低剂量秋水仙碱预防中风：系统综述和荟萃分析。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-02-01 DOI:10.1016/j.jstrokecerebrovasdis.2024.108167

Giovani Noll MD, MSc , Wyllians Vendramini Borelli MD, PhD , Gabriel Paulo Mantovani MD , Sheila Cristina Ouriques Martins MD, PhD , Luciano A. Sposato MD, MBA

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引用次数: 0

摘要

背景：尽管有优化的预防策略，脑卒中的发病率仍然是一个值得关注的问题。秋水仙碱在全球范围内显示出改善中风预防的潜力。目的：从随机对照试验（rct）的系统评价和荟萃分析（SRMAs）中总结秋水仙碱与常规治疗或安慰剂预防脑卒中的疗效和安全性评估。方法：我们通过在Pubmed、Embase和Cochrane图书馆进行系统搜索，根据综述指南的首选报告项目对srma进行了综述。使用RevMan Web进行统计分析。采用I²统计量评估异质性。结果：纳入32项研究。秋水仙碱显著降低卒中复发率(RR 0.46；95% ci 0.41-0.52；P < 0.0001；我² = 0%;或0.44,95% ci 0.36-0.55；P < 0.0001；I² = 0%)，但胃肠道不良事件增加(RR 1.54, 95% CI 1.33-1.79；P < 0.0001；我² = 63%;或1.60,95% ci 1.08-2.38；p = 0.0007;我² = 82%)。大多数srma（93.75%）报告卒中发生率降低（RR 0.26-0.54）， 65.22%报告胃肠道事件增加（RR 1.05-2.66）。在死亡率、感染率和癌症发病率方面没有观察到显著差异。总体质量评价为高的占28.12%，中等的占6.25%，低的占40.06%，极低的占25%。数据主要来自7项低偏倚风险的随机对照试验。结论：中等质量的证据支持秋水仙碱在高危人群中预防卒中的益处和合理的安全性。然而，中风并不是分析研究的主要终点。直接评估秋水仙碱预防中风的随机对照试验是有根据的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Low-dose colchicine for stroke prevention: A systematic overview of systematic reviews and meta-analyses

Background

Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally.

Aims

To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention.

Methods

We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics.

Results

Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95 % CI 0.41–0.52; p < 0.0001; I² = 0 %; OR 0.44, 95 % CI 0.36–0.55; p < 0.0001; I² = 0 %) but increased gastrointestinal adverse events (RR 1.54, 95 % CI 1.33–1.79; p < 0.0001; I² = 63 %; OR 1.60, 95 % CI 1.08–2.38; p = 0.0007; I² = 82 %). Most SRMAs (93.75 %) showed reduced stroke incidence (RR 0.26–0.54), while 65.22 % reported increased gastrointestinal events (RR 1.05–2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12 %, moderate in 6.25 %, low in 40.06 %, and critically low in 25 % of SRMAs. Data were primarily derived from seven RCTs with low risk of bias.

Conclusions

Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.