有症状颅内动脉狭窄长期转归的汇总分析：支架置入与药物治疗比较

Meta-analysis of long-term outcome of symptomatic intracranial artery stenosis： comparison of stenting and medical therapy

目的比较支架治疗与药物治疗有症状颅内动脉狭窄患者的长期转归。方法通过PubMed、Cochrane数据库、EMBASE、Google学术检索比较支架治疗与药物治疗有症状颅内动脉狭窄的文献。对支架治疗与药物治疗后1年时卒中复发和复合血管事件风险以及2年复合血管事件风险和临床转归（转归良好定义为改良Rankin量表评分0～2分）进行汇总分析。结果6项研究纳入分析，共包括920例有症状脑动脉狭窄患者，支架组458例，药物治疗组为462例，平均年龄61.8岁，男性66%。汇总分析显示，支架组与药物治疗组在1年时卒中复发风险[合并优势比（odds ratio, OR）1.74，95%可信区间（confidence interval, CI）0.95～3.20；P＝0.07]和复合血管事件风险（合并OR 1.27，95% CI 0.74～2.16；P＝0.39）以及2年时复合血管事件风险（合并OR 1.30，95% CI 0.89～1.89；P＝0.17）和临床转归（合并OR 1.37，95% CI 0.32～5.82；P＝0.67）方面差异均无统计学意义。结论接受支架置入或药物治疗的有症状颅内动脉狭窄患者1年时卒中复发和复合血管事件风险以及2年时复合血管事件风险和临床转归方面无显著性差异。

Objective To compare the long-term outcomes between the stenting and the medical therapy in patients with symptomatic intracranial artery stenosis. Methods The articles that compared between the stenting and the medical therapy in patients with symptomatic intracranial artery stenosis searched from PubMed, Cochrane Library, EMBASE, and Google Scholar. A meta-analysis was conducted to evaluate risks of stroke recurrence and composite vascular events at 1 years, and composite vascular events risk and clinical outcomes （a good outcome was defined as the modified Rankin scale score 0-2） at 2 years after stent therapy or medical therapy. Resulls Six studies, comprising a total of 920 patients with symptomatic intracranial artery stenosis were included, 458 in the stenting group, and 462 in the medical therapy group, their mean age was 61.8 years and 66% were males. The meta-analysis showed that there were no significant differences in the risks of stroke recurrence （pooled odds ratio [OR] 1.74, 95% confidence interval [ CI] 01. 95-3.20; P =0.07） and composite vascular events （pooled OR 1.27, 95% CI 0. 74-2.16; P =0. 39） at 1 year, as well as composite vascular events risk （pooled OR 1.30, 95% CI 0. 89- 1.89; P =0. 17） and clinical outcome （pooled OR 1.37, 95% CI 0. 32-5.82; P =0. 67） at 2 years between stenting group and medical therapy group. Conclusions There were no significant differences in the risks of stroke recurrence and composite vascular events at 1 year, as well as composite vascular events risk and clinical outcome at 2 years after stenting or medical therapy in patients with symptomatic intracranial artery stenosis.