Beijing University of Chinese Medicine, Beijing, China.
Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China.
Syst Rev. 2024 May 30;13(1):141. doi: 10.1186/s13643-024-02568-3.
Acute ischemic stroke (AIS) is a significant health burden in China, affecting a sizable portion of the population. Conventional pharmacological treatments frequently fall short of desirable outcomes. Therefore, exploring alternative therapies is crucial. Remote ischemic postconditioning (RIPostC) is a noninvasive and cost-effective adjunctive therapy. This study aimed to investigate the efficacy and safety of RIPostC as an adjunctive therapy for AIS to inform clinical practice.
A comprehensive search was conducted across the PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, Weipu (VIP), and China Biology Medicine disc (CBM) databases up to October 2023. All included studies underwent bias risk assessment using the Cochrane risk-of-bias assessment tool. The primary outcome measure was the National Institute of Health Stroke Scale (NIHSS), with secondary outcomes including the Barthel index (BI), D-dimer, C-reactive protein (CRP), fibrinogen (FIB), brain-derived neurotrophic factor (BDNF), modified Rankin scale (mRS), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels. The data were analyzed using fixed-effects and random-effects models in Review Manager, with mean differences (MDs) and 95% confidence intervals (CIs) calculated for each outcome. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to evaluate the level of evidence for each outcome measure.
This meta-analysis included 38 studies, encompassing 4334 patients. Compared with the control group, the RIPostC group had significantly lower NIHSS scores, serum CRP, D-dimer, IL-6, TNF-α, and FIB levels, and increased BDNF levels. Moreover, it improved the patient's BI and mRS scores. According to the GRADE approach, the quality of evidence for mRS was deemed "moderate," while the NIHSS, BI, and CRP were rated as "low" quality. IL-6, TNF-α, FIB, D-dimer, and BDNF received "very low" quality ratings.
The findings suggest that RIPostC activates endogenous protective mechanisms, providing benefits to patients with AIS.
急性缺血性脑卒中（AIS）在中国是一项重大的健康负担，影响了相当一部分人群。常规的药物治疗往往难以达到理想的效果。因此，探索替代疗法至关重要。远程缺血后处理（RIPostC）是一种非侵入性且具有成本效益的辅助治疗方法。本研究旨在探讨 RIPostC 作为 AIS 辅助治疗的疗效和安全性，为临床实践提供信息。
全面检索了 PubMed、Embase、Web of Science、中国知网（CNKI）、万方、维普（VIP）和中国生物医学文献数据库（CBM），检索时间截至 2023 年 10 月。所有纳入的研究均使用 Cochrane 偏倚风险评估工具进行偏倚风险评估。主要结局测量指标为国立卫生研究院卒中量表（NIHSS），次要结局测量指标包括巴氏指数（BI）、D-二聚体、C 反应蛋白（CRP）、纤维蛋白原（FIB）、脑源性神经营养因子（BDNF）、改良 Rankin 量表（mRS）、白细胞介素 6（IL-6）和肿瘤坏死因子-α（TNF-α）水平。使用 Review Manager 分析数据，采用固定效应和随机效应模型，计算每个结局的均数差（MD）和 95%置信区间（CI）。使用推荐评估、制定与评价分级（GRADE）方法评估每个结局测量指标的证据等级。
本荟萃分析纳入了 38 项研究，共包含 4334 例患者。与对照组相比，RIPostC 组的 NIHSS 评分、血清 CRP、D-二聚体、IL-6、TNF-α和 FIB 水平更低，BDNF 水平更高，BI 和 mRS 评分也更高。根据 GRADE 方法，mRS 的证据质量被评为“中等”，而 NIHSS、BI 和 CRP 的证据质量评为“低”。IL-6、TNF-α、FIB、D-二聚体和 BDNF 的证据质量评为“极低”。
研究结果表明，RIPostC 激活了内源性保护机制，为 AIS 患者带来了益处。
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