Balla Hajnal Zsuzsanna, Cao Yang, Ström Jakob O
Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
Clin Epidemiol. 2021 Mar 16;13:225-236. doi: 10.2147/CLEP.S268105. eCollection 2021.
Cardiovascular events and infections are common in the acute phase after stroke. It has been suggested that these complications may be associated with excessive sympathetic activation due to the stroke, and that beta-adrenergic antagonists (beta-blockers) therefore may be beneficial.
The aim of the current meta-analysis was to investigate the association between beta-blocker treatment in acute stroke and the three outcomes: mortality, functional outcome and post-stroke infections.
A literature search was performed using the keywords stroke, cerebrovascular disorders, adrenergic beta-antagonists, treatment outcome and mortality. Randomized clinical trials and observational studies were eligible for data extraction. Heterogeneity was investigated using I statistics. Random effect model was used when heterogeneity presented among studies; otherwise, a fixed-effect model was used. Publication bias was assessed using Egger's test and by visually inspecting funnel plots.
A total of 20 studies were eligible for at least one of the three outcomes. Two of the included studies were randomized controlled trials and 18 were observational studies. Quality assessments indicated that the risk of bias was moderate. The meta-analysis found no significant association between treatment with beta-blockers and any of the three outcomes. The studies analyzed for the outcomes mortality and infection were heterogeneous, while studies analyzed for functional outcome were homogeneous. The articles analyzed for mortality showed signs of publication bias.
The lack of significant effects in the current meta-analysis, comprising more than 100,000 patients, does not support the proposed beneficial effects of beta-blockers in the acute phase of stroke.
心血管事件和感染在卒中后的急性期很常见。有人提出，这些并发症可能与卒中导致的交感神经过度激活有关，因此β-肾上腺素能拮抗剂（β受体阻滞剂）可能有益。
本荟萃分析的目的是研究急性卒中患者使用β受体阻滞剂治疗与以下三个结局之间的关联：死亡率、功能结局和卒中后感染。
使用关键词“卒中”“脑血管疾病”“肾上腺素能β拮抗剂”“治疗结局”和“死亡率”进行文献检索。随机临床试验和观察性研究均符合数据提取要求。使用I统计量研究异质性。当研究之间存在异质性时，使用随机效应模型；否则，使用固定效应模型。使用Egger检验并通过直观检查漏斗图评估发表偏倚。
共有20项研究至少符合三个结局之一的要求。纳入的研究中有2项为随机对照试验，18项为观察性研究。质量评估表明偏倚风险为中度。荟萃分析发现，使用β受体阻滞剂治疗与上述三个结局中的任何一个均无显著关联。分析死亡率和感染结局的研究存在异质性，而分析功能结局的研究具有同质性。分析死亡率的文章显示存在发表偏倚迹象。
在这项纳入了超过100,000名患者的荟萃分析中，未发现显著效果，这并不支持β受体阻滞剂在卒中急性期具有预期的有益作用这一观点。
