性缺血性脑卒中治疗效果的Meta分析  

A meta analysis on the efficacy of intravenous alteplase alone vs.argatroban plus intravenous alteplase in acute ischemic stroke

作　　者：张东东 杨进超 郑俊[1] ZHANG Dongdong;YANG Jinchao;ZHENG Jun(Dept.of Neural Rehabilitation,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院神经康复科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2023年第12期1538-1544,共7页Medical Journal of Wuhan University

摘　　要：目的:对静脉输注阿替普酶联合阿加曲班与单独静脉输注阿替普酶对急性缺血性脑卒中患者的疗效进行荟萃分析。方法:检索包括PubMed、EMBASE、Scopus、Cochrane Controlled Trials Register和CNKI在内的电子数据库中从2000年1月至2023年4月的相关研究。纳入静脉输注阿替普酶联合阿加曲班对比单独静脉输注阿替普酶的临床试验。采用RevMan 5.4软件进行Meta分析,并使用I2统计量评估研究间异质性。结果:本研究纳入了4项临床试验,其中包括3项随机对照研究及1项队列研究,共1118名参与者。Meta分析结果显示,与单独静脉输注阿替普酶相比,联合用药对患者的神经功能恢复并无积极作用(OR=0.96,95%CI:0.72~1.28,P=0.77,I2=0%),且未提高溶栓后的血管再通(RR=0.96,95%CI:0.84~1.10,P=0.58,I2=77%)。安全性上,联合用药相比单药治疗组在溶栓后脑实质血肿2型(OR=1.11,95%CI:0.47~2.61,P=0.81,I2=0%)和症状性脑出血(OR=0.92,95%CI:0.59~1.42,P=0.70,I2=0%)的发生率上也无明显区别。结论:与单独静脉输注阿替普酶相比,联合应用静脉输注阿替普酶和阿加曲班治疗急性缺血性脑卒中患者并未表现出更好的疗效。Objective:To conduct a meta-analysis on the efficacy of intravenous alteplase combined with agatroban compared with intravenous alteplase alone in patients with acute ischemic stroke.Methods:Digital libraries including PubMed,EMBASE,Scopus,Cochrane Central Register of Controlled Trials,and CNKI were used to search relevant studies from January 2000 to April 2023.Clinical trials that compared intravenous alteplase combined with argatroban vs.intravenous alteplase alone were included.The meta-analysis was performed with RevMan 5.4 software and between-study heterogeneity was estimated by using the I2 statistic.Results:This meta-analysis comprised four clinical trials,which consisted of three randomized controlled trials and one cohort study,involving a total of 1118 participants.The results showed that compared with intravenous alteplase alone,intravenous alteplase combined with argatroban did not improve the neurological function(OR=0.96,95%CI:0.72-1.28,P=0.77,I2=0%)and recanalization(RR=0.96,95%CI:0.84-1.10,P=0.58,I2=77%)of the patients.Moreover,no significant difference was found in the incidence of parenchymal hemorrhage type 2(OR=1.11,95%CI:0.47-2.61,P=0.81)and symptomatic intracranial hemorrhage(OR=0.92,95%CI:0.59-1.42,P=0.70,I2=0%)between the two groups.Conclusion:Intravenous alteplase combined with argatroban does not yield superior results as compared with intravenous alteplase alone in treating patients with acute ischemia stroke.

关 键 词：阿替普酶 阿加曲班 急性缺血性脑卒中 

分 类 号：R971[医药卫生—药品]