University of Tennessee Health Science Center.
University of Tennessee Health Science Center.
J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106741. doi: 10.1016/j.jstrokecerebrovasdis.2022.106741. Epub 2022 Aug 26.
A systematic review of published cases of standard-dose IV tPA for acute ischemic stroke (AIS) within 4.5 hours of symptom onset and intracranial tumor was performed.
PubMed, Embase, and Cochrane were used to identify studies that included patients given standard-dose IV tPA for presumed AIS within 4.5 hours of symptom onset who had an intracranial tumor. The primary outcome measure was rate of ICH.
Twenty-three studies were included, involving 495 patient cases. One case-control study presented data only in the form of an odds ratio (OR), with OR 0.72 (p=0.16) for risk of ICH in 297 benign brain tumors, and OR for ICH of 2.33 (p value <0.001) in 119 malignant brain tumors, compared to controls. The remaining 22 sources included 79 cases; 49 were classified as benign, 16 malignant, and 14 "not otherwise specified." ICH occurred in 4; one was an asymptomatic parenchymal hematoma (5.1% total ICH, 3.8% symptomatic ICH). ICH only occurred in cases of malignant or metastatic intracranial tumors.
There were no reports of ICH in cases of benign intracranial tumor, and the reported rate of ICH with standard-dose IV tPA in the setting of any brain tumor appears similar to the general AIS population. There is heterogeneity and risk of selection bias with the included studies, and findings are not confirmatory. Further research is indicated to assess the rate of ICH with IV tPA for AIS in the setting of brain tumor.
对已发表的在症状发作后 4.5 小时内给予标准剂量 IV tPA 治疗急性缺血性脑卒中（AIS）和颅内肿瘤的病例进行系统回顾。
使用 PubMed、Embase 和 Cochrane 数据库检索纳入在症状发作后 4.5 小时内给予标准剂量 IV tPA 治疗疑似 AIS 且伴有颅内肿瘤的患者的研究。主要结局指标为脑出血（ICH）发生率。
共纳入 23 项研究，涉及 495 例患者。1 项病例对照研究仅以比值比（OR）形式呈现数据，在 297 例良性脑肿瘤患者中，ICH 的 OR 为 0.72（p=0.16），在 119 例恶性脑肿瘤患者中，ICH 的 OR 为 2.33（p 值<0.001），与对照组相比。其余 22 项研究共纳入 79 例患者；49 例为良性肿瘤，16 例为恶性肿瘤，14 例为“其他未特指”。ICH 发生 4 例，1 例为无症状脑实质血肿（总 ICH 发生率为 5.1%，症状性 ICH 发生率为 3.8%）。ICH 仅发生在恶性或转移性颅内肿瘤的患者中。
良性颅内肿瘤患者无 ICH 报告，任何脑肿瘤患者接受标准剂量 IV tPA 治疗后 ICH 的报告发生率与一般 AIS 人群相似。纳入研究存在异质性和选择偏倚风险，研究结果无法证实。需要进一步研究评估 IV tPA 治疗 AIS 时脑肿瘤患者的 ICH 发生率。
