基于CT平扫的发病时间未知卒中患者溶栓安全性评估的Meta分析

Meta-analysis of thrombolysis safety assessment in stroke patients with unknown onset time based on CT plain scan

目的评估基于CT平扫醒后/发病时间未知(wake up/unknown onset stroke,WUS/UNK)的卒中患者静脉溶栓的安全性。方法系统检索中国知网、万方、维普、PubMed、Embase、Web of Science和Cochrane数据库建库至2021-05基于CT平扫WUS/UNK患者静脉溶栓安全性的相关文献。采用Revman 5.3软件进行Meta分析。计算相关危险因素比值比(odds ratio,OR)和95%置信区间(confidence interval,CI)。结果纳入7篇研究,共767例WUS/UNK患者,其中396例经静脉溶栓。Meta分析显示,与未溶栓WUS/UNK患者相比,溶栓增加溶栓后症状性脑出血风险(OR=4.38,95%CI=1.13~17.00,P=0.03),但其与脑出血总风险及死亡相关性差异无统计学意义(P>0.05)。而与时间窗溶栓患者相比,WUS/UNK患者溶栓与脑出血及死亡相关性差异无统计学意义(P>0.05)。结论WUS/UNK患者基于CT平扫溶栓增加症状性脑出血风险,但不增加患者死亡风险,因而WUS/UNK患者溶栓需进一步全面评估。

Objective To evaluate the safety of intravenous thrombolysis in wake up/unknown onset(WUS/UNK)stroke patients based on CT plain scan.Methods A systematic search was conducted on CNKI,WanFang,Weipu,PubMed,Embase,Web of Science,and Cochrane databases until May 2021 based on CT plain scan WUS/UNK patients with intravenous thrombolysis safety related literature.Revman 5.3 software was used for Meta-analysis.Calculate the odds ratio(OR)and 95%confidence interval(CI)of related risk factors.Results Seven studies were included in this article.A total of 767 WUS/UNK patients were included,of which 396 were in⁃travenous thrombolysis.Meta-analysis results showed that compared with non-thrombolytic WUS/UNK patients,thrombolysis increased the risk of symptomatic cerebral hemorrhage after thrombolysis(OR=4.38,95%CI=1.13-17.00,P=0.03),but it was associated with cerebral hemorrhage.There was no statistically significant diffe-rence in total risk and death correlation(P>0.05).Compared with time window thrombolysis patients,there was no statistically significant difference in the correlation between thrombolysis and cerebral hemorrhage and death in WUS/UNK patients.Conclusion Thrombolysis based on CT plain scan in WUS/UNK patients increases the risk of symptomatic cerebral hemorrhage,but does not increase the risk of death.Therefore,thrombolysis in WUS/UNK patients requires further comprehensive evaluation.