溶栓前使用他汀类药物对缺血性卒中静脉溶栓疗效的系统评价

Efficacy of using statins before thrombolysis for intravenous thrombolysis in ischemic stroke:a systematic review

目的系统评价缺血性卒中急性期静脉溶栓前使用他汀类药物对患者的疗效和安全性。方法计算机检索Pub Med、EMbase、Web of Science和Cochrane Library等数据库,并辅以手工和其他检索,收集关于静脉溶栓前他汀类药物使用对缺血性卒中急性期静脉溶栓患者的疗效和安全性的研究,检索时间截至2016年4月。由两名研究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 5.3软件进行统计学分析。结果共纳入12个队列研究,包括9 237例患者。他汀类药物使用对缺血性卒中静脉溶栓与近期预后无关（3个月改良Rankin量表评分≤2分：OR=1.05,95%CI：0.93-1.18,P=0.47）或呈负相关（3个月改良Rankin量表评分≤1分：OR=0.82,95%CI：0.73-0.92,P〈0.01）;与症状性颅内出血呈正相关（OR=1.46,95%CI：1.17-1.82,P〈0.01）;与病死率无关（OR=1.16,95%CI：0.79-1.71,P=0.44）。结论溶栓前使用他汀类药物可能导致急性缺血性卒中患者溶栓后出血等不良反应,并且可能导致卒中患者溶栓后3个月预后不良。

Objective To systematically review the efficacy and safety of using statins before stroke thrombolysis on intravenous thrombolysis in patients with acute ischemic stroke. Methods The databases including Pub Med,EMbase,Web of Science,and Cochrane Library were retrieved by computer,and also supplemented by manual and other retrievals. The studies on the efficacy and safety of statins for intravenous thrombolysis in patients with acute ischemic stroke before stroke thrombolysis were collected. The deadline of the retrieval time was April 2016. After 2 reviewers independently screening literature,extracting data and evaluating the methodological quality of the included studies according to the inclusion and exclusion criteria,Revman 5. 3 software was used to make statistical analysis. Results A total of 12 cohort studies were included,including 9 237 patients. The use of statins was not associated with intravenous thrombolysis in ischemic stroke and short-term prognosis（ the modified Rankin scale [mRS] score at 3 months ≤2 ：OR,1. 05,95% CI 0. 931. 18,P = 0. 47） or it had a negative correlation（ mRS≤1： OR,0. 82,95% CI 0. 73-0. 92,P = 0. 01）. It had a positive correlation with symptomatic intracranial hemorrhage（ OR,1. 46,95% CI1. 17-1. 82,P 〈0. 01）,but it was not associated with the mortality（ OR,1. 16,95% CI 0. 79-1. 71,P =0. 44）. Conclusion Using statins before thrombolysis may result in adverse reactions,such as hemorrhage in patients with acute ischemic stroke,and may result in poor prognosis in patients with stroke at 3 months after thrombolysis.