羟乙基淀粉联合阿托伐他汀治疗老年脑分水岭梗死的疗效与安全性的系统评价

Systematic Review on Efficacy and Safety of Hydroxyethyl Starch Combined with Atorvastatin in the Treatment of Elderly Patients with Cerebral Watershed Infarction

目的:系统评价羟乙基淀粉联合阿托伐他汀治疗老年脑分水岭梗死的临床疗效和安全性。方法:计算机检索PubMed、中国生物医学文献数据库、中国知网、万方数据库、维普数据库等数据库(检索时间为建库至2024年1月),收集在基础治疗的基础上,羟乙基淀粉联合阿托伐他汀(观察组)对比单纯使用阿托伐他汀(对照组)治疗老年脑分水岭梗死患者的临床疗效和安全性的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取和质量评价后,采用RevMan 5.3统计软件进行Meta分析。结果:共纳入18项RCT,共1632例患者。Meta分析结果显示,观察组患者的总有效率(RR=1.25,95%CI=1.20~1.31,P<0.00001)、巴塞尔指数(MD=10.42,95%CI=8.93~11.90,P<0.00001)和日常生活活动量表评分(MD=12.25,95%CI=11.02~13.48,P<0.00001)显著高于对照组,美国国立卫生研究院卒中量表评分(MD=-3.11,95%CI=-3.52~-2.70,P<0.00001)和3类主要不良反应(上消化道出血、肺部感染和脑血管病后抑郁)发生率(P<0.00001)显著低于对照组,上述差异均有统计学意义。结论:羟乙基淀粉联合阿托伐他汀治疗老年脑分水岭梗死的临床疗效和安全性均优于单纯使用阿托伐他汀。

OBJCETIVE:To systematically review the efficacy and safety of hydroxyethyl starch combined with atorvastatin in the treatment of elderly patients with cerebral watershed infarction.METHODS:Randomized controlled trials on the clinical efficacy and safety of hydroxyethyl starch combined with atorvastatin(observation group)versus atorvastatin alone(control group)in the treatment of elderly patients with cerebral watershed infarction based on basic treatment were retrieved from PubMed,CBM,CNKI,Wanfang Data and VIP databases(the retrieval time was from database establishment to Jan.2024),RevMan 5.3 statistical software was adopted to conduct Meta-analysis after data extraction and quality evaluation on the clinical researches that matched the inclusion criteria.RESULTS:A total of 18 RCT including 1632 patients were enrolled.Meta-analysis indicated that the total effective rate(RR=1.25,95%CI=1.20-1.31,P<0.00001),Barthel index(MD=10.42,95%CI=8.93-11.90,P<0.00001)and ADL score(MD=12.25,95%CI=11.02-13.48,P<0.00001)of the observation group were significantly higher than those of the control group,the NIHSS score(MD=-3.11,95%CI=-3.52--2.70,P<0.00001)and incidence of three major adverse drug reactions(upper gastrointestinal hemorrhage,pulmonary infection and depression after cerebrovascular disease)were significantly lower than those of the control group(P<0.00001),the differences were statistically significant.CONCLUSIONS:The clinical efficacy and safety of hydroxyethyl starch combined with atorvastatin in the treatment of elderly patients with cerebral watershed infarction are better than atorvastatin alone.