心房颤动与缺血性卒中静脉溶栓预后相关性的Meta分析

Correlation between Atrial Fibrillation and Prognosis of Patients with Ischemic Stroke after Intravenous Thrombolysis: A Meta-Analysis

目的系统评价心房颤动对缺血性卒中静脉溶栓预后的影响。方法计算机检索Pub Med、EMbase、h e Cochrane Library(2014年第4期)、Web of Science、CBM和Wan Fang Data,查找国内外有关心房颤动与缺血性卒中静脉溶栓有关的队列研究,检索时限均为从建库至2014年4月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果最终纳入7个队列研究,共计69 017例患者。Meta分析结果显示:1与无心房颤动的缺血性卒中患者相比,心房颤动会减少缺血性卒中患者溶栓后3个月的良好神经功能结局[OR=0.85,95%CI(0.73,0.98),P=0.03],但不影响溶栓后死亡风险[OR=1.47,95%CI(0.75,2.86),P=0.26]。2心房颤动会增加溶栓后颅内出血转化风险[OR=1.36,95%CI(1.26,1.47),P<0.001]及症状性出血风险[OR=1.43,95%CI(1.02,1.99),P=0.04]。结论心房颤动不影响溶栓后3个月死亡风险,但会增加颅内出血风险以及降低溶栓后3个月神经功能预后。对合并心房颤动的缺血性卒中患者,需重视溶栓前评估及溶栓后监测。但受纳入研究质量和数量所限,上述结论尚需开展更多高质量研究加以验证。

Objective To systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Methods Literature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library （Issue 4, 2014）, CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation （OR=0.85, 95%CI 0.73 to 0.98, P=0.03） but did not influence the risk of death after intravenous thrombolysis （OR=1.47, 95%CI 0.75 to 2.86, P=0.26）; and increased the risks of intracranial haemorrhagic transformation （OR=1.36, 95%CI 1.26 to 1.47, P〈0.001） and symptomatic intracranial hemorrhage after intravenous thrombolysis （OR=1.43, 95%CI 1.02 to 1.99, P=0.04）. Conclusion For patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.