重组组织型纤溶酶原激活剂治疗急性脑梗死效果荟萃分析

目的评价重组组织型纤溶酶原激活剂（rt-PA）治疗急性脑梗死（acute cerebral Infarction,ACI）的效果。方法检索近10年PubMed、Cochrane Database of Systematic Reviews、EMbase、中国知网、万方数据库中关于rt-PA治疗ACI的随机对照试验（RCT）研究,同时筛检纳入文献的参考文献,对纳入研究的方法学进行评价。对文献质量进行严格评价和资料提取,对符合质量标准的RCT文献用Review manager 5.0软件进行Meta分析。结果 5篇RCT文献共283例ACI纳入研究,方法学质量均为中等,其中治疗组（使用rt-PA）122例,对照组（常规溶栓治疗）161例。Meta分析结果表明治疗组存活率、脑血管再通率明显高于对照组,差异均有统计学意义RR=2.55,95%CI（1.33,4.87）;RR=2.20,95%CI（1.24,3.90）];在继发血管闭塞、脑出血、再灌注损伤等不良反应方面,两组RCT结果比较差异无统计学意义RR=0.91,95%CI（0.51,1.62）]。结论相比应用尿激酶等传统溶栓方案,rt-PA可显著提升ACI患者的治愈率,且不增加发生不良结局的危险性,治疗效果显著。

Prognosis Following rt-PA Treatment of Acute Cerebral Infarction: A Systematic Analysis

Objective To assess the effects of rt-PA in the treatment of cerebral infarction(ACI).Methods We searched papers from three English databases(PubMed,Cochrane Database of Systematic Reviews,EMbase) and two Chinese databases(WANFANG DATA and CNKI) for RCT of ACI treatment using rt-PA,then we made an assessment of the methodology after screening and selecting all the papers with the help of the software of review manager 5.0.Results 5 RCT and a total of 283 cares of ACI were included in the study;122 cases in the group of intervention group(using rt-PA) and 161 cases in the control group(using conventional fibrinolytic therapy).Meta-analysis showed that the survival rate and recanalization rate were significantly higher in the intervention group,and there was no difference in terms of adverse effects,such as secondary cerebrovascular blocking,hematencephalon and ischemia reperfusion injury.Conclusion Compared with conventional therapy plans,rt-PA can significantly improve the recovery rate in ACI patients without increasing the rate of adverse outcomes.and as such is an option in the treatment of ACI.