Yanan Wang, Linrui Huang, Jingjing Li, Jiangang Duan, Xiaohua Pan, Bijoy K Menon, Craig S Anderson, Ming Liu, Simiao Wu
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引用次数: 0
摘要
背景：皮质类固醇在实践中经常用于治疗神经系统疾病患者。然而，其对中风和创伤性脑损伤（TBI）的影响仍存在争议。本研究旨在系统回顾和评价皮质类固醇治疗脑卒中和脑外伤的疗效和安全性。方法：我们在Ovid-Medline和Ovid-Embase数据库中检索随机对照试验（RCTs）和队列研究，评估皮质类固醇治疗缺血性卒中、脑出血（ICH）、蛛网膜下腔出血（SAH）或脑外伤患者的疗效和安全性。治疗干预为皮质类固醇，对照组为安慰剂或常规护理。结局指标为死亡、功能结局和不良事件。我们计算了效应大小的优势比（OR）和95%置信区间（CI），使用随机效应模型合并结果，并通过I2统计量评估异质性。结果：我们纳入了47项研究（41项随机对照试验和6项队列研究）。9项研究纳入了缺血性卒中患者（n = 2806）， 6项研究纳入了脑出血患者（n = 1229）， 1项研究同时纳入了缺血性卒中患者（n = 13）和脑出血患者（n = 27）， 10项研究纳入了SAH患者（n = 1318）， 21项研究纳入了TBI患者（n = 12414）。地塞米松是使用最多的皮质类固醇（28项研究）。皮质类固醇可降低缺血性卒中后3个月的死亡风险(n = 1791；31% vs. 26%, OR 0.77, 95% CI 0.62-0.95；df = 1, I2 = 0%)和ICH后(1项研究；n = 850；44%对27% (OR 0.48, 95% CI 0.35-0.64)，对SAH后1个月的死亡没有影响(1项研究；n = 140；22%对32%，OR 1.73, 95% CI 0.81-3.68)， TBI后6个月死亡风险增加(n = 10,755；23%对27%，OR 1.20, 95% CI 1.10-1.32；df = 6, I2 = 0%)。合并分析发现，皮质类固醇分别对缺血性卒中、脑出血、SAH或TBI后的功能结局没有显著影响。结论：皮质类固醇降低了脑卒中患者的死亡风险，如血栓切除后大动脉闭塞的患者，但增加了脑外伤后的死亡风险，对功能结局没有影响。需要进一步的试验来确定可能受益于皮质类固醇的个体中风患者。系统评价注册：国际前瞻性系统评价注册（CRD42023474473）。
Efficacy and safety of corticosteroids for stroke and traumatic brain injury: a systematic review and meta-analysis.
Background: Corticosteroids are frequently used in practice to treat patients with neurological disorders. However, its effect for stroke and traumatic brain injury (TBI) remains controversial. This study aimed to systematically review and evaluate efficacy and safety of corticosteroids for the treatment of stroke and TBI.
Methods: We searched Ovid-Medline and Ovid-Embase databases for randomised controlled trials (RCTs) and cohort studies evaluating the efficacy and safety of corticosteroids in patients with ischaemic stroke, intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) or TBI. The treatment intervention was corticosteroid, and the control was placebo or routine care. Outcome measures were death, functional outcomes and adverse events. We calculated odds ratio (OR) and 95% confidence interval (CI) for the effect size, pooled the results using random-effects modelling, and assessed heterogeneity by I2 statistic.
Results: We identified 47 studies (41 RCTs and 6 cohort studies). Nine studies enrolled patients with ischaemic stroke (n = 2806), 6 studies for ICH (n = 1229), 1 study recruited both ischaemic stroke (n = 13) and ICH (n = 27), 10 studies for SAH (n = 1318) and 21 studies for TBI (n = 12,414). Dexamethasone was the most used corticosteroid (28 studies). Corticosteroids reduced risk of death at 3 months after ischaemic stroke (n = 1791; 31% vs. 26%, OR 0.77, 95% CI 0.62-0.95; df = 1, I2 = 0%) and after ICH (1 study; n = 850; 44% vs. 27%, OR 0.48, 95% CI 0.35-0.64), had no effect on death at 1 month after SAH (1 study; n = 140; 22% vs. 32%, OR 1.73, 95% CI 0.81-3.68), and increased risk of death at 6 months after TBI (n = 10,755; 23% vs. 27%, OR 1.20, 95% CI 1.10-1.32; df = 6, I2 = 0%). The pooled analyses found no significant effect of corticosteroids on functional outcome after ischaemic stroke, ICH, SAH or TBI, respectively.
Conclusion: Corticosteroids reduced the risk of death and in selected patients with stroke, such as those with large artery occlusion after thrombectomy, but increased the risk of death after TBI, had no effect on functional outcomes. Further trials are needed to identify individual stroke patients who may benefit from corticosteroids.
Systematic review registration: International Prospective Register of Systematic Reviews (CRD42023474473).
期刊介绍：
Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies. The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.
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