标题：尤瑞克林联合阿替普酶治疗急性缺血性卒中有效性及安全性的Meta分析

      作者：孟桃 1，蒋萍 1，牟凌梅 1，刘沁 1，夏坤伟 2    宜宾市第二人民医院·四川大学华西医院宜宾医院神经内科 1、神经外科 2，四川 宜宾 644000

      卷次： 2023年34卷1期

      【摘要】 目的 系统评价尤瑞克林(HUK)联合阿替普酶(rt-PA)治疗急性缺血性卒中(AIS)的有效性及安全性。方法 检索PubMed，Web of Science，Embase，The Cochrane Library，中国生物医学文献数据库、万方数据库、维普中文科技期刊全文数据库、中国期刊全文数据库，检索时间为2015年4月至2021年1月。筛选有关尤瑞克林联合阿替普酶治疗AIS的随机对照试验(RCT)文献。由两名研究人员对纳入的临床研究独立进行数据提取和质量评价，采用RevMan5.3软件进行Meta分析。结果 共纳入7项RCT文献共602例AIS患者，均为中文文献。Meta分析结果显示，与阿替普酶比较，尤瑞克林联合阿替普酶治疗的总有效率明显提高 (RR=1.23，95%CI：1.15~1.32，P<0.000 01)，患者神经功能缺损程度显著改善 (MD=-2.43，95%CI：-2.70~-2.16，P<0.000 01)，Barthel指数显著提高(MD=17.41，95%CI：13.19~21.63，P<0.000 01)，而不良事件的发生率比较差异无统计学意义(RR=0.73，95%CI：0.42~1.24，P=0.24)。结论 现有证据表明，与单独使用阿替普酶相比，尤瑞克林联合阿替普酶可提高疗效，减少神经功能缺损程度，且不增加不良反应。但受纳入研究质量限制，上述结论需要更多大规模、高质量的随机对照试验来加以验证。
      【关键词】 急性缺血性卒中；尤瑞克林；阿替普酶；有效性；安全性；Meta分析
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2023）01—0108—05

Efficacy and safety of human urinary kallidinogenase combined with alteplase for acute ischemic stroke: asystematic review and meta-analysis.
MENG Tao 1, JIANG Ping 1, MOU Ling-mei 1, LIU Qin 1, XIA Kun-wei 2.Department of Neurology 1, Department of Neurosurgery 2, the Second People's Hospital of Yibin/West China Yibin Hospital,Sichuan University, Yibin 644000, Sichuan, CHINA
【Abstract】 Objective To systematically evaluate the efficacy and safety of human urinary kallidinogenasen(HUK) combined with alteplase (rt-PA) in the treatment of acute ischemic stroke (AIS).Methods PubMed, Web of Sci-ence, Embase, The Cochrane Library, Chinese Biomedical Literature Database, Wanfang database, VIP Chinese Scientif-ic Journals Full-text Database, China Academic Journals Full-text Database were retrieved from April 2015 to January2021 to screen literature on randomized controlled trials (RCT) of HUK combined with rt-PA in the treatment of AIS. Tworesearchers independently extracted data and evaluated the quality of the included clinical studies. Meta-analysis was per-formed using RevMan5.3 software. Results A total of 7 RCTs (602 AIS patients) were included, which were all Chi-nese. According to meta-analysis, compared with rt-PA, the effective rate of HUK combined with rt-PA was significantlyimproved (RR=1.23, 95%CI: 1.15 to 1.32, P<0.000 01); the neurological deficits of AIS patients was significantly im-proved (MD=-2.43, 95%CI: -2.70 to -2.16, P<0.000 01); Barthel Index was significantly increased (MD=17.41, 95%CI:13.19 to 21.63, P<0.000 01); there was no significant difference in the incidence of adverse events (RR=0.73, 95%CI: 0.42to 1.24, P=0.24). Conclusion Available evidence suggests that, compared with rt-PA alone, HUK in combination withrt-PA improves the efficacy and reduces the neurological deficits without incurring any added adverse events. Morelarge-scale and high-quality RCTs are warranted to confirm these results, due to the limited quality of the included study.
      【Key words】 Acute ischemic stroke; Human urinary kallidinogenasen; Alteplase; Efficacy; Safety; Meta-analysis　　　·荟萃分析·doi:10.3969/j.issn.1003-6350.2023.01.025基金项目：四川省医学青年创新科研课题计划(编号：Q20067)。第一作者：孟桃(1988—)，女，主治医师，主要研究方向为癫痫、脑血管疾病。