依达拉奉治疗急性缺血性脑卒中有效性及安全性的荟萃分析

Meta-analysis on effectiveness and safety of edaravone for acute ischemic stroke

目的定量分析依达拉奉治疗成人急性缺血性脑卒中(AIS)的临床疗效及安全性。方法依据Cochrane系统回顾检索Pubmed、Cochrane Library、Clinical Trails、Google Scholar、知网、维普、万方数据库(截至2018年1月),查找依达拉奉治疗成人AIS的随机对照试验(RCT)。由2位研究者按纳入排除标准独立进行筛选文献、提取资料和方法学质量评价,采用Revman5.3软件进行荟萃分析。结果最终纳入18篇RCT,共计患者3176例。荟萃分析显示:依达拉奉治疗组(观察组)有效率、显效率、治疗后神经功能缺损评分,治疗后日常生活活动能力评分方面均优于常规治疗的对照组患者,差异均有统计学意义(均P<0.05)。两组不良反应发生率比较差异无统计学意义(OR=0.78,95%CI:0.42~1.44,P=0.42)。灵敏度分析显示观察组的有效率、显效率仍高于对照组(OR=1.56、1.78,95%CI:1.22~2.00、1.35~2.35,均P=0.00)。结论依达拉奉治疗成人AIS疗效显著,安全性可靠。但由于存在一些低质量RCT的影响,上述结论仍需进一步论证。

Objective To assess the effectiveness and safety of edaravone for acute ischemic stroke(AIS).Methods Randomized controlled trials(RCT)of edaravone for AIS were searched from databases Pubmed,Cochrane Library,Clinical Trails,Google Scholar,VIP,CNKI,Wang Fang from inception to January 2018.Two reviewers independently selected the literature,extracted the data and assessed the methodological quality of the including RCTs.Meta-analysis analysis was performed using the software Review Manager 5.3 provided by Cochrane Collaboration.Results Eighteen RCTs involving 3176 patients were included.The Meta-analysis showed that the effective rate,significantly-effective rate,neurological impairment score after treatment and activity of daily living(ADL)scores after treatment of edaravone group were superior to the those of conventional treatment group(all P<0.05);while there was no significant difference in the incidence of adverse reactions between two groups(OR=0.78,95%CI:0.42~1.44,P=0.42).The sensitivity analysis strongly proved the convining statistical conclusion:The edaravone intervention group was superior to the conventional treatment group with significant differences in the effective rate(OR=1.56,95%CI:1.22~2.00,P=0.00),significantly-effective rate(OR=1.78,95%CI:1.35~2.35,P=0.00).Conclusion Edaravone is an effective and safe neuroprotective treatments for AIS and beneficial in improving neurological impairment resulting from stroke.Otherwise,extracting poor-quality trials will benefit to convining conclusion.