慢性肾脏病患者的静脉溶栓治疗：系统评价和荟萃分析。
Intravenous thrombolysis in patients with chronic kidney disease: A systematic review and meta-analysis.
机构信息
From the Department of Neurology (K.M., A.T.), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (A.H.K., A.W.A., A.V.A.), University of Ioannina School of Medicine, Greece; Department of Neurology (N.G., G.T.), University of Tennessee Health Science Center, Memphis; Department of Neurology and Stroke Center (H.G., G.M.D.M.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology (P.D.M.), School of Medicine, University of Crete, Greece; Department of Cardiology (E.B.), Oslo University Hospital, Norway; and Second Department of Neurology (G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece.
出版信息
Neurology. 2020 Jul 14;95(2):e121-e130. doi: 10.1212/WNL.0000000000009756. Epub 2020 Jun 17.
OBJECTIVE
To determine the association of chronic kidney disease (CKD) with the safety and efficacy of IV thrombolysis (IVT) among patients with acute ischemic stroke (AIS).
METHODS
A systematic review and pairwise meta-analysis of studies involving patients with CKD undergoing IVT for AIS were conducted to evaluate the following outcomes: symptomatic intracranial hemorrhage (sICH), asymptomatic and any intracranial hemorrhage (ICH), in-hospital and 3-month mortality, 3-month favorable functional outcome (FFO; modified Rankin Scale [mRS] score 0-1), and 3-month functional independence (FI, mRS score 0-2). CKD was defined with estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60-89 mL/min) to moderate (eGFR 30-59 mL/min) to severe (eGFR 15-29 mL/min).
RESULTS
We identified 20 studies comprising 60,486 patients with AIS treated with IVT. In unadjusted analyses, CKD was associated with sICH according to the National Institute of Neurological Disorders and Stroke (NINDS) (7 studies; odds ratio [OR] 1.41, 95% confidence interval [CI] 1.19-1.67) and European Cooperative Acute Stroke Study (ECASS) II (9 studies; OR 1.37, 95% CI 1.01-1.85) definitions, any ICH (8 studies; OR 1.42, 95% CI 1.18-1.70), 3-month mortality (9 studies; OR 2.20, 95% CI 1.72-2.81), 3-month FFO (8 studies; OR 0.58, 95% CI 0.47-0.72), and 3-month FI (8 studies; OR 0.57, 95% CI 0.46-0.71). In adjusted analyses, CKD was associated with sICH according to NINDS (4 studies; OR 1.34, 95% CI 1.01-1.79) and ECASS II (3 studies; OR 2.08, 95% CI 1.27-3.43) definitions, any ICH (6 studies; OR 1.41, 95% CI 1.01-1.97), in-hospital mortality (2 studies; OR 1.19, 95% CI 1.09-1.30), and 3-month FFO (6 studies; OR 0.80, 95% CI 0.70-0.92).
CONCLUSIONS
After adjustment for confounders in this pairwise meta-analysis, moderate to severe CKD is associated with increased risks of ICH and worse functional outcomes among patients with AIS treated with IVT.
目的
确定慢性肾脏病（CKD）与急性缺血性脑卒中（AIS）患者接受静脉溶栓（IVT）的安全性和疗效之间的关系。
方法
对 CKD 患者接受 IVT 治疗 AIS 的研究进行了系统评价和成对荟萃分析，以评估以下结局：症状性颅内出血（sICH）、无症状和任何颅内出血（ICH）、住院和 3 个月死亡率、3 个月良好功能结局（改良 Rankin 量表[mRS]评分 0-1）和 3 个月功能独立性（mRS 评分 0-2）。CKD 的定义为肾小球滤过率（eGFR）轻度（eGFR 60-89 mL/min）至中度（eGFR 30-59 mL/min）至重度（eGFR 15-29 mL/min）。
结果
我们确定了 20 项纳入了 60486 例接受 IVT 治疗的 AIS 患者的研究。在未调整的分析中，CKD 与 NINDS（7 项研究；比值比[OR]1.41，95%置信区间[CI]1.19-1.67）和 ECASS II（9 项研究；OR 1.37，95%CI 1.01-1.85）定义的 sICH、任何 ICH（8 项研究；OR 1.42，95%CI 1.18-1.70）、3 个月死亡率（9 项研究；OR 2.20，95%CI 1.72-2.81）、3 个月良好功能结局（8 项研究；OR 0.58，95%CI 0.47-0.72）和 3 个月功能独立性（8 项研究；OR 0.57，95%CI 0.46-0.71）相关。在调整后的分析中，CKD 与 NINDS（4 项研究；OR 1.34，95%CI 1.01-1.79）和 ECASS II（3 项研究；OR 2.08，95%CI 1.27-3.43）定义的 sICH、任何 ICH（6 项研究；OR 1.41，95%CI 1.01-1.97）、住院死亡率（2 项研究；OR 1.19，95%CI 1.09-1.30）和 3 个月良好功能结局（6 项研究；OR 0.80，95%CI 0.70-0.92）相关。
结论
在这项成对荟萃分析中，对混杂因素进行调整后，中重度 CKD 与 AIS 患者接受 IVT 治疗后 ICH 风险增加和功能结局较差相关。
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