重组组织型纤溶酶原激活剂动脉溶栓治疗急性脑梗死的Meta分析

A Meta analysis of intra-arterial thrombolysis of recombinant tissue-plasminogen activator for treatment of acute cerebral infarction

目的系统评价重组组织型纤溶酶原激活剂(rt-PA)动脉溶栓治疗急性脑梗死(ACI)的疗效和安全性。方法检索Cochrane Library、Medline、Embase、中国生物医学文献数据库(CBM),查找关于rt-PA动脉溶栓治疗ACI随机对照试验(RCT),采用RevMan 5.1软件对纳入的文献进行Meta分析。结果共纳入9项研究,包括473例患者。使用rt-PA动脉溶栓治疗ACI的有效性高于静脉溶栓组[RR=1.26,95%CI(1.09,1.45),P=0.002],而两组治疗后的颅内出血发生率和病死率差异无统计学意义。结论现有的证据表明,rt-PA动脉溶栓疗效优于静脉溶栓,但尚需进行大样本的随机对照试验进一步验证。

Objective To evaluate the efficacy and safety of intra-arterial thrombolysis with recombinant tissue-plasminogen ac- tivator（rt-RA） for treatment of acute cerebral infarction（ACI）. Methods The randomized controlled trials（RCT） of intra-arterial thrombolysis with rt-PA for treatment of ACI were selected from Cochrane Library, Medline, Embase and CBM by the computer re- trieval. A meta analysis of the data were analyzed by using RevMan 5. 1 software. Results A total of 473 patients in 9 selected RCTs were involved in the systematic review. Meta-analysis results disclosed suggested that the effectiveness of intra-arterial thrombolysis treated ACI group was better than that of intravenous thrombolysis groupl-RR = 1. 26,95 % CI （1. 09,1. 45）, P = 0. 002]. No difference was observed between the two groups in intracranial hemorrhage and mortality rate. Conclusion The current evidence showed that,the clinical effect of intra-arterial thrombolysis with rt-PA for treatment of ACI was obviously superior to that of intravenous thrombolysis,but the result still needs to be confirmed by large-sample RCTs.