中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
9期
643-647
,共5页
陈胡萍%曾宪容%高椿%程媛媛%任泗昌%赵沁
陳鬍萍%曾憲容%高椿%程媛媛%任泗昌%趙沁
진호평%증헌용%고춘%정원원%임사창%조심
颅内动脉瘤%脑梗死%血栓溶解疗法%Meta分析
顱內動脈瘤%腦梗死%血栓溶解療法%Meta分析
로내동맥류%뇌경사%혈전용해요법%Meta분석
Intracranial aneurysm%Brain infarction%Thrombolytic therapy%Meta-analysis
目的 系统评价伴有无症状颅内动脉瘤(以下简称颅内动脉瘤)的急性脑梗死患者在溶栓时间窗内接受静脉溶栓治疗的安全性.方法 计算机检索数据库包括万方数据、中国知网(CNKI)、VIP、Pubmed、EMBASE、EBSCO HOST、迈特思创等.全面收集伴有颅内动脉瘤的急性脑梗死患者接受静脉溶栓治疗的研究,检索时限均为建库至2013年10月,并追溯纳入研究的参考文献.由2位研究者独立筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行meta分析.结果 共纳入4个队列研究707例患者,其中48例伴有颅内动脉瘤,急性脑梗死患者无症状颅内动脉瘤发生率为6.8%;文献质量均较高,异质性较小.meta分析结果显示:该类患者与无颅内动脉瘤的脑梗死患者相比,在静脉溶栓后发生脑出血的风险差异无统计学意义(RR=1.17,95% CI0.69 ~ 1.99,P=0.56),发生症状性脑出血的风险差异无统计学意义(OR=1.70,95%CI0.44 ~6.59,P=0.45),发生蛛网膜下腔出血的风险差异无统计学意义(OR=1.13,95%CI0.20 ~6.27,P=0.89).结论 基于现有证据,未发现伴有无症状颅内动脉瘤的急性脑梗死患者在溶栓时间窗内接受静脉溶栓治疗出血风险增加.本研究结果仍需今后临床中累积更多的病例来进一步证实.
目的 繫統評價伴有無癥狀顱內動脈瘤(以下簡稱顱內動脈瘤)的急性腦梗死患者在溶栓時間窗內接受靜脈溶栓治療的安全性.方法 計算機檢索數據庫包括萬方數據、中國知網(CNKI)、VIP、Pubmed、EMBASE、EBSCO HOST、邁特思創等.全麵收集伴有顱內動脈瘤的急性腦梗死患者接受靜脈溶栓治療的研究,檢索時限均為建庫至2013年10月,併追溯納入研究的參攷文獻.由2位研究者獨立篩選文獻、提取資料和評價質量後,採用RevMan 5.0軟件進行meta分析.結果 共納入4箇隊列研究707例患者,其中48例伴有顱內動脈瘤,急性腦梗死患者無癥狀顱內動脈瘤髮生率為6.8%;文獻質量均較高,異質性較小.meta分析結果顯示:該類患者與無顱內動脈瘤的腦梗死患者相比,在靜脈溶栓後髮生腦齣血的風險差異無統計學意義(RR=1.17,95% CI0.69 ~ 1.99,P=0.56),髮生癥狀性腦齣血的風險差異無統計學意義(OR=1.70,95%CI0.44 ~6.59,P=0.45),髮生蛛網膜下腔齣血的風險差異無統計學意義(OR=1.13,95%CI0.20 ~6.27,P=0.89).結論 基于現有證據,未髮現伴有無癥狀顱內動脈瘤的急性腦梗死患者在溶栓時間窗內接受靜脈溶栓治療齣血風險增加.本研究結果仍需今後臨床中纍積更多的病例來進一步證實.
목적 계통평개반유무증상로내동맥류(이하간칭로내동맥류)적급성뇌경사환자재용전시간창내접수정맥용전치료적안전성.방법 계산궤검색수거고포괄만방수거、중국지망(CNKI)、VIP、Pubmed、EMBASE、EBSCO HOST、매특사창등.전면수집반유로내동맥류적급성뇌경사환자접수정맥용전치료적연구,검색시한균위건고지2013년10월,병추소납입연구적삼고문헌.유2위연구자독립사선문헌、제취자료화평개질량후,채용RevMan 5.0연건진행meta분석.결과 공납입4개대렬연구707례환자,기중48례반유로내동맥류,급성뇌경사환자무증상로내동맥류발생솔위6.8%;문헌질량균교고,이질성교소.meta분석결과현시:해류환자여무로내동맥류적뇌경사환자상비,재정맥용전후발생뇌출혈적풍험차이무통계학의의(RR=1.17,95% CI0.69 ~ 1.99,P=0.56),발생증상성뇌출혈적풍험차이무통계학의의(OR=1.70,95%CI0.44 ~6.59,P=0.45),발생주망막하강출혈적풍험차이무통계학의의(OR=1.13,95%CI0.20 ~6.27,P=0.89).결론 기우현유증거,미발현반유무증상로내동맥류적급성뇌경사환자재용전시간창내접수정맥용전치료출혈풍험증가.본연구결과잉수금후림상중루적경다적병례래진일보증실.
Objective To assess the safety among acute ischemic stroke patients with asymptomatic intracranial aneurysm after the administration of intravenous thrombolysis.Methods We searched database including Wanfang,CNKI,VIP,Pubmed,EMBASE,EBSCO HOST and Metstr data for all the cohort studies on the use of thrombolysis for acute ischemic patients with asymptomatic intracranial aneurysm,and ascended the correlated references listed on the articles.Meta-analysis was conducted based on the methods recommended by the Cochrane collaboration.The outcomes of the meta-analysis were intracerebral hemorrhage (ICH),symptomatic intracerebral hemorrhage (sICH),subarachnoid hemorrhage (SAH).Results Four cohort studies included 707 patients,of whom 48 patients had asymptomatic cerebral aneurysms.The risk ratio prevalence of ICH among those patients did not differ statistically with those without aneurysms (RR =1.17,95% CI 0.69-1.99,P =0.56).No statistical differences were found in both odds ratio prevalence of sICH (OR =1.70,95% CI 0.44-6.59,P =0.45) and SAH (OR =1.13,95% CI 0.20-6.27,P =0.89) between the patients with asymptomatic cerebral aneurysms and those without.Conclusion Current evidence did not indicate that the risk of hemorrhage increased in acute ischemic stroke patients with asymptomatic intracranial aneurysm after the administration of intravenous thrombolysis.