阿替普酶静脉溶栓治疗前、后循环卒中的安全性和有效性的meta分析

Comparison of safety and efficacy of intravenous thrombolysis with alteplase between anterior and posterior circulation stroke:A meta-analysis

目的 比较阿替普酶静脉溶栓治疗前、后循环卒中的安全性和有效性。方法 利用计算机检索Pub Med、Cochrane Library（2016年第1期）、EMbase、Web of Science和Wang Fang Data,查找国内外有关应用阿替普酶静脉溶栓在前循环与后循环卒中患者中的疗效对比的观察性队列研究,检索时限均为从建库至2016年1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质量后,采用Stata 14.0软件进行meta分析,从而比较前、后循环卒中患者在溶栓后发生症状性脑出血、所有脑出血、院内或90 d死亡、出院或90 d良好预后的情况有无差别。结果 最终纳入9个观察性队列研究,共计3592例患者,前循环卒中有3177例（占88.4%）,后循环卒中有415例（占11.6%）。meta分析结果显示：与前循环卒中相比,后循环卒中溶栓后发生症状性脑出血（OR=0.29,95%CI=0.11-0.80,P=0.017）和所有脑出血（OR=0.27,95%CI=0.16-0.46,P〈0.001）的风险更低,并且后循环卒中患者在出院时或溶栓后90 d的良好预后比例更高（OR=1.73,95%CI=1.23-2.41,P=0.001）,但是两组患者的院内或90 d死亡情况却无显著差异（OR=0.67,95%CI=0.39-1.16,P=0.155）。结论与前循环卒中相比,后循环卒中患者在接受阿替普酶静脉溶栓治疗后发生脑出血风险更低,短期功能预后更好,更安全有效。但受纳入研究的数量和质量所限,上述结论尚需开展更多高质量研究加以验证。

Objective We aimed to systematically review the safety and efficacy of intravenous thrombolysis （ IVT） with alteplase for anterior circulation stroke （ACS） and posterior circulation stroke （PCS）.Methods Literature search 2was carried out in PubMed,Cochrane Library （Issue 1,2016）,EMbase,Web of Science and WangFang Data up to January016 for the foreign and domestic cohort studies on comparing the thrombolytic outcome between ACS and PCS.Two re-viewers independently screened literature according to inclusion and exclusion criteria,extracted data,and assessed method-ological quality of included studies.Then meta-analysis was performed by using Stata 14.0.Results A total of 9 cohort studies were finally included involving 3592 cases.The results of meta-analysis showed that,as compared with ACS pa-tients,PCS patients had not only lower rates of symptomatic intracranial hemorrhage （odds ratio [OR]=0.29,95%confi-0d.ence interval [CI]=0.11-0.80,P=0.017） and any intracranial hemorrhage （OR=0.27,95%CI=0.16-0.46,P〈0.001） within 7 days but also higher proportions of favorable outcome at discharge or 90 days （OR=1.73,95%CI=1.232.41,P=0.001）.However,there was no significant difference in the occurrence of in-hospital or 90-day mortality be-tween both groups （OR=0.67,95%CI=0.39-1.16,P=0.155）.ConclusionsOur study suggests that PCS patients trea-ted with IVT experience less intracranial hemorrhagic transformation and better neurological outcome than ACS patients. Our results will provide reassurance to the clinicians in using intravenous alteplase to treat all kinds of stroke patients with confidence,including those with PCS.Due to limited quality and quantity of the included studies,the abovementioned con-clusion still needs to be verified by conducting more high quality studies.