抗血小板药物治疗腔隙性梗死效果的Meta分析

目的评价抗血小板药物对腔隙性梗死患者二级预防的治疗效果。方法以stroke,lacunar infarction,platelet aggregation inhibitors,antiplatelet,randomized controlled trial等英文词汇计算机检索1980年1月1日-2016年11月20日美国国立医学图书馆生物医学信息检索系统、荷兰医学文摘、Cochrane在线图书馆等数据库收录的关于腔隙性梗死患者抗血小板治疗的随机对照临床试验,采用Jadad量表、Cochrane系统评价手册和Rev Man 5.3统计软件进行文献质量评价和Meta分析,R软件Gemtc程序包和JAGS软件进行网状Meta分析。结果共获得4068篇英文文献,经剔除重复和不符合纳入标准者,最终纳入12项质量较高(Jadad评分≥4分)的临床试验共24 969例腔隙性梗死患者。Meta分析显示:与安慰剂相比,抗血小板药物单抗治疗可以显著降低缺血性卒中复发率(RR=0.480,95%CI:0.300~0.780;P=0.003)和所有脑卒中复发率(RR=0.780,95%CI:0.630~0.970;P=0.030);而抗血小板药物单抗与双抗治疗效果差异无统计学意义(缺血性卒中复发率:RR=0.900,95%CI:0.760~1.050,P=0.170;所有脑卒中复发率:RR=0.910,95%CI:0.820~1.010,P=0.070)。网状Meta分析(包括阿司匹林、安慰剂、西洛他唑和噻氯匹定4种干预措施)显示:仅西洛他唑治疗后所有脑卒中复发率低于阿司匹林(OR=0.341,95%Cr I:0.011~0.673)和安慰剂(OR=0.615,95%Cr I:0.191~1.042)。结论抗血小板药物单抗治疗可以显著降低腔隙性梗死患者缺血性卒中和所有脑卒中复发风险,且与双抗治疗效果无明显差异;西洛他唑较阿司匹林能够更显著降低腔隙性梗死患者所有脑卒中复发风险。

Efficacy of antiplatelet therapy for treating lacunar infarct: Meta-analysis

Objective To evaluate the efficacy of antiplatelet agents in secondary prevention of patients with lacunar infarct (LACI).Methods Retrieve relevant randomized controlled trials (RCTs) that reported antiplatelet therapy in patients with LACI from online databases (January 1,1980-November 20,2016) in PubMed,EMBASE/SCOPUS and Cochrane Online Library with key words:stroke,lacunar infarction,platelet aggregation inhibitors,antiplatelet,randomized controlled trial.Quality of studies was evaluated by using Jadad Scale and Cochrane Handbook for Systematic Reviews of Interventions.All data were pooled by RevMan 5.3 software for Meta-analysis.A network Meta-analysis was done by R software Gemtc and JAGS software.Results A total of 4068 articles were enrolled and 12 high-quality RCTs (Jadad ≥ 4 scores) with 24 969 eligible participants were finally included after excluding duplicates and those not meeting the inclusion criteria.Meta-analysis showed single antiplatelet therapy was more effective than placebo in reducing ischemic stroke recurrence rate (RR =0.480,95％CI:0.300-0.780;P =0.003) and any stroke recurrence rate (RR =0.780,95％CI:0.630-0.970;P =0.030).The efficacy of single antiplatelet therapy was not significantly different from that of dual antiplatelet therapy (ischemic stroke recurrence rate:RR =0.900,95％CI:0.760-1.050,P =0.170;any stroke recurrence rate:RR =0.910,95％CI:0.820-1.010,P =0.070).Network Meta-analysis (four interventions including aspirin,placebo,cilostazol and ticlopidine)showed that cilostazol was associated with a significant reduction in recurrence of any stroke compared with aspirin (OR =0.341,95％ CrI:0.011-0.673) and placebo (OR =0.615,95％ CrI:0.191-1.042).Conclusions Single antiplatelet therapy could significantly reduce the recurrence of any stroke,especially ischemic stroke in patients with LACI.There is no evidence showing that dual antiplatelet therapy is probably better than single therapy.Cilostazol is better than aspirin in reducing any stroke recurrence in the treatment of LACI.