中国全科医学 ›› 2024, Vol. 27 ›› Issue (14): 1761-1774.DOI: 10.12114/j.issn.1007-9572.2023.0645

所属专题: 神经系统疾病最新文章合集 脑健康最新研究合集

• 论著·医学循证 • 上一篇    下一篇

川芎嗪类注射液辅助治疗急性缺血性脑卒中疗效的贝叶斯网状Meta分析

牛靖元1, 陈会生2,*(), 于嘉祥1, 崔钰2   

  1. 1.110847 辽宁省沈阳市,辽宁中医药大学第一临床学院
    2.110016 辽宁省沈阳市,北部战区总医院神经内科
  • 收稿日期:2023-05-24 修回日期:2023-12-08 出版日期:2024-05-15 发布日期:2024-03-22
  • 通讯作者: 陈会生

  • 作者贡献:

    牛靖元、于嘉祥负责文章的构思与设计,文献筛选与提取,撰写论文;陈会生负责文章的质量控制及审校,对文章整体负责;于嘉祥、崔钰负责数据处理、论文的修订。

  • 基金资助:
    辽宁省科学技术计划(2022JH2/101500020); 国家重点研发计划(2017YFC1308200); 沈阳市科技计划项目(20-205-4-007)

Ligustrazine Injection in the Treatment of Acute Ischemic Stroke: a Bayesian Network Meta-analysis

NIU Jingyuan1, CHEN Huisheng2,*(), YU Jiaxiang1, CUI Yu2   

  1. 1. First College of Clinical Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
    2. Department of Neurology, General Hospital of Northern Theatre Command, Shenyang 110016, China
  • Received:2023-05-24 Revised:2023-12-08 Published:2024-05-15 Online:2024-03-22
  • Contact: CHEN Huisheng

摘要: 背景 急性缺血性脑卒中(AIS)是一种严重的脑血管疾病,给社会和患者造成了沉重的负担。川芎嗪类注射液已被广泛用于AIS的治疗,且疗效明显,但目前还缺乏川芎嗪类注射液之间直接或间接比较。 目的 系统评价川芎嗪类注射液辅助治疗72 h内AIS的疗效性和安全性。 方法 计算机检索中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)、PubMed、Cochrane Library、Embase和Web of Science数据库中有关川芎嗪类注射液治疗AIS的随机对照试验,检索时限从建库至2023年4月。由2位研究员独立筛选文献、提取资料并用Cochrane评价工具对文献进行质量评价,采用RevMan 5.3、Stata 17、Addis及RStudio软件进行统计分析,比较不同川芎嗪类注射液的疗效及安全性差异并进行排序。 结果 共纳入71篇文献,总样本量7 304例,干预措施包括:丹参川芎嗪注射液(DSCXQ)、参芎葡萄糖注射液(SXPTT)、杏芎氯化钠注射液(XXLHN)、磷酸川芎嗪注射液(LSCXQ)和盐酸川芎嗪注射液(YSCXQ)分别联合常规西医治疗(CT)及单独CT。直接Meta分析结果显示:川芎嗪类注射液联合CT的总有效率、美国国立卫生研究院卒中量表(NIHSS)评分、纤维蛋白原水平、不良反应发生率均优于单独CT(P<0.05)。网状Meta分析结果显示:在总有效率方面,累积概率排序为:SXPTT+CT(0.60)>YSCXQ+CT(0.20)>LSCXQ+CT(0.15)>DSCXQ+CT(0.03)>XXLHN+CT(0.02)>CT(0);在降低NIHSS评分方面,累积概率排序为:SXPTT+CT(0.55)>XXLHN+CT(0.26)>YSCXQ+CT(0.12)>DSCXQ+CT(0.07)>CT(0);在降低纤维蛋白原水平方面,累积概率排序为:XXLHN+CT(0.32)>LSCXQ+CT(0.22)>DSCXQ+CT(0.17)>SXPTT+CT(0.15)>YSCXQ+CT(0.14)>CT(0);在安全性方面,累积概率排序为:SXPTT+CT(0.79)>XXLHN+CT(0.13)>CT(0.04)>DSCXQ+CT(0.03)>YSCXQ+CT(0.01)。 结论 川芎嗪类注射液辅助治疗AIS疗效显著、安全性好,其中参芎葡萄糖注射液在总有效率方面和改善NIHSS评分方面最佳、不良反应最少;杏芎氯化钠注射液在降低纤维蛋白原水平方面最有优势。

关键词: 急性缺血性脑卒中, 川芎嗪类注射液, 贝叶斯网状Meta分析, 疗效, 安全性

Abstract:

Background

Acute ischemic stroke (AIS) is a serious cerebrovascular disease, which causes a heavy burden on society and patients. Ligustrazine injection has been widely used in the treatment of AIS with significant efficacy, but there is still a lack of direct or indirect comparison between ligustrazine injections.

Objective

To systematically evaluate the efficacy and safety of ligustrazine injection in the adjuvant treatment of AIS within 72 hours.

Methods

CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Cochrane Library, Embase, and Web of Science databases were searched for randomized controlled trials (RCTs) about the efficacy and safety of ligustrazine injection in the treatment of AIS from inception to April 2023. Literature was independently screened, extracted and quality assessed by 2 investigators using the Cochrane Evaluation Tool. RevMan 5.3, Stata 17, Addis and RStudio software were used to statistically compare and rank the efficacy and safety of different types of ligustrazine injection.

Results

A total of 71 papers involving 7 304 cases were included, and the interventions included Salvia Miltiorrhiza Ligustrazine Injection (DSCXQ), Shenxiong Glucose Injection (SXPTT), Xingxiong Sodium Chloride Injection (XXLHN), Ligustrazine Phosphate Injection (LSCXQ) and Ligustrazine Hydrochloride Injection (YSCXQ) combined with conventional western medical therapy (CT), respectively, and CT alone. Direct Meta-analysis results showed that in improving all the outcome indicators of AIS, the total effective rate, NIHSS score, fibrinogen level, and incidence of adverse reactions of ligustrazine injection combined with CT were better than those of CT alone (P<0.05). The results of network Meta-analysis showed that the order of cumulative probability in total effective rate was SXPTT+CT (0.60) >YSCXQ+CT (0.20) >LSCXQ+CT (0.15) >DSCXQ+CT (0.03) >XXLHN+CT (0.02) >CT (0) ; the order of cumulative probability in improving NIHSS score was SXPTT+CT (0.55) >XXLHN+CT (0.26) >YSCXQ+CT (0.12) >DSCXQ+CT (0.07) >CT (0) ; the order of cumulative probability in reducing fibrinogen level was XXLHN+CT (0.32) >LSCXQ+CT (0.22) >DSCXQ+CT (0.17) >SXPTT+CT (0.15) >YSCXQ+CT (0.14) >CT (0) ; the order of cumulative probability in safety was SXPTT+CT (0.79) >XXLHN+CT (0.13) >CT (0.04) >DSCXQ+CT (0.03) >YSCXQ+CT (0.01) .

Conclusion

Ligustrazine injection is effective and safe in adjuvant treatment of AIS, among which Shenxiong glucose injection was the best in total effective rate and improving NIHSS scores, with the least adverse reactions; Xingxiong sodium chloride injection has the most advantages in fibrinogen level.

Key words: Acute ischemic stroke, Ligustrazine injection, Bayesian network meta-analysis, Therapeutic efficacy, Safety