Emergency Department, Hongqiao Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 200052, China.
80w Ward, Pudong Branch, Huashan Hospital Affiliated to Fudan University, Shanghai 200120, China.
J Clin Neurosci. 2022 May;99:190-203. doi: 10.1016/j.jocn.2021.12.025. Epub 2022 Mar 11.
To perform an updated meta-analysis to comprehensively assess the efficacy and safety of cilostazol in preventing aneurysmal subarachnoid hemorrhage (SAH)-related secondary complications.
Electronic databases of PubMed, the Cochrane library, CNKI and Wanfang were searched on August 2021. Pooled odds ratio (OR) and standardized mean difference (SMD) were calculated for dichotomous and continuous outcomes, respectively.
A total of 14 studies [comprising 18,726 aneurysmal SAH patients (6654 in the cilostazol group and 12,072 in the control group)] performed in Japan or China were included. Compared with the control group, cilostazol treatment significantly reduced the median cerebral artery (SMD = -0.49; p < 0.001), improved the therapeutic efficacy (OR = 2.37; p = 0.009), decreased the incidence of symptomatic vasospasm/delayed cerebral ischemia (OR = 0.42; p < 0.001), severe angiographic vasospasm (OR = 0.54; p < 0.001), new cerebral infarction (OR = 0.33; p < 0.001), poor outcomes (OR = 0.86; p = 0.001), mortality (OR = 0.62; p < 0.001) and increased the incidence of no or mild angiographic vasospasm (OR = 1.94; p = 0.004), but did not induce more adverse events (OR = 1.08; p = 0.871). The mechanism of cilostazol treatment was to inhibit the production of tenascin-C (SMD = -1.46; p < 0.001). These results were hardly changed by subgroup analysis.
This meta-analysis indicates cilostazol may be an effective and safe drug for aneurysmal SAH patients. However, further trials involving other world populations are required to demonstrate the generalization of treatment effects of cilostazol.
进行更新的荟萃分析，全面评估西洛他唑预防蛛网膜下腔出血（SAH）相关继发性并发症的疗效和安全性。
于 2021 年 8 月检索 PubMed、Cochrane 图书馆、中国知网和万方数据库。对二分类和连续性结局分别计算合并优势比（OR）和标准化均数差（SMD）。
共纳入 14 项研究[包括 18726 例动脉瘤性蛛网膜下腔出血患者（西洛他唑组 6654 例，对照组 12072 例）]，均在日本或中国进行。与对照组相比，西洛他唑治疗可显著降低大脑中动脉（SMD=−0.49；p<0.001），提高治疗效果（OR=2.37；p=0.009），降低症状性血管痉挛/迟发性脑缺血（OR=0.42；p<0.001）、严重血管造影性血管痉挛（OR=0.54；p<0.001）、新发脑梗死（OR=0.33；p<0.001）、不良结局（OR=0.86；p=0.001）和死亡率（OR=0.62；p<0.001），增加无或轻度血管造影性血管痉挛的发生率（OR=1.94；p=0.004），但不会引起更多的不良反应（OR=1.08；p=0.871）。西洛他唑治疗的机制可能是抑制 tenascin-C 的产生（SMD=−1.46；p<0.001）。亚组分析结果变化不大。
本荟萃分析表明，西洛他唑可能是一种治疗动脉瘤性蛛网膜下腔出血患者有效且安全的药物。但是，需要进一步涉及其他世界人群的试验来证明西洛他唑治疗效果的推广。
