本文選題：促紅細(xì)胞生成素　切入點：腦梗死　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的：腦梗死是人類致殘和致死的主要疾病之一，目前缺乏有效的特異性治療措施。在體內(nèi)或體外多種動物模型都證實促紅細(xì)胞生成素（erythropoietin，EPO）對不同的致傷因子導(dǎo)致的腦損傷均有神經(jīng)保護(hù)作用。EPO應(yīng)用于腦梗死動物模型實驗研究已得到廣泛的開展，并證實EPO能有效減少腦梗死面積，改善預(yù)后。但其臨床試驗研究仍處于起步階段，，EPO治療腦梗死的臨床療效及安全性尚存在爭議。本系統(tǒng)評價為國內(nèi)外首次采用cochrane系統(tǒng)評價的方法，評價EPO治療腦梗死的療效及安全性，為臨床應(yīng)用提供參考。 方法：用Cochrane系統(tǒng)評價方法，檢索Cochrane library、Pubmed、Embase、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫、維普中文科技期刊數(shù)據(jù)庫、中國知網(wǎng)、萬方數(shù)據(jù)庫，檢索時間截止至2014年3月。由兩名評價員獨立篩選促紅細(xì)胞生成素治療腦梗死的安慰劑隨機(jī)對照試驗（Random Control Trials，RCTs），提取資料并評價文獻(xiàn)質(zhì)量。采用急性期DWI及FLAIR提示腦梗死面積變化情況、治療后1個月的神經(jīng)功能缺損的改善、日常生活能力、殘疾程度、不良反應(yīng)及治療后3個月神經(jīng)功能缺損的改善和死亡率作為結(jié)局指標(biāo)，共同評價EPO治療腦梗死的療效及安全性。統(tǒng)計軟件采用Cochrane協(xié)作網(wǎng)提供的RevMan5.2，用I2統(tǒng)計量描述研究間異質(zhì)性，采用比值比（OddsRatio，OR）、均數(shù)差（weighted mean difference，WMD）或者標(biāo)準(zhǔn)化均數(shù)差(standardized mean difference，SMD)及其95%的可信區(qū)間（confidenceinterval，CI）作為合并統(tǒng)計量進(jìn)行統(tǒng)計分析。 結(jié)果：共檢索到相關(guān)文獻(xiàn)119篇，符合本系統(tǒng)評價的文獻(xiàn)納入標(biāo)準(zhǔn)共6篇，1002例患者。Meta分析結(jié)果顯示，EPO能有效減少急性期DWI和FLAIR提示腦梗死的面積（分別為P=0.05，WMD=-12.11，95%CI=-24.20~-0.02和P=0.03，WMD=-13.45，95%CI=-25.67~-1.23）；但治療后1個月，EPO并未能有效改善神經(jīng)功能缺損（P=0.07，SMD=-0.88，95%CI=-1.83~0.07）、提高日常生活能力（P=0.62，WMD=-1.76，95%CI=-8.69~5.16）和改善殘疾程度（P=0.40，WMD=0.14，95%CI=-0.19~0.46）,敏感性分析結(jié)果前后保持一致。此外，EPO還顯著提高了血細(xì)胞壓積的水平（P＜0.00001，WMD=1.42，95%CI=0.93~1.90）。治療后3個月，EPO對改善神經(jīng)功能缺損仍未證明有效（P=0.99，SMD=-0.00，95%CI=-0.32~0.32），而死亡的風(fēng)險較對照組明顯增加（P=0.01，OR=1.98，95%CI=1.18~3.34）。 結(jié)論: EPO聯(lián)合常規(guī)治療腦梗死可以在一定程度上減少急性期的腦梗死面積，但尚不足以改善短期內(nèi)神經(jīng)功能缺損、提高日常生活能力和改善殘疾程度。此外，EPO治療腦梗死有顯著增加病死率和潛在的紅細(xì)胞增多的風(fēng)險。因此，EPO治療腦梗死的有效性及安全性有待更大量的隨機(jī)對照試驗進(jìn)一步研究印證。
[Abstract]:Background and objective: cerebral infarction is one of the major diseases that cause disability and death in human beings. In vivo or in vitro, erythropoietin erythropoietin (EPO) has neuroprotective effect on brain injury induced by different injury factors. EPO is used in animal models of cerebral infarction. Type A experimental research has been widely carried out, It is proved that EPO can effectively reduce the area of cerebral infarction. However, the clinical efficacy and safety of EPO in the treatment of cerebral infarction are still in the initial stage. The evaluation of this system is the first time that cochrane system is used in the evaluation of cerebral infarction at home and abroad. To evaluate the efficacy and safety of EPO in the treatment of cerebral infarction. Methods: Cochrane system was used to search the database of Cochrane library.Pubmedmedus Embase, Chinese biomedical literature database, Weipu Chinese science and technology journal database, China Zhiwang database and Wanfang database. The search time was up to March 2014. Random Control trialsl RCTs were screened by two evaluators independently for the treatment of cerebral infarction. The data were extracted and the quality of the literature was evaluated. The brain was indicated by DWI and FLAIR in the acute phase. Changes in infarct area, One month after treatment, the improvement of neurological function deficit, the ability of daily living, the degree of disability, the adverse reaction, the improvement of nerve function defect at 3 months after treatment and the mortality rate were taken as the outcome indicators. To evaluate the efficacy and safety of EPO in the treatment of cerebral infarction, the statistical software was used to describe the heterogeneity between the two groups with the help of RevMan5.2provided by the Cochrane Cooperative Network, and I2 statistics were used to describe the heterogeneity between the two groups. OddsRatio OR, weighted mean difference or standardized mean difference (SD) and its confidence interval confidence intervalation (95%) were used for statistical analysis. Results: a total of 119 literatures were retrieved. The results of Meta-analysis showed that EPO could effectively reduce the area of cerebral infarction indicated by DWI and FLAIR in acute stage (P < 0.05) WMD-12.1195 ~ (95) CI-24.20 ~ (-0.02) and P ~ (0.03) WMD-13.459 ~ (95) CI-25.67 ~ (-1.23), but no effective improvement was found one month after treatment. P0.07 SMD-0.8895 CI-1.830.07, P0.62WMD-1.76-95CI-8.695.16) and improvement of the degree of disability P0.40mWMD0.1495CI-0.190.466.EPO also significantly increased the level of hematocrit (P < 0.00001WMD1.4295CI0.931.90). The defect was not proved to be effective. The risk of death was significantly higher than that of the control group. The risk of death was 1.98 / 95CI1.180.32 / 0.34. Conclusion: EPO combined with conventional therapy can reduce the area of acute cerebral infarction to some extent, but it is not sufficient to improve the neurological deficit in the short term. In addition, EPO treatment of cerebral infarction has a significant increase in mortality and potential risk of polycythemia. Therefore, the efficacy and safety of EPO in the treatment of cerebral infarction need to be more randomized. Further research was carried out according to the experiment.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.33

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