小剂量尿激酶治疗短暂性脑缺血发作的系统评价

Treatment with low- dose urokinase for transient ischemic attack： a systematic review and meta - analysis

目的 评价小剂量尿激酶治疗短暂性脑缺血发作的疗效和安全性.方法 计算机检索国内数据库有关尿激酶治疗短暂性脑缺血发作的临床文献,按纳入、排除标准进行文献筛选,评价入选文献的质量并提取相关资料,用RevMan4.2.2软件对24 h内短暂性脑缺血发作控制率、72 h 内短暂性脑缺血发作控制率、治疗期间脑梗死发生率和出血发生率进行Meta分析.结果 共纳入15篇临床研究文献,病例总数1133例.Meta分析结果显示,与对照组比较,尿激酶能够显著提高短暂性脑缺血发作24 h内控制率（OR=7.79,95%CI 5.76～10.55,P〈0.00001）、72 h 内控制率（OR=6.38,95%CI 4.64～8.77,P〈0.00001）,显著降低治疗期间脑梗死发生率（OR=0.12,95%CI 0.06～0.24,P〈0.00001）,但治疗期间尿激酶组出血发生率显著增加（OR=8.05,95%CI 2.6～24.9,P=0.0003）.结论 小剂量尿激酶能显著降低短暂性脑缺血的发作次数和脑梗死发生率,但增加出血发生率.

Objective To assess the curative effect and safety of low - dose urokinase in the patients with transient ischemic attack （TIA）. Methods We searched Chinese database on line by computer and chose the articles according to the inclusive and exclusive standards, then we evaluated the quality of the included articles strictly and extracted information. A Meta analysis was performed by using RevMan4.2.2 software to analyze 24 h control rate of TIA,72 h control rate of TIA,occurrence of acute cerebral infarction and hemorrhages during treatment. Results Fifteen clinical articles including 1133 cases were analyzed. There were significant differences in 24 h control rate of TIA （OR = 7.79,95% CI 5.76-10.55,P〈0.00001）, 72 h control rate of TIA （OR =6.38,95%CI 4.64 -8.77,P 〈 0. 00001 ） , occurrence of acute cerebral infarction during treatment （OR = 0. 12,95% CI 0. 06 -0. 24, P 〈0.00001 ） between urokinase treatment group and control group. There were more hemorrhages in urokinase treatment group （OR =8.05,95%CI 2.6 -24.9,P=0.0003）. Conclusion The low -dose urokinase is efficient and safe treatment for TIA, and can reduce occurrence of acute cerebral infarction.