血浆Fib、D-D与急性缺血性卒中静脉溶栓后出血转化相关性的Meta分析

Association of plasma fibrinogen and D-dimer with hemorrhagic transformation for acute ishcemic stroke patients receiving intravenous thrombolysis:a meta-analysis

目的系统评价血浆纤维蛋白原(Fib)、D-二聚体(D-D)与急性缺血性卒中(AIS)患者接受阿替普酶(rt-PA)静脉溶栓治疗后出血转化(HT)的相关性。方法通过计算机检索中国知网、万方数据、维普资讯、PubMed、Web of Science、Embase、SpringerLink数据库,检索时间从建库到2023年4月,查找公开发表的关于Fib、D-D与AIS患者静脉溶栓治疗后HT的相关性研究。由两名研究者独立对纳入文献进行数据提取。在遇到差异时,共同查阅全文,通过讨论解决分歧。使用Newcastle-Ottawa量表对文献质量进行评价,使用RevMan 5.4软件对数据进行处理。结果共纳入11篇研究,合共2938例患者。Meta分析显示:基线血浆Fib升高与AIS患者溶栓后HT呈正相关(合并OR=1.53,95%CI=1.24~1.89,P<0.0001),溶栓后2 h血浆Fib升高与AIS患者溶栓后HT无明显相关性(合并OR=1.73,95%CI=0.36~8.27,P=0.49);基线血浆D-D升高与AIS患者溶栓后HT无明显相关性(合并OR=1.19,95%CI=0.98~1.45,P=0.08),溶栓后24 h血浆D-D升高与AIS患者溶栓后HT无明显相关性(合并OR=1.71,95%CI=0.92~3.18,P=0.09)。结论基线血浆Fib升高可能是AIS溶栓后HT的预测标志物,基线血浆D-D、溶栓后2 h血浆Fib、溶栓后24 h血浆D-D对AIS患者静脉溶栓治疗后HT预测价值不足。

Objective To systematically evaluate the association of plasma fibrinogen(Fib)and D-dimer(D-D)with hemorrhagic transformation(HT)for acute ischemic stroke(AIS)patients receiving intravenous thrombolysis.Methods CNKI,WanFang,CQVIP,PubMed,Web of Science,Embase,and SpringerLink databases from the establishment of the library to April 2023 were searched by computer.Data about the relationship between plasma Fib,D-D and the hemorrhagic transformation of AIS patients with rt-PA intravenous thrombolytic therapy were collected.The quality of literature was evaluated using the Newcastle-Ottawa scale.RevMan 5.4 software was used to analyze the data.Results 11 literatures were enrolled,including 2938 cases.Meta-analysis revealed as follows:Baseline plasma Fib elevation was positively correlated with postthrombolysis HT in AIS patients(OR=1.53,95%CI=1.24~1.89,P<0.0001).There was no significant correlation between plasma Fib elevation at 2 hours after thrombolysis with post-thrombolysis HT in AIS patients(OR=1.73,95%CI=0.36~8.27,P=0.49).There was no significant correlation between baseline plasma D-D elevation with post-thrombolysis HT in AIS patients(OR=1.19,95%CI=0.98~1.45,P=0.08).There was no significant correlation between plasma D-D elevation 24 hours after thrombolysis with post-thrombolysis HT in AIS patients(OR=1.71,95%CI=0.92~3.18,P=0.09).Conclusion Baseline plasma Fib might be effective predictive markers for HT post-thrombolysis.While baseline plasma D-D,plasma Fib 2 hours post-thrombolysis and D-D within 24 hours couldn’t be effective predictive markers of the aforementioned prognosis.