高密度脂蛋白水平与缺血性脑卒中静脉溶栓治疗后出血性转化的关系：系统评价和荟萃分析。
High-density lipoprotein level is associated with hemorrhage transformation after ischemic stroke treatment with intravenous thrombolysis: A systematic review and meta-analysis.
机构信息
Department of Neurology, Shaanxi Provincial People's Hospital, No. 256 Youyixi Road, Xi'an 710068, Shaanxi, China; Xi'an Medical University, No. 74 Hanguangbei Road, Xi'an 710068, Shaanxi, China.
Department of Neurology, Shaanxi Provincial People's Hospital, No. 256 Youyixi Road, Xi'an 710068, Shaanxi, China.
出版信息
J Clin Neurosci. 2022 Dec;106:122-127. doi: 10.1016/j.jocn.2022.10.016. Epub 2022 Oct 22.
BACKGROUND
Treatment of acute ischemic stroke (AIS) with intravenous tissue-type plasminogen activator is effective in few patients when administered within 4.5 h after symptom onset. Hemorrhage transformation (HT) is a major cause of poor prognosis of AIS patients post intravenous rt-PA. Several studies report that high-density lipoprotein (HDL) cholesterol is associated with increased risk of HT. However, various studies report inconsistent results.
OBJECTIVE
The aim of the present study was to explore the association between HDL and HT after treatment of AIS patients by intravenous thrombolysis.
METHODS
A literature search for studies on the relationship between HDL and HT after treatment of AIS by intravenous thrombolysis published before, 28 Mar 2022, was conducted in PubMed, EMBASE, Cochrane, Web of Science, CNKI, CPVIP, Wan fang and SINOMED databases. Fixed effects model was used to estimate the mean differences (MDs) at 95% confidence interval (CI). Heterogeneity was assessed by Cochran's Q statistic and quantified by the I statistic. Analysis of included studies was carried out using Review Manager 5.4 and the publication bias was evaluated using Stata 16.0.
RESULTS
A total of 445 studies were screened and 9 studies met the inclusion criteria and were included in this meta-analysis (n = 3673). The results showed that AIS patients with HT had significantly higher HDL concentrations compared with the AIS patients without HT (pooled mean difference, 0.05; 95% confidence interval (CI), 0.01-0.09; P = 0.008).
CONCLUSION
The findings showed that HDL was associated with HT after treatment of AIS by intravenous thrombolysis, implying that is a potential predictor of the risk of HT.
背景
在症状发作后 4.5 小时内，静脉注射组织型纤溶酶原激活剂治疗急性缺血性中风（AIS）对少数患者有效。出血转化（HT）是 AIS 患者静脉 rt-PA 治疗后预后不良的主要原因。一些研究报告称，高密度脂蛋白（HDL）胆固醇与 HT 风险增加相关。然而，各种研究报告的结果并不一致。
目的
本研究旨在探讨静脉溶栓治疗 AIS 患者后 HDL 与 HT 的关系。
方法
在 PubMed、EMBASE、Cochrane、Web of Science、CNKI、CPVIP、万方和 SINOMED 数据库中检索了截至 2022 年 3 月 28 日发表的关于静脉溶栓治疗 AIS 后 HDL 与 HT 关系的研究。采用固定效应模型估计 95%置信区间（CI）的均数差（MDs）。采用 Cochran's Q 统计量评估异质性，并采用 I ² 统计量进行量化。使用 Review Manager 5.4 分析纳入研究，使用 Stata 16.0 评估发表偏倚。
结果
共筛选出 445 篇研究，其中 9 项研究符合纳入标准并纳入本荟萃分析（n=3673）。结果表明，与无 HT 的 AIS 患者相比，HT 的 AIS 患者的 HDL 浓度显著升高（合并平均差，0.05；95%置信区间（CI），0.01-0.09；P=0.008）。
结论
研究结果表明，HDL 与静脉溶栓治疗 AIS 后的 HT 相关，提示其可能是 HT 风险的潜在预测指标。
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