摘要
目的 系统评价急性缺血性卒中患者在重组组织型纤溶酶原激活剂静脉溶栓前抗血小板药物治疗对出血性转化（HT）的影响和安全性.方法 计算机检索相关数据库,辅以文献追溯、网上查询等方法,检索建库至2013年12月31日国内、外公开发表的抗血小板药物对静脉溶栓后HT影响的对照研究,由2名研究者独立进行文献筛选和数据信息采集,采用RevMan 5.2和Stata 12.0软件进行荟萃分析,漏斗图和Egger＇s回归法评估发表偏倚.结果 共纳入文献10篇,其中8项研究中的抗血小板组5 185例及对照组10 660例的症状性颅内出血（SICH）发生率经荟萃分析后结果显示：溶栓前抗血小板治疗增加了溶栓后SICH的发生率,其差异有统计学意义（OR=1.67,95％ CI1.44 ～1.93,P＜0.01）;6项研究中的抗血小板组1 359例及对照组2 497例的任何颅内出血发生率荟萃分析结果显示：溶栓前抗血小板治疗增加了溶栓后颅内出血的发生率,其差异有统计学意义（OR=1.23,95％ CI 1.04 ～ 1.47,P＜0.05）;3项研究中的抗血小板组3 966例及对照组8 368例的3个月功能独立情况荟萃分析结果显示：抗血小板组3个月功能独立性较对照组略差,其差异有统计学意义（OR=0.86,95％ CI 0.80～0.93,P＜0.01）.漏斗图和Egger＇s检验均提示无明显发表偏倚（P＞0.05）.结论 溶栓前接受抗血小板聚集药物治疗可能可以增加溶栓后SICH及颅内出血的风险,且3个月功能独立性也略差.受纳入研究质量限制,以上结果有待大规模前瞻性研究予以证实.
Objective To evaluate the influence of antiplatelet therapy prior to intravenous thrombolysis （IVT） on acute ischemic stroke （AIS） patients receiving IVT with recombinant tissue type plasminogen activator （rt-PA）.Methods Researches about the safety of pre-existing antiplatelet treatment on AIS patients undergoing rt-PA IVT published before 31st December 2013 were retrieved based on internet databases.A meta-analysis of included clinical trials was performed by RevMan 5.2 and Stata 12.0 software.Simultaneously,funnel plot and Egger＇s test were used to evaluate the publication bias.Results A total of 10 papers were included.Eight researches based meta-analysis showed that pre-existing antiplatelet therapy increased the risk of symptomatic intracranial hemorrhage （SICH ; OR =1.67,95％ CI 1.44-1.93,P ＜ 0.01）,6 researches based analysis suggested pre-existing antiplatelet therapy increased the risk of any intracranial hemorrhage （ICH ; OR =1.23,95％ CI 1.04-1.47,P ＜ 0.05） and 3 trials based analysis indicated the functional independence of patients receiving antiplatelet treatment was a bit worse than control group （OR =0.86,95％ CI0.80-0.93,P ＜0.01）.Funnel plots and Egger＇ s test showed that there was no significant publication bias （P ＞ 0.05）.Conclusions Antiplatelet therapy might increase the risk of post thrombolysis SICH and ICH,and their 3-month function independence is not so satisfied as those who had no antiplatelet agents before IVT.However,this review has limitations and the above results should be validated in future large prospective clinical studies.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2015年第1期65-70,共6页
Chinese Journal of Neurology
