不同剂量rt-PA桥接治疗急性大血管闭塞性缺血性脑卒中的Meta分析  

A Meta-analysis of different dose of rt-PA bridging in treatment of patients with acute ischemic stroke with large vessel occlusion

作　　者：王艳[1] 徐国锋 WANG Yan;XU Guofeng(Centre for Emergency and Disaster Medicine,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen,Guangdong 518107,China;Department of Laboratory Medicine,the Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen,Guangdong 518107,China)

机构地区：[1]中山大学附属第七医院急诊与灾难医学中心,广东深圳518107 [2]中山大学附属第七医院检验科,广东深圳518107

出　　处：《医药前沿》2025年第1期18-22,共5页Journal of Frontiers of Medicine

摘　　要：目的系统评价不同剂量重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓桥接机械取栓治疗急性大血管闭塞性缺血性脑卒中(AIS-LVO)的临床效果和安全性。方法采用主题词和自由词组合检索方式,通过计算机检索中国知网、万方、维普、Pubmed、SpringerLink、Web of Science,收集AIS-LVO患者分别采用标准剂量和低剂量rt-PA静脉溶栓桥接机械取栓的队列研究及随机对照研究,检索时限均为建库至2023年2月。提取相关数据并采用RevMan5.4软件进行Meta分析。结果共纳入5篇文献,共314例患者,其中标准剂量组142例,低剂量组172例。Meta分析结果显示,低剂量组与标准剂量组治疗后症状性脑出血率比较,差异有统计学意义(P<0.05);而两组90 d病死率、72 h美国国立卫生研究院卒中量表评分好转率、脑梗死溶栓(TICI)分级好转率及90 d改良Rankin量表评分好转率比较,差异无统计学意义(P>0.05)。结论在rt-PA静脉溶栓桥接机械取栓治疗后sICH率方面低剂量rt-PA优于标准剂量;在rt-PA静脉溶栓桥接机械取栓治疗后近期及远期神经功能变化、TICI分级好转率、治疗后90 d病死率方面,低剂量rt-PA不劣于标准剂量。Objective To systematically evaluate the clinical efficacy and safety of different doses of recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis bridging mechanical thrombectomy in the treatment of patients with acute ischemic stroke with large vessel occlusion(AIS-LVO).Methods The databases of CNKI,Wanfang,VIP,PubMed,SpringerLink and Web of Science were searched from the database establishment to February 2023 by using the combination method of subject words and free words.AIS-LVO patients using standard dose and low dose rt-PA intravenous thrombolysis bridging mechanical thrombectomy were respectively collected as a cohort study and a randomized controlled study.Meta-analysis was performed by using RevMan5.4 software after extracting relevant data.Results A total of 314 patients in 5 articles were finally included which included 142 patients were in the standard dose group and 172 patients were in the low dose group.Meta analysis showed that there was statistically significant difference in incidence rate of symptomatic intracerebral hemorrhage(sICH)between the low-dose and standard-dose groups after treatment(P<0.05).There were no statistically significant differences in 90 d mortality,72 h improvement rate of National Institutes of Health Stroke Scale score,improvement rate of thrombolysis in cerebral infarction(TICI)grade and 90 d modified Rankin Scale score between the two groups(P>0.05).Conclusions Low dose rt-PA is superior to standard dose in terms of sICH rate,while it is not inferior in terms of short-term and long-term neurological function changes,improvement rate of TICI grade,and 90 d mortality after rt-PA intravenous thrombolysis bridging mechanical thrombectomy in the treatment of patients with AIS-LVO.

关 键 词：重组组织型纤溶酶原激活剂 静脉溶栓 机械取栓 大血管闭塞 急性缺血性脑卒中 

分 类 号：R742[医药卫生—神经病学与精神病学]