标题：银杏内酯注射液联合阿替普酶治疗急性缺血性卒中的Meta分析

      作者：罗宏，岑海媚，罗彬，张玉生，张誉    暨南大学附属第一医院神经内科，广东 广州 510632

      卷次： 2021年32卷7期

      【摘要】 目的 系统评价银杏内酯注射液联合阿替普酶治疗急性缺血性卒中(AIS)的疗效与安全性。方法 采用Cochrane系统评价方法，检索中国期刊全文数据库、万方数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库、中国硕士和博士论文全文数据库、Clinical Trials.gov、PubMed、Embase、The Cochrane Library和Web of Science等数据库，截止日期为2020年7月。筛选关于银杏内酯注射液联合阿替普酶治疗AIS的随机对照试验(RCT)文献。由两名评价员对所有纳入临床研究独立进行数据分析提取及质量评价，采用 revman5.3软件进行Meta分析。结果 共纳入9项RCT、765例AIS患者，全部为中文文献。Meta分析结果显示，与阿替普酶治疗比较，银杏内酯类注射液联合阿替普酶治疗显著改善AIS患者神经功能缺损(MD=-3.08，95%CI：-3.74~-2.43，P<0.000 01)，临床有效率显著提高(OR=3.93，95%CI：2.37~6.52，P<0.000 01)，患者生活质量(MD=7.06，95%CI：3.71~10.40，P<0.000 1)及Barthel指数显著改善(MD=8.96，95%CI：6.00~11.92，P<0.000 01)，而不良反应发生率比较差异无统计学意义(OR=0.76，95%CI：0.42~1.40，P=0.38)。结论 银杏内酯注射液联合阿替普酶治疗AIS患者可显著改善神经功能缺损，提高临床疗效和患者生活质量，但仍需要更多大样本、多中心、高质量研究证实。
      【关键词】 急性缺血性卒中；银杏内酯注射液；阿替普酶；随机对照实验；系统评价；Meta分析
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2021）07—0924—06

Clinical efficacy of ginkgolide injection combined with alteplase in the treatment of acute ischemic stroke: ameta-analysis.
LUO Hong, CEN Hai-mei, LUO Bin, ZHANG Yu-sheng, ZHANG Yu. Department of Neurology, the FirstAffiliated Hospital, Guangzhou 510632, Guangdong, CHINA
【Abstract】 Objective To systematically evaluate the efficacy and safety of ginkgolide injection combined withalteplase in the treatment of acute ischemic stroke (AIS). Methods The Cochrane system evaluation method was usedto search randomized controlled trials (RCT) of ginkgolide injection combined with alteplase in the treatment of AISfrom China Academic Journals Full-text Database, Wanfang Database, VIP Chinese Scientific Journals Full-text Data-base, Chinese Biomedical Literature Database, Chinese Master's and Doctoral Thesis Full-text Database, Clinical Trials.gov, PubMed, Embase, The Cochrane Library and Web of Science and other databases. Search time was limited to July2020. Two reviewers independently conducted data analysis and quality evaluation and used RevMan 5.3 software formeta-analysis. Results A total of 9 RCTs and 765 stroke patients were included, all of which were Chinese literature.Meta-analysis results showed that compared with alteplase treatment, ginkgolide injection combined with alteplase treat-ment had significantly improved neurological deficits in AIS patients (MD=-3.08, 95%CI: -3.74 to -2.43, P<0.000 01),significantly improved clinical effective rate (OR=3.93, 95% CI: 2.37 to 6.52, P<0.000 01), improved quality of life(MD=7.06, 95%CI: 3.71 to 10.40, P<0.000 1), and improved Barthel index (MD=8.96, 95%CI: 6.00 to 11.92, P<0.000 01).There was no significant difference in the adverse reactions between ginkgolide injection combined with alteplase and al-teplase alone (OR=0.76，95%CI: 0.42 to 1.40, P=0.38). Conclusion Ginkgolide injection combined with alteplase inthe treatment of AIS patients can significantly improve neurological deficits, clinical efficacy and patient quality of life,which still needs more large samples, multi-center, high-quality research to confirm.
      【Key words】 Acute ischemic stroke (AIS); Ginkgolide injection; Alteplase; Randomized controlled trials (RCT);Systematic evaluation; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2021.07.028基金项目：国家自然科学基金(编号：81801246、81171084)；广东省自然科学基金(编号：2018A030313636、2020A1515011249)；广东省科技计划项目(编号：2017A020215094)