不同方式远端缺血适应治疗在脑卒中患者应用效果的网状Meta分析

Network Meta-analysis of the effects of different methods of remote ischemic conditioning in stroke patients

目的利用网状Meta分析方法评价不同方式远端缺血适应(remote ischemic conditioning,RIC)治疗在脑卒中患者中的应用效果。方法系统检索中国知网、维普网、中国生物医学文献数据库、万方数据、PubMed、EMbase、Web of Science核心合集、The Cochrane Library等中、英文数据库,收集不同方式RIC治疗在脑卒中患者应用的随机对照试验,检索时限均为建库至2024年1月。完成文献筛选和资料提取,同时对纳入的研究进行偏倚风险评价后,应用Stata 16.0和RevMan 5.4软件进行网状Meta分析。结果经过严格筛选,最终共纳入37个随机对照实验,共包括5984例脑卒中患者和3种方式的RIC治疗:上肢治疗,1次/d;上肢治疗,2次/d;下肢治疗,1次/d。网状Meta分析结果显示,在改善脑卒中患者神经功能方面[基于美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NHISS)评分],上肢治疗、1次/d、持续7 d;上肢治疗、1次/d、持续14 d;上肢治疗、1次/d、持续6月;上肢治疗、2次/d、持续7 d;上肢治疗、2次/d、持14 d的治疗效果均优于常规治疗模式(P<0.05)。上肢治疗、1次/d、持续14 d治疗效果排序最优。结论当前证据显示,上肢治疗、1次/d、持续14 d的RIC治疗在提高脑卒中患者神经功能方面(基于NHISS评分)可能更具有优势。由于纳入研究的质量限制,今后需纳入更多样本、更高质量的研究以进一步验证上述结论。

Objective To evaluate the effect of different methods of remote ischemic conditioning(RIC)therapy in stroke patients by using network Meta-analysis.Methods A comprehensive search was conducted on Chinese and English databases,including CNKI,VIP Journal official website,Wanfang Database,Chinese Biomedical Literature Database,PubMed,EMbase,Web of Science Core Collection,The Cochrane Library,and others.Randomized controlled trial(RCT)with different methods of RIC therapy in stroke patients were collected,with the retrieval time limit from the establishment of the database to January 2024.Literature screening and data extraction were performed by two independent researchers.After the risk of bias was assessed for the included studies,Stata 16.0 and RevMan 5.4 software were used for network Meta-analysis.Results After rigorous screening,a total of 37 RCTs were finally undertaken on 5984 patients with stroke and in 3 methods of RIC:upper limb treatment,once a day;upper limb treatment,twice a day;lower limb treatment,once a day.The results of network Meta-analysis showed that in terms of improving the neurological function of stroke patients(based on the US National Institute of Health stroke scale,NHISS score),all of the five treatment sub-modes of upper limb treatment once a day for 7 days,upper limb treatment once a day for 14 days,upper limb treatment once a day for 6 months,upper limb treatment twice a day for 7 days,and upper limb treatment twice a day for 14 days had better therapeutic effects than the conventional treatment mode(P<0.05).Upper limb treatment once a day for 14 days intervention effect ranked the best.Conclusions Current evidence suggests that upper limb therapy once a day for 14 days may be more advantageous in improving neurological function in patients with stroke(based on US NHISS score).The above conclusions are limited by the number and quality of included studies,and need to be verified by future studies with more samples and higher quality.