胞二磷胆碱治疗急性脑卒中效果的Meta分析

Cytidine Diphosphate Choline for Acute Stroke:A Meta-analysis

目的评价胞二磷胆碱治疗急性脑卒中的疗效及安全性。方法计算机检索PubMed、Cochrane图书馆、EMbase、Web of Science、CNKI、VIP和中华医学会数字化期刊库,收集胞二磷胆碱治疗急性脑卒中的随机对照试验,检索时间均从建库至2010年9月,并追查已获文献的参考文献。按照纳入标准由2名研究者独立筛选文献并提取资料,参照Jadad评分标准对纳入文献的方法学质量进行评估,而后采用RevMan 5.0软件进行Meta分析。结果共纳入13个研究,共2837例患者。Meta分析结果显示:与安慰剂相比,胞二磷胆碱治疗急性脑卒中的远期病死率或依赖率差异无统计学意义[OR=0.94,95%CI(0.66,1.36),P=0.75];但胞二磷胆碱治疗急性脑卒中的总有效率高于安慰剂,差异有统计学意义[OR=1.72,95%CI(1.41,2.10),P<0.00001]。5个研究报道了胞二磷胆碱治疗急性脑卒中的不良反应发生率,不良反应程度轻微,无严重不良反应发生,临床应用安全。结论目前研究表明,胞二磷胆碱治疗急性脑卒中的总有效率优于安慰剂且安全性好,但无法降低远期(3个月)病死率或依赖率。

Objectives To assess the efficacy and safety of cytidine diphosphate choline for patients with acute stroke.Methods Such databases as PubMed,The Cochrane Library,EMbase,Web of Science,CNKI,VIP Database and Chinese Medical Association Journals were searched from the establishment to September of 2010,and the references of the included literatures were also searched to collect randomized controlled trials（RCTs） of cytidine diphosphate choline for patients with acute stroke.The data were extracted by two reviewers independently in accordance with the inclusion criteria.The quality of included trials was evaluated according to the Jadad scale standard.RevMan5.0 software was used for data analyses.Results Thirteen RCTs involving 2837 patients were included.The results of meta-analyses showed that,there was no significant difference in the mortality or the rate of dependency at the end of follow-up（OR=0.94,95%CI 0.66 to 1.36,P=0.75） between the cytidine diphosphate choline group and the placebo group.But the total effective rate of the cytidine diphosphate choline group was higher than that of the placebo group with a significant difference（OR=1.72,95%CI 1.41 to 2.10,P0.000 01）.Five trials reported the incidence of adverse reaction of cytidine diphosphate choline treatment which showed the adverse reaction was mild;no severe adverse events（SAEs） were reported and the clinical application was safe.Conclusion The cytidine diphosphate choline is effective and safe for acute stroke.However,it is invalid to reduce the mortality and the rate of dependency at the end of three months＇ follow-up.