目的:系统评价依达拉奉联合氯吡格雷对比单用氯吡格雷治疗急性脑梗死的疗效和安全性,为临床提供循证参考。方法:计算机检索PubMed、Medline(Ovid)、中国期刊全文数据库、中文科技期刊数据库、万方数据库,收集依达拉奉联合氯吡格雷(试验组)对比单用氯吡格雷(对照组)治疗急性脑梗死的随机对照试验(RCT),对纳入研究进行质量评价和资料提取后,采用Rev Man 5.3 统计软件进行Meta 分析。结果:共纳入18 项RCT,合计1 611例患者。Meta 分析结果显示,试验组患者总有效率 [OR=4.07,95%CI(3.01,5.49),P<0.001]、基本痊愈率[OR=2.09,95%CI(1.68,2.59),P<0.001]、日常生活能力评分[MD=13.42,95%CI(11.62,15.23),P<0.001]均显著高于对照组,神经功能缺损评分显著低于对照组[MD=-6.20,95%CI(-8.14,-4.26),P<0.001],差异均有统计学意义。两组患者治疗后期复发率[OR=0.52,95%CI(0.24,1.13),P=0.10]和不良反应发生率比较,差异均无统计学意义。结论:依达拉奉联合氯吡格雷治疗急性脑梗死的疗效显著优于单用氯吡格雷,可改善患者的神经功能缺损状态,提高日常生活能力,在安全性方面两者相当。
Abstract
OBJECTIVE: To systematically review the efficacy and safety of edaravone combined with clopidogrel versus clopidogrel alone in the treatment of acute cerebral infarction, and provide evidence-based reference for clinic. METHODS: Retrieved from PubMed, Medline (Ovid), CJFD, VIP Database and Wanfang Database, according to inclusion and exclusion criteria, retrieval strategy was developed, and randomized controlled trials (RCT) about edaravone combined with clopidogrel versus clopidogrel alone in the treatment of acute cerebral infarction were collected. Meta-analysis was performed by using Rev Man 5.3 software after quality evaluation and data extraction. RESULTS: Totally 18 RCTs were enrolled, involving 1 611 patients. Results of Meta-analysis showed, the total effective rate [OR=4.07,95%CI(3.01,5.49),P<0.001], basic recovery rate [OR=2.09,95%CI (1.68,2.59),P<0.001], and ADL score of daily living ability [MD=13.42,95%CI(11.62,15.23),P<0.001] were higher than control group,while neurological deficit NIHSS score was lower than control group[MD=-6.20,95%CI(-8.14,-4.26),P<0.001] with statistic significances; there were no significant differences in late recurrence rate [OR=0.52,95%CI(0.24,1.13),P=0.10] and the incidence of adverse reactions in 2 groups. CONCLUSIONS: Edaravone combined with clopidogrel shows better efficacy than clopidogrel alone in the treatment of acute cerebral infarction, can correct neuroloyic impairment and improve the activity of daily living. The safety of them are similar to each other.