无症状颅内动脉瘤的急性脑梗死患者静脉溶栓治疗安全性的系统评价

The safety among acute ischemic stroke patients with asymptomatic intracranial aneurysm after the administration of intravenous thrombolysis

目的 系统评价伴有无症状颅内动脉瘤（以下简称颅内动脉瘤）的急性脑梗死患者在溶栓时间窗内接受静脉溶栓治疗的安全性.方法 计算机检索数据库包括万方数据、中国知网（CNKI）、VIP、Pubmed、EMBASE、EBSCO HOST、迈特思创等.全面收集伴有颅内动脉瘤的急性脑梗死患者接受静脉溶栓治疗的研究,检索时限均为建库至2013年10月,并追溯纳入研究的参考文献.由2位研究者独立筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行meta分析.结果 共纳入4个队列研究707例患者,其中48例伴有颅内动脉瘤,急性脑梗死患者无症状颅内动脉瘤发生率为6.8％;文献质量均较高,异质性较小.meta分析结果显示：该类患者与无颅内动脉瘤的脑梗死患者相比,在静脉溶栓后发生脑出血的风险差异无统计学意义（RR=1.17,95％ CI0.69 ～ 1.99,P=0.56）,发生症状性脑出血的风险差异无统计学意义（OR=1.70,95％CI0.44 ～6.59,P=0.45）,发生蛛网膜下腔出血的风险差异无统计学意义（OR=1.13,95％CI0.20 ～6.27,P=0.89）.结论 基于现有证据,未发现伴有无症状颅内动脉瘤的急性脑梗死患者在溶栓时间窗内接受静脉溶栓治疗出血风险增加.本研究结果仍需今后临床中累积更多的病例来进一步证实.

Objective To assess the safety among acute ischemic stroke patients with asymptomatic intracranial aneurysm after the administration of intravenous thrombolysis.Methods We searched database including Wanfang,CNKI,VIP,Pubmed,EMBASE,EBSCO HOST and Metstr data for all the cohort studies on the use of thrombolysis for acute ischemic patients with asymptomatic intracranial aneurysm,and ascended the correlated references listed on the articles.Meta-analysis was conducted based on the methods recommended by the Cochrane collaboration.The outcomes of the meta-analysis were intracerebral hemorrhage （ICH）,symptomatic intracerebral hemorrhage （sICH）,subarachnoid hemorrhage （SAH）.Results Four cohort studies included 707 patients,of whom 48 patients had asymptomatic cerebral aneurysms.The risk ratio prevalence of ICH among those patients did not differ statistically with those without aneurysms （RR =1.17,95％ CI 0.69-1.99,P =0.56）.No statistical differences were found in both odds ratio prevalence of sICH （OR =1.70,95％ CI 0.44-6.59,P =0.45） and SAH （OR =1.13,95％ CI 0.20-6.27,P =0.89） between the patients with asymptomatic cerebral aneurysms and those without.Conclusion Current evidence did not indicate that the risk of hemorrhage increased in acute ischemic stroke patients with asymptomatic intracranial aneurysm after the administration of intravenous thrombolysis.