免疫疗法治疗脑卒中的网状Meta分析  

Efficacy and safety of immunotherapy in stroke:a network meta-analysis

作　　者：杨海欢 张超 于瑞芸 王晓城 王媛媛[1] 马大勇[1] YANG Haihuan;ZHANG Chao;YU Ruiyun(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《中风与神经疾病杂志》2024年第5期445-451,共7页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金资助项目(82274458)。

摘　　要：目的探讨免疫疗法治疗脑卒中的临床疗效。方法检索中国知网、维普、万方、CBM、Cochrane Library、Embase、PubMed和Web of Science数据库2000—2022年关于免疫疗法治疗脑卒中的随机对照试验,通过RevMan5.3、Stata14进行质量评估和网状Meta分析。结果最终纳入11篇文献,共计2742例患者。Meta分析结果显示,与安慰剂相比,免疫药物干预对第90 d mRS评分(P=0.45)及Barthel指数(P=0.33)均无明显影响。网状Meta分析结果显示,与安慰剂相比,GSK249320(OR=1.33,95%CI 0.48~3.67)、Abciximab(OR=1.20,95%CI 0.69~2.07)、Cyclosporine(OR=1.07,95%CI 0.39~2.95)的mRS评分0~1分的患者比例及IL-1Ra(OR=1.22,95%CI 0.75~1.96)、Abciximab(OR=2.75,95%CI 0.36~20.96)的Barthel指数评分有升高趋势,但差异均无统计学意义(P>0.05)。mRS评分累计概率排名曲线下面积(SUCRA)排序为GSK249320>Abciximab>Cyclosporine>Placebo>IL-1Ra>Natalizumab>Enlimomab;Barthel指数SUCRA排序为IL-1Ra>Abciximab>Placebo>Natalizumab。结论与安慰剂相比,免疫疗法治疗脑卒中并未表现出更好的疗效,其原因可能与目前对卒中免疫的时空动态性、个体化特征了解尚不足,缺乏系统、全面的免疫治疗方案有关。Objective To investigate the clinical efficacy of immunotherapy in stroke.Methods CNKI,VIP,Wanfang Data,CBM,the Cochrane Library,Embase,PubMed,and Web of Science databases were searched for randomized controlled trials on immunotherapy for stroke published from 2000 to 2022,and RevMan5.3 and Stata14 were used for quality assessment and network meta-analysis.Results A total of 11 articles with 2742 patients were included.The meta-analysis showed that compared with the placebo control group,the immune drug intervention group had no significant influence on modified Rankin Scale(mRS)score(P=0.45)and Barthel index(P=0.33)on day 90.The network metaanalysis showed that compared with the placebo group,there was a tendency of increase in the proportion of patients with an mRS score of 0-1 in the groups of GSK249320(OR=1.33,95%CI 0.48‒3.67,P>0.05),Abciximab(OR=1.20,95%CI 0.69‒2.07,P>0.05),and Cyclosporine(OR=1.07,95%CI 0.39‒2.95,P>0.05),and there was a tendency of increase in Barthel index in the groups of IL-1Ra(OR=1.22,95%CI 0.75‒1.96,P>0.05)and Abciximab(OR=2.75,95%CI 0.36‒20.96,P>0.05).The largest surface under the cumulative ranking curve(SUCRA)of mRS score was observed for GSK249320,followed by Abciximab,Cyclosporine,Placebo,IL-1Ra,Natalizumab,and Enlimomab,and the largest SUCRA of Barthel index was observed for IL-1Ra,followed by Abciximab,Placebo,and Natalizumab.Conclusion Compared with placebo,immunotherapy does not show a better efficacy in the treatment of stroke,which may be associated with the inadequate understanding of the spatiotemporal dynamics and individualized characteristics of stroke immunity and a lack of systematic and comprehensive immunotherapy regimens.

关 键 词：脑卒中 免疫疗法 随机对照 网状Meta分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]