Zhang Wen-Hui, Cai Fang-Fang, Wen Zhong-Min
Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Neural Regen Res. 2015 Apr;10(4):667-72. doi: 10.4103/1673-5374.155443.
To assess the efficacy and safety of cilostazol on the progression and regression of symptomatic intracranial artery stenosis.
We searched the main databases for eligible trials including Medline (from 1966 to June 2014), Embase (from 1980 to June 2014), Cochrane Library (Issue 6, 2014), Chinese National Knowledge Infrastructure (from 1995 to June 2014), Current Controlled Trials (http://controlled-trials.com), Clinical Trials.gov (http://clinicaltrials.gov), and Chinese Clinical Trial Registry (http://www.chictr.org). All studies regarding prevention and treatment of symptomatic intracranial arterial stenosis by cilostazol were collected. The Mesh or text keywords were the English words: "cilostazol, phosphodiesterase 3 inhibitor, atherosclerosis, and ischemic stroke." No restrictions were put on publications or publication language.
Grade A or B randomized controlled trials were selected according to the quality of evaluation criteria from the Cochrane Collaboration, in which cilostazol and aspirin were used to evaluate the effects of cilostazol in the treatment of patients with symptomatic intracranial artery stenosis. The quality of study methodology was evaluated based on criteria described in Cochrane Reviewer's Handbook 5.0.1. RevMan 5.2 software was used for data analysis.
Clinical efficacy and safety of cilostazol in stopping progression and promoting regression of symptomatic intracranial artery stenosis were measured by magnetic resonance angiography and transcranial Doppler.
Two randomized controlled trials with a total of 203 patients were included in this study. The results showed that while cilostazol was associated with a significantly reduced progression of intracranial artery stenosis (OR = 0.21, 95%CI: 0.09-0.47, P < 0.01), it had no beneficial effect on symptom regression (OR = 1.42, 95%CI: 0.80-2.51, P = 0.24). During the follow-up period, although some adverse effects developed, including headache, gastrointestinal disturbance, and dizziness, incidences of bleeding were lower than in aspirin-treated patients.
Cilostazol may prevent the progression of symptomatic intracranial artery stenosis, which could reduce the incidence of ischemic stroke.
评估西洛他唑对有症状颅内动脉狭窄进展及逆转的疗效和安全性。
我们在主要数据库中检索符合条件的试验，包括医学文献数据库（1966年至2014年6月）、荷兰医学文摘数据库（1980年至2014年6月）、考克兰图书馆（2014年第6期）、中国知网（1995年至2014年6月）、当前对照试验库（http://controlled-trials.com）、临床试验.gov（http://clinicaltrials.gov）以及中国临床试验注册中心（http://www.chictr.org）。收集了所有关于西洛他唑预防和治疗有症状颅内动脉狭窄的研究。主题词或文本关键词为英文单词：“西洛他唑、磷酸二酯酶3抑制剂、动脉粥样硬化和缺血性卒中”。对出版物或出版语言不设限制。
根据考克兰协作网的评估标准质量，选择A级或B级随机对照试验，其中使用西洛他唑和阿司匹林评估西洛他唑治疗有症状颅内动脉狭窄患者的效果。研究方法的质量根据《考克兰系统评价员手册5.0.1》中描述的标准进行评估。使用RevMan 5.2软件进行数据分析。
通过磁共振血管造影和经颅多普勒测量西洛他唑在阻止有症状颅内动脉狭窄进展和促进其逆转方面的临床疗效和安全性。
本研究纳入了两项共203例患者的随机对照试验。结果显示，虽然西洛他唑与颅内动脉狭窄进展显著降低相关（比值比=0.21，95%置信区间：0.09 - 0.47，P<0.01），但对症状逆转无有益影响（比值比=1.42，95%置信区间：0.80 - 2.51，P = 0.24）。在随访期间，虽然出现了一些不良反应，包括头痛、胃肠道不适和头晕，但出血发生率低于阿司匹林治疗的患者。
西洛他唑可能预防有症状颅内动脉狭窄的进展，这可能降低缺血性卒中的发生率。
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