Bath P M, Bath F J, Asplund K
Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, Nottinghamshire, UK, NG5 1PB.
Cochrane Database Syst Rev. 2000(2):CD000162. doi: 10.1002/14651858.CD000162.
Methylxanthine derivatives are vasodilators. They also inhibit platelet aggregation and thromboxane A2 synthesis, decrease the release of free radicals and may be neuroprotective.
The objective of this review was to assess the effect of intravenous or oral methylxanthines (pentoxifylline, propentofylline, or pentifylline) in patients with acute ischaemic stroke.
We searched the Cochrane Stroke Group trials register, Medline (from 1965), Embase (from 1981), ISI (from 1981) and the Ottawa stroke trials registry. We contacted drug companies.
Randomised trials comparing pentoxifylline, propentofylline or pentifylline with placebo or control in patients with definite or presumed acute ischaemic stroke. Trials were included if treatment was started within one week of stroke onset.
Two reviewers independently applied the inclusion criteria. Trial quality was assessed.
Five trials were included. Four trials tested pentoxifylline in 763 people, and one tested propentofylline in 30 people. No trials of pentifylline were found. Early death (within four weeks) occurred in 34 of 408 patients given a methylxanthine drug compared with 49 of 385 given placebo (odds ratio 0.64, 95% confidence interval 0.41 to 1.02). This non-significant trend to less deaths was due mainly to one pentoxifylline trial that found a highly significant reduction in early deaths. Two trials reported early death or disability and found a non-significant reduction (odds ratio 0.49, 95% confidence interval 0.20 to 1.20). Late death (beyond four weeks) was reported in the propentofylline trial involving 30 patients, with no difference between treatment and placebo (odds ratio 0.70, 95% confidence interval 0.13 to 3.68). Data for neurological impairment and disability were not in a form suitable for analysis. Data on quality of life, stroke recurrence, thromboembolism and bleeding were not reported.
REVIEWER'S CONCLUSIONS: There is not enough evidence to assess the effectiveness and safety of methylxanthines after acute ischaemic stroke.
甲基黄嘌呤衍生物是血管扩张剂。它们还可抑制血小板聚集和血栓素A2的合成，减少自由基的释放，并且可能具有神经保护作用。
本综述的目的是评估静脉或口服甲基黄嘌呤（己酮可可碱、丙戊茶碱或戊茶碱）对急性缺血性中风患者的疗效。
我们检索了Cochrane中风小组试验注册库、Medline（始于1965年）、Embase（始于1981年）、ISI（始于1981年）以及渥太华中风试验注册库。我们还联系了制药公司。
将己酮可可碱、丙戊茶碱或戊茶碱与安慰剂或对照进行比较的随机试验，受试对象为确诊或疑似急性缺血性中风患者。如果在中风发作后一周内开始治疗，则纳入该试验。
两名评价者独立应用纳入标准。对试验质量进行了评估。
纳入了五项试验。四项试验对763人进行了己酮可可碱测试，一项试验对30人进行了丙戊茶碱测试。未发现戊茶碱试验。在接受甲基黄嘌呤药物治疗的408例患者中，有34例在四周内死亡，而接受安慰剂治疗的385例患者中有49例死亡（比值比0.64，95%置信区间0.41至1.02）。这种死亡人数减少的趋势无统计学意义，主要是由于一项己酮可可碱试验发现早期死亡人数显著减少。两项试验报告了早期死亡或残疾情况，发现减少幅度无统计学意义（比值比0.49，95%置信区间0.20至1.20）。在涉及30例患者的丙戊茶碱试验中报告了晚期死亡（四周后），治疗组与安慰剂组之间无差异（比值比0.70，95%置信区间0.13至3.68）。神经功能缺损和残疾的数据形式不适合分析。未报告生活质量、中风复发、血栓栓塞和出血的数据。
没有足够的证据来评估急性缺血性中风后甲基黄嘌呤的有效性和安全性。
