Shi Ligen, Liang Feng, Li Yunping, Shao Anwen, Zhou Keren, Yu Jun, Zhang Jianmin
Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China.
Sci Rep. 2016 Sep 27;6:33989. doi: 10.1038/srep33989.
Recent studies have shown inconsistent results regarding the value of desmoteplase for treating acute ischemic stroke (AIS) when administered within an extended time window. We performed a meta-analysis to explore the value of desmoteplase in AIS treatment. The MEDLINE, EMBASE, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that had evaluated desmoteplase versus placebo for AIS. The primary outcomes were intracranial hemorrhage (ICH) within 72 hours and favorable outcome at Day 90. We pooled 819 patients from 5 RCTs. Desmoteplase treatment showed a neutral effect on favorable outcome (P = 0.42) but a favorable safety profile in terms of ICH (P = 0.64) compared with the placebo group. In the subgroup analysis, 90 μg/kg desmoteplase, a late time to treatment (6-9 hours), and serious stroke symptoms at baseline (NIHSS > 12) subgroups showed high risks of ICH (P ≤ 0.02). A high dose of desmoteplase (125 μg/kg) showed a tendency to improve recanalization (P = 0.05), but was also associated with an increased risk of death (P = 0.04). In conclusion, desmoteplase administered over an extended time window had no significant effect on functional recovery but exhibited a favorable safety profile in patients with AIS.
近期研究表明，在延长的时间窗内给予去氨普酶治疗急性缺血性卒中（AIS）的价值存在不一致的结果。我们进行了一项荟萃分析以探讨去氨普酶在AIS治疗中的价值。检索MEDLINE、EMBASE和Cochrane图书馆数据库，查找评估去氨普酶与安慰剂治疗AIS的随机对照试验（RCT）。主要结局为72小时内颅内出血（ICH）和第90天的良好结局。我们汇总了来自5项RCT的819例患者。与安慰剂组相比，去氨普酶治疗对良好结局显示出中性作用（P = 0.42），但在ICH方面安全性良好（P = 0.64）。在亚组分析中，90μg/kg去氨普酶、治疗时间较晚（6 - 9小时）以及基线时严重卒中症状（美国国立卫生研究院卒中量表评分>12）亚组显示ICH风险较高（P≤0.02）。高剂量去氨普酶（125μg/kg）显示出改善再通的趋势（P = 0.05），但也与死亡风险增加相关（P = 0.04）。总之，在延长的时间窗内给予去氨普酶对功能恢复无显著影响，但在AIS患者中显示出良好的安全性。
