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针对急性缺血性中风的重组组织等离子体激活剂:更新的系统性审查和元分析
Joanna M Wardlaw1, Veronica Murray, Eivind Berge
1Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK. joanna.wardlaw@ed.ac.uk
Lancet (London, England)
|May 29, 2012
概括
重组组织等离子体激活剂 (rt-PA) 改善了急性缺血性中风患者在6小时内治疗的结果. 早期治疗,特别是在3小时内,最大限度地提高了生存和独立等好处.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 重组组织等离子体激活剂 (rt-PA) 是急性缺血性中风的关键治疗方法.
- 之前的试验表明,当中风发作后不久服用rt-PA时,它改善了功能结果.
- 许可限制和可变的临床使用需要进一步的证据综合.
研究的目的:
- 对所有评估急性缺血性中风静脉rt-PA的随机试验进行更新的系统审查和元分析.
- 评估在中风发作后6小时内服用rt-PA的疗效和安全性.
主要方法:
- 在2012年3月30日之前搜索了静脉注射rt-PA与对照的随机试验.
- 包括在急性缺血性中风发作后6小时内给予rt-PA的试验.
- 估计的概要概率比率 (ORs) 结果在7天内和最后的后续.
主要成果:
- 在最后的随访 (OR 1.17) 时,rt-PA显著增加了活着和独立 (mRS 0-2) 的几率.
- 在3小时内接受治疗的患者的益处最大,表现出有利结局的大幅增加 (mRS 0-1和0-2).
- 虽然早期死亡人数增加,主要是由于症状性内出血,但在最终的随访中,这种过剩并不显着.
结论:
- 静脉rt-PA增加了患者的比例,有利的结果和那些活着和独立的中风后.
- 这些发现加强了早期治疗的重要性,理想情况下在3小时内,但效益可能会延长到6小时.
- 在80岁以上的患者中也观察到类似的益处,特别是早期治疗.
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