Falcão Luciano, Gomes Pedro Antonio Lopes, Silva Rafael Andrade Sampaio, Ogasawara Kenzo, Gonzalez João Victor Pereira, Nishizima André, Ohannesian Victor Arthur, Magalhães Lara Souza, Solla Davi J Fontoura
Bahiana School of Medicine and Public Health, Brotas, Salvador, Bahia, Brazil.
Bahia Federal University, Av. Milton Santos, Ondina, Salvador, Bahia 40170-110, Brazil.
Clin Neurol Neurosurg. 2025 May;252:108847. doi: 10.1016/j.clineuro.2025.108847. Epub 2025 Mar 17.
Glibenclamide, a sulfonylurea receptor 1 (SUR1) inhibitor initially developed for diabetes, has shown potential in reducing cerebral edema and neuroinflammation. This study evaluates its efficacy in improving functional outcomes and reducing complications in aSAH.
Databases including PubMed, EMBASE, and Web of Science were searched for RCTs assessing Glibenclamide's effects in aSAH. Outcomes included modified Rankin Scale (mRS), mortality, rebleeding risk, hydrocephalus incidence, and hospital stay duration. Risk Ratio (RR) and Mean Differences (MD) were calculated using random- or fixed-effects models based on heterogeneity (I² statistic).
Four RCTs (290 participants) met inclusion criteria. No significant differences were found in mRS scores at 90 days (MD: 0.06, 95 % CI: -0.59-0.71, p = 0.86) or 180 days (MD: -0.43, 95 % CI: -1.09-0.23, p = 0.20). Similarly, mortality (RR: 0.87, 95 % CI: 0.49-1.54, p = 0.665), rebleeding risk (RR: 0.78, 95 % CI: 0.23-2.60, p = 0.639), hydrocephalus incidence (RR: 1.64, 95 % CI: 0.96-2.79, p = 0.064), and hospital stay (MD: 0.09 days, 95 % CI: -2.15-2.32, p = 0.94) showed no significant differences. The meta-regression analysis showed that Glibenclamide dosage (p = 0.0007) and modified Fisher Scale (p = 0.0312) were significantly associated with mRS outcomes, while age (p = 0.1506), WFNS grade (p = 0.1956), and Hunt-Hess Scale (p = 0.1464) had no significant impact.
Current evidence indicates that Glibenclamide does not significantly improve outcomes or reduce complications in aSAH. While promising for cerebral edema, larger multicenter RCTs with standardized protocols and extended follow-ups are needed to clarify its role.
格列本脲是一种最初用于治疗糖尿病的磺酰脲受体1（SUR1）抑制剂，已显示出在减轻脑水肿和神经炎症方面的潜力。本研究评估了其在改善动脉瘤性蛛网膜下腔出血（aSAH）患者功能结局和减少并发症方面的疗效。
检索包括PubMed、EMBASE和科学网在内的数据库，以查找评估格列本脲对aSAH影响的随机对照试验（RCT）。结局指标包括改良Rankin量表（mRS）、死亡率、再出血风险、脑积水发生率和住院时间。根据异质性（I²统计量），使用随机或固定效应模型计算风险比（RR）和平均差（MD）。
四项RCT（290名参与者）符合纳入标准。在90天（MD：0.06，95%置信区间：-0.59至0.71，p = 0.86）或180天（MD：-0.43，95%置信区间：-1.09至0.23，p = 0.20）时，mRS评分无显著差异。同样，死亡率（RR：0.87，95%置信区间：0.49至1.54，p = 0.665）、再出血风险（RR：0.78，95%置信区间：0.23至2.60，p = 0.639）、脑积水发生率（RR：1.64，95%置信区间：0.96至2.
