盐酸替罗非班在急性缺血性脑卒中应用的Meta分析

Application of tirofiban hydrochloride in acute ischemic stroke:a meta-analysis

目的探讨盐酸替罗非班在急性缺血性脑卒中的应用疗效。方法通过检索PubMed、Embase、OVID、The Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,选择符合纳入及排除标准的随机对照试验。由2名评价者独立对文献进行筛选并进行质量评价后,采用RevMan 5.3软件进行数据分析。结果纳入25篇随机对照试验,包括2310例患者。替罗非班单独使用及溶栓后联合使用神经功能改善均优于对照组,合并效应量分别为[MD=-1.93,95%CI(-2.30,-1.55),P<0.05]、[MD=-3.47,95%CI(-4.70,-2.25),P<0.05];远期预后优于对照组[RR=1.51,95%CI(1.17,1.96),P<0.05];日常生活能力改善优于对照组[MD=6.63,95%CI(3.42,9.84),P<0.05];替罗非班组死亡率低于对照组[RR=0.52,95%CI(0.30,0.91),P<0.05];颅内出血率高于对照组,但差异无统计学意义[RR=1.08,95%CI(0.80,1.46),P>0.05]。结论盐酸替罗非班在急性缺血性脑卒中的治疗效果疗效显著,但安全性还需要进一步研究明确。

Objective To investigate the effect of tirofiban on acute ischemic stroke.Methods Randomized controlled trials(RCTs) meeting the inclusion and exclusion criteria were selected by searching PubMed,Embase,OVID,The Cochrane Library,CNKI,WanFangData,VIP and CBM databases from the establishment of the database to December 2018. After the literatures were screened and evaluated by two evaluators independently,the data were analyzed by RevMan5.3 software.ResultsTwenty-five randomized controlled trials(RCTs) were included,including 2310 patients. The improvement of neurological function in tirofiban alone and in combination after thrombolysis was better than that in the control group,and the combined effects were [MD=-1.93,95% CI(-2.30,-1.55),P<0.05],[MD=-3.47,95% CI(-4.70,-2.25),P<0.05],and the long-term prognosis was better than that in the control group [RR=1.51,95% CI(1.17,1.96),P<0.05]. The improvement of ADL in tirofiban group was better than that in control group[MD=6.63,95% CI(3.42,9.84),P<0.05],the mortality in tirofiban group was lower than that in control group [RR=0.52,95% CI(0.30,0.91),P<0.05],and the rate of intracranial hemorrhage in tirofiban group was higher than that in control group,but there was no statistical significance [RR=1.08,95% CI(0.80,1.02. 46),P>0.05].ConclusionTirofiban hydrochloride is effective in the treatment of acute ischemic stroke,but its safety needs to be further clarified.