关键词: 组织型, 纤溶酶原激活物, 脑梗塞, 血栓溶解疗法, meta分析

Abstract: Objective  To evaluate the efficacy and safety of thrombolysis with recombinant tissue plasminogen activator (rtPA) for patients with acute mild ischemic infarction. Methods  PubMed， Cochrane Central Register of Controlled Trials， Embase， Ovid， Sinomed， Wanfang Data， VIP and Chinese National Knowledge Infrastructure (CNKI) databases were searched from inception to 31st April， 2017 to comprehensively collect randomized controlled trials (RCTs) of rtPA for acute mild ischemic infarction. The relevant data were extracted by two reviewers independently. The methodological quality of the included RCTs  were assessed according to the Cochrane Handbook. Then， metaanalysis was performed by RevMan5.3 software. Pooled effect sizes were calculated using the fixed effects model when  I2＜50%，P＞0.1， otherwise the random effects model were applied. Mean difference (MD) and 95% confidence interval (CI) were applied on the measurement data and Odds risk (OR) and CI on the enumeration data. Five RCTs involving 3 070 patients met the inclusion criteria. Results  A total of 5 RCTs involving 4 401 patients were finally included. Trial group were given rtPA while no rtPA groups， i.e.， control group， were given the standard antiplatelet therapy or other therapies. The results of metaanalysis showed that more patients in the rtPA groups had mRS scores of 0 to 1 than no rtPA groups did  at 90 days after thrombolytic therapy (OR=0.80，95%CI=0.611.06，P>0.05). As to safety， rtPA group did not show a notable change of incidence of death compared with no rtPA groups after thrombolysis (OR=0.66，95%CI0.271.64，P>0.05). However， hemorrhagic transformation (HT) rates between two groups showed significance (OR=14.09，95%CI=5.3237.31，P＜0.01). Conclusion  Multiple evidence suggests that rtPA group had similar outcomes as patients receiving the standard antiplate therapy and as not receiving thrombolysis. In addition， rtPA had hemorrhagic tendency for thrombolysis purpose in patients with acute mild ischemic infarction.

Key words: tissue plasminogen activator; , brain infarction, thrombolytic therapy, metaanalysis