| 摘要: | 背景：在大血管阻塞行橋接治療的背景下，以低劑量和標準劑量Alteplase行靜脈內血栓溶解治療急性缺血性腦中風的療效和安全性尚未得到一致性的比較。本研究比較了橋接治療以低劑量和標準劑量Alteplase治療大血管阻塞患者的臨床結果。
方法：我們在PubMed、Embase 和Cochrane Library 數據庫中搜索了隨機對照試驗和前瞻性或回溯性世代研究，以探討橋接治療在急性缺血性腦中風的臨床結果。感興趣的結果是90 天功能獨立、成功再通、症狀性腦出血發生率和死亡率；這些結果在接受低劑量和標準劑量Alteplase橋接治療的患者之間進行了比較。
結果：納入了2017 年後發表、總共408 名患者的五個觀察性研究。統合分析結果顯示，使用低劑量Alteplase行橋接治療，相較於標準劑量Alteplase，在90 天功能獨立的表現沒有顯著差異（勝算比，1.02；95%信賴區間，0.58-1.80）；在取栓後的成功再通率沒有比較差（勝算比，1.35；95%信賴區間，0.68-2.67）、症狀性腦出血發生率較低（勝算比，0.36；95%信賴區間，0.10-1.36），以及死亡率較低（勝算比，0.64；95%信賴區間，0.27-1.54），但以上差異並不顯著。在基於人種的次群組分析中，亞洲和非亞洲參與者之間沒有顯著差異。
結論：在急性缺血性腦中風併大血管阻塞患者中，以低劑量或標準劑量Alteplase行橋接治療可能提供相似療效，除此之外，使用低劑量Alteplase可能是較安全的選擇。未來需要更多設計良好的前瞻性研究來證實這一結果。
Background: The efficacy and safety of low- and standard-dose alteplase for acute ischemic stroke, in the context of bridging therapy for large vessel occlusion, have not been compared consistently. This study compared clinical outcomes between bridging therapy with low- and standard-dose alteplase in patients with large vessel occlusion-related acute ischemic stroke.
Methods: We performed a search for randomized controlled trials and prospective or retrospective cohort studies investigating the clinical outcomes of bridging therapy in acute ischemic stroke in the PubMed, Embase, and Cochrane Library databases. The outcomes of interest were 90-day functional independence, successful recanalization, symptomatic intracerebral hemorrhage and mortality; these outcomes were compared between patients who received bridging therapy with low- and standard-dose alteplase.
Results: Five observational studies, published after 2017 and involving 408 patients, were included. The meta-analysis results demonstrated that compared with bridging therapy with standard-dose alteplase, bridging therapy with low-dose alteplase did not improve 90-day functional independence (odds ratio, [OR] 1.02; 95% confidence interval [CI], 0.58-1.80). Nevertheless, bridging therapy with low-dose alteplase led to a higher successful recanalization rate (OR, 1.35; 95% CI, 0.68-2.67) but lower symptomatic intracerebral hemorrhage incidence (OR 0.36; 95% CI, 0.10-1.36), and morality (OR, 0.64; 95% CI, 0.27-1.54) than did bridging therapy with standard-dose alteplase; however, these results were nonsignificant. In the ethnicity-based subgroup analyses, no differences were noted between Asian and non-Asian participants.
Conclusion: In patients with large vessel occlusion-related acute ischemic stroke, bridging therapy with low- or standard-dose alteplase may provide similar efficacy; nevertheless, low-dose alteplase use is relatively safer. Additional well-designed prospective studies are required to confirm this result. |
