奥扎格雷钠联合依达拉奉治疗脑梗死的系统评价

Sodium Ozagrel Combined with Edaravone for Cerebral Infarction:A Systematic Review

目的系统评价奥扎格雷钠联合依达拉奉治疗脑梗死的疗效及安全性。方法计算机检索PubMed(1995～2010)、FMJS外文全文数据库(EMCC,1995～2010)、CBM(1995～2010)、CNKI(1995～2010)和VIP(1989～2010),查找奥扎格雷钠联合依达拉奉治疗脑梗死的随机对照试验。按照事先制定的纳入排除标准筛选文献、提取资料和进行方法学质量评价后,采用RevMan5.0软件进行Meta分析。结果共纳入32个随机对照试验,合计3059例患者,其中治疗组1559例,对照组1500例。各纳入研究基线资料具有可比性,均报道采用随机方法但未提及具体随机方法,也未提及盲法和分配隐藏情况。Meta分析结果显示:奥扎格雷钠联合依达拉奉在治疗脑梗死有效率方面与单独应用奥扎格雷钠和常规治疗比较,其差异均有统计学意义[其OR(95%CI)分别为3.51(2.70,4.57)和3.77(2.58,5.52)];奥扎格雷钠联合依达拉奉在治疗脑梗死神经功能缺损方面与单独应用奥扎格雷钠和常规治疗比较,其差异也均有统计学意义[其WMD(95%CI)分别为-4.26(-4.97,-3.55)和-3.89(-4.96,-2.82)];此外,奥扎格雷钠联合依达拉奉在改善日常生活能力方面优于单独应用奥扎格雷钠[WMD=13.57,95%CI(9.84,17.30)]。结论本系统评价结果提示,奥扎格雷钠联合依达拉奉治疗脑梗死疗效显著,且对神经功能障碍有良好改善作用。但由于本系统评价纳入研究的质量较低,存在偏倚的高度可能性,影响了结果的论证强度,因此上述结论应谨慎对待,并期待更多高质量的随机双盲对照试验以提供更高质量的证据。

Objective To assess the effectiveness and safety of sodium ozagrel combined with edaravone for cerebral infarction.Methods Such databases as PubMed（1995 to 2010）,EMCC（1995 to 2010）,CBM（1995 to 2010）,CNKI（1995 to 2010）,and VIP（1989 to 2010） were searched to collect randomized controlled trials（RCTs） of odium ozagrel combined with edaravone for cerebral infarction.Then the retrieved studies were screened according to the predefined inclusion and exclusion criteria,the data were extracted,the quality of the included studies was evaluated,and meta-analyses were performed by using the Cochrane Collaboration＇s RevMan 5.0 software.Results A total of 32 RCTs involving 3059 cases were involved,among which 1？559 cases were in the treatment group and the other 1500 were in the control group.All studies with comparable baseline data reported the application of random methods without explaining the detailed methods,the blinding method and the allocation concealment.The results of meta-analyses indicated that sodium ozagrel combined with edaravone had significant differences in the effective rate for cerebral infarction compared with both single sodium ozagrel（OR=3.51,95%CI 2.70 to 4.57） and routine treatment（OR=3.77,95%CI 2.58 to 5.52）,and it had significant differences in treating the defect of neurological function compared with both sodium ozagrel（WMD=-4.26,95%CI-4.97 to-3.55） and routine treatment（WMD=-3.89,95%CI-4.96 to-2.82）.In addition,Sodium ozagrel combined with edaravone was superior to sodium ozagrel（WMD=13.57,95%CI 9.84 to 17.30） in improving the ability of daily living.Conclusion This systematic review shows that sodium ozagrel combined with edaravone is quite effective in treating cerebral infarction,and it can improve the nerve dysfunction.This conclusion should be treated cautiously for the poor quality and higher possibility of bias in the included studies which may impact on the power of proof,so more double-blind RCTs with high quality are expected to provide high-quality evidence.