Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Stroke Vasc Neurol. 2018 Jan 5;3(1):22-27. doi: 10.1136/svn-2017-000106. eCollection 2018 Mar.
The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL), from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0-1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.
静脉注射重组组织纤溶酶原激活剂（IV-tPA）治疗轻度缺血性脑卒中（MIS）的获益和安全性仍不明确。本荟萃分析的目的是评估 IV-tPA 治疗 MIS 的疗效和安全性。我们对 MEDLINE、Embase、CENTRAL、全球健康和护理学及相关健康文献累积索引（CINAHL）进行了系统文献检索，检索时间截至 2016 年 11 月 10 日，以确定所有相关研究。只要有可能，我们将使用固定效应模型，通过比值比（OR）和相应的 95%置信区间（CI）对数据进行合并分析。MIS 的定义为国立卫生研究院卒中量表评分≤6。我们根据预设的纳入和排除标准，纳入了 7 项共纳入 1591 例患者的研究。荟萃分析结果表明，与未接受 IV-tPA 治疗的患者相比，接受 IV-tPA 治疗的患者具有更好的改良 Rankin 量表或牛津残疾评分 0-1 分的功能结局（OR=1.43；95%CI 1.14-1.79；P=0.002，I²=35%）的可能性更高（74.8% vs 67.6%）。接受 IV-tPA 治疗后发生症状性颅内出血（sICH）的风险较高（OR=10.13；95%CI 1.93-53.02；P=0.006，I²=0%）（1.9% vs 0.0%），但死亡率无差异（OR=0.78；95%CI 0.43-1.43；P=0.43，I²=0%）（2.4% vs 2.9%）。在 MIS 患者中，IV-tPA 治疗与更好的功能结局相关，但与死亡率无关，尽管 sICH 风险增加。需要开展随机试验来证实这些发现。
