疏血通注射液联合阿替普酶静脉溶栓治疗急性脑梗死疗效与安全性的Meta分析

Effect and Safety of Shuxuetong Injection Combined with rt-PA Intravenous Thrombolysis on ACI:a Meta-analysis

目的:系统评价疏血通注射液联合阿替普酶(rt-PA)静脉溶栓对急性脑梗死病人临床总有效率、神经功能损伤、日常生活能力、血流变、炎性因子的影响。方法:计算机检索中国期刊全文数据库(CNKI)、维普数据库(VIP)、万方数据库、中国生物医学文献数据库(CBM)、PubMed、the Cochrane Library、Web of Science数据库中疏血通注射液联合rt-PA静脉溶栓治疗急性脑梗死的临床随机对照试验(RCTs)研究,检索时限为建库至2022年10月。按照Cochrane系统评价手册进行偏倚风险评价,运用RevMan 5.4软件进行Meta分析。结果:最终纳入文献8篇。Meta分析结果显示,与对照组相比,疏血通注射液联合rt-PA静脉溶栓可明显提高脑梗死病人临床总有效率[OR=3.60,95%CI(2.12,6.10),P<0.00001],降低美国国立卫生研究院卒中量表评分[MD=-2.24,95%CI(-2.92,-1.55),P<0.00001],提高日常生活能力评分[MD=10.28,95%CI(9.94,10.62),P<0.00001],改善全血高切黏度[MD=-0.61,95%CI(-0.74,-0.48),P<0.00001]、全血低切黏度[MD=-1.84,95%CI(-2.06,-1.61),P<0.00001]、纤维蛋白原[MD=-0.72,95%CI(-1.40,-0.04),P=0.04],降低C反应蛋白[SMD=-0.67,95%CI(-0.99,-0.35),P<0.0001]、肿瘤坏死因子-α[SMD=-2.22,95%CI(-4.35,-0.09),P=0.04]水平。安全性方面,与对照组比较,试验组的安全性较高。结论:疏血通注射液联合rt-PA静脉溶栓可提高急性脑梗死的临床总有效率,改善病人神经功能缺损、日常生活能力、血流变及炎性因子指标。

Objective:To evaluate the effects of Shuxuetong injection combined with recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis on clinical total effective rate,neurological impairment,daily living ability,blood rheology and inflammatory factors in patients with acute cerebral infarction.Methods:The clinical randomized controlled trial(RCTs)of Shuxuetong injection combined with rt-PA intravenous thrombolysis for the treatment of acute cerebral infarction in Chinese Journal Full-text Database(CNKI),VIP database,Wanfang Database,Chinese Biomedical Literature Database(CBM),PubMed,the Cochrane Library,and Web of Science databases were searched.The search time was from self-built database to October 2022.Bias risk assessment was conducted according to Cochrane system assessment manual,and meta-analysis was conducted using RevMan 5.4 software.Results:Eight RCTs were included.Meta analysis showed that Shuxuetong injection combined with rt-PA intravenous thrombolysis could significantly improve the clinical total effective rate of patients with cerebral infarction compared with the control group(OR=3.60,95%CI 2.12-6.10,P<0.00001),reduce the score of National Institutes of Health Stroke Scale(MD=-2.24,95%CI-2.92--1.55,P<0.00001),improve the score of daily living ability(MD=10.28,95%CI 9.94-10.62,P<0.00001),improve whole blood high tangent viscosity(MD=-0.61,95%CI-0.74--0.48,P<0.00001),whole blood with low tangential viscosity(MD=-1.84,95%CI-2.06--1.61,P<0.00001)and fibrinogen(MD=-0.72,95%CI-1.40--0.04,P=0.04),reduce C-reactive protein(SMD=-0.67,95%CI-0.99--0.35,P<0.0001),tumor necrosis factor-α(SMD=-2.22,95%CI-4.35--0.09,P=0.04).In terms of safety,compared with the control group,the safety of experimental group was higher.Conclusion:Shuxuetong injection combined with rt-PA intravenous thrombolysis can improve the clinical total effective rate of acute cerebral infarction,improve nerve function deficit,daily living ability,blood rheology and inflammatory factors.