替罗非班治疗急性缺血性卒中安全性及有效性的Meta分析

Effectiveness and Safety of Tirofiban for patients with acute ischemic stroke:A Meta-analysis

目的系统评价临床应用替罗非班治疗急性缺血性卒中(Acute Ischemic Stroke,AIS)的疗效及安全性。方法对3个英文数据库PubMed、EMBASE、Cochrane Library进行计算机检索,全面收集替罗非班治疗AIS的相关临床研究,检索时间为各库建库至2019年8月31日。对纳入的文献进行数据提取与质量评价,并采用软件RevMan 5.3进行统计分析。结果最终纳入12篇文献,共2137例患者,其中试验组921例患者,对照组1216例患者。Meta分析结果显示:替罗非班可明显降低AIS患者2~7 d的NHISS评分[均数差(MD)=-1.53,95%CI-2.98^-0.09,P=0.04],显著改善90 d的良好预后(mRS≤2)[相对危险度(RR)=1.17,95%CI 1.05~1.30,P=0.003],但未提高24 h的血管再通率(RR=1.01,95%CI 0.95~1.06,P=0.84)。同时,替罗非班可显著降低90 d死亡率(RR=0.79,95%CI 0.65~0.97,P=0.02),且未增加颅内出血率(颅内出血转化:RR=0.89,95%CI 0.77~1.03,P=0.11;症状性颅内出血:RR=0.93,95%CI 0.70~1.25,P=0.64)。结论替罗非班应用于AIS的治疗是安全的,能明显改善患者早期神经功能缺损症状及90 d良好预后,降低90 d死亡风险,但未改善24 h内的血管再通情况。

Objective To systematically evaluate the efficacy and safety of tirofiban for patients with acute ischemic stroke.Methods Three electronic information sources(PubMed、EMBASE、Cochrane Library)were searched to identify relevant clinical studies on tirofiban in the treatment of people with acute ischemic stroke from initiation of the databases to August 31,2019.The reviewers extracted the data and assessed the quality of included studies,then meta-analysis is performed by RevMan 5.3 software.Results We included twelve trials involving 2137 participants.The trial group had 921 patients,the control group had 1216 patients.The patients in trial group had lower NHISS scorce at 2~7 days after the therapy of tirofiban[Mean Difference(MD)=-1.53,95%Confidence Interval(CI)-2.98^-0.09,P=0.04].The use of tirofiban could increase the proportion of 90-day favorite outcome of AIS patients significantly,but did not improve the condition of recanalization of the blood vessels in 24 hours after the therapy of tirofiban.At the same time,tirofiban significantly reduced the 90-day mortality(RR=0.79,95%CI 0.65~0.97,P=0.02),and did not increase the intracranial hemorrhage rate(intracranial hemorraghic transformation:RR=0.89,95%CI 0.77~1.03,P=0.11;symptomatic intracranial hemorrhage:RR=0.93,95%CI 0.70~1.25,P=0.64).Conclusion Tirofiban administration is safe in patients with AIS,and can significantly improve the symptoms of early neurological impairment,a good prognosis at 90 days,and can reduce the risk of death at 90 days.But it does not improve the vascular recanalization within 24 hours treatment.