山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (4): 28-34.doi: 10.6040/j.issn.1673-3770.1.2020.057

• 眼缺血综合征多学科精准诊疗 临床研究 • 上一篇    下一篇

动脉溶栓治疗视网膜中央动脉阻塞Meta分析

陈曦,李珊珊,赵露,尤冉,王艳玲   

  1. 陈曦, 李珊珊, 赵露, 尤冉, 王艳玲首都医科大学附属北京友谊医院 眼科, 北京 100050
  • 收稿日期:2020-06-01 出版日期:2020-07-20 发布日期:2020-08-28
  • 基金资助:
    国家自然科学基金资助(81870686);北京市自然科学基金资助(7184201);首都卫生发展科研专项资助(编号:首发2018-1-2021)

Intra-arterial thrombolysis for central retinal artery occlusion: a Meta-analysisCHEN Xi, LI Shanshan, ZHAO Lu, YOU Ran, WANG Yanling Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, ChinaAbstract:

ObjectiveTo compare the effects of intra-arterial thrombolysis and traditional treatment in central retinal artery occlusion(CRAO). MethodsWe searched the Pubmed, Embase, Clinical.gov, CNKI, and Wan Fang databases for related studies that were published up to May 14, 2020. We included clinical controls that compared intra-arterial thrombolysis and conventional treatment in CRAO. The random effect model and R software were used for data analysis. ResultsWe identified seven studies including 563 CRAO patients. Meta-analysis results of two randomized controlled trials(RCTs)showed that there was no significant difference in visual acuity improvement between CRAO patients treated with arterial thrombolysis therapy and those with conventional therapy(RR: 1.17, 95% confidence interval 0.80-1.72, P=0.409). Meta-analysis results of five cohort studies indicated that compared with conventional therapy, arterial thrombolysis therapy significantly improved visual acuity(RR: 1.86, 95% confidence interval 1.43-2.41, P<0.001). The difference between thrombolysis therapy and conventional therapy may be caused by the different treatment time windows in patients. Concerning the adverse reactions after treatment, two RCTs and five cohort studies showed that the adverse reactions in the thrombolysis group are significantly higher than those in the conventional treatment group. ConclusionAlthough intra-arterial thrombolysis therapy has therapeutic potential in CRAO patients, there is still insufficient clinical evidence to prove its effectiveness and safety. Further studies with a large sample and high quality RCTs are required.   

  1. Key words: Central retinal artery occlusion;
    Intra-arterial thrombolysis;
    Systematic review;
    Meta-analysis视网膜中央动脉阻塞(central retinal artery occlusion, CRAO)常常迅速导致严重的视力损害甚至完全丧失［1］, 病理过程为视网膜中央动脉阻塞导致视网膜急性缺血缺氧［2］, 是缺血性卒中的眼部表现形式之一［1-3］。早期治疗对于挽救CRAO患者视功能十分关键［4］, 直接影响此类患者的视功能预后［5］。CRAO治疗的目的是尽快恢复视网膜血液循环及其功能［6］。现有对CRAO传统治疗的方法主要包括有扩张血管、解除痉挛及吸氧治疗, 增加视网膜血供, 改善组织缺血缺氧［7］;
    降眼压治疗, 增加视网膜血液灌注［8］;
    按摩眼球, 驱使栓子进入小支血管。
  • Received:2020-06-01 Online:2020-07-20 Published:2020-08-28

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464

摘要： 目的 动脉溶栓治疗与传统方法治疗视网膜中央动脉阻塞(CRAO)疗效对比分析。 方法 检索Pubmed、Embase、Clinical.gov、中国知网以及万方数据库,纳入动脉溶栓治疗与传统方法治疗CRAO的临床对照研究,文献发表的时间截止为2020年5月14日。采用随机效应模型并使用R软件进行数据分析。 结果 共纳入7篇文献,入组563例CRAO患者。2篇随机对照试验的Meta分析结果显示经动脉溶栓治疗的CRAO患者与传统的治疗方法相比视力提高并无统计学差异(RR: 1.17,95%CI 0.80~1.72,P=0.409),5篇队列研究的Meta分析结果显示动脉溶栓治疗较传统治疗患者视力明显提高(RR: 1.86,95%CI 1.43~2.41,P<0.001)。引起两者不同的原因可能为动脉溶栓治疗和传统治疗纳入患者治疗时间窗不同。治疗后的不良反应方面,2篇随机对照试验研究和5篇队列研究的Meta分析结果均显示溶栓组不良反应发生率明显高于传统治疗。 结论 虽然动脉溶栓治疗对CRAO的患者表现出一定的应用前景,但是尚缺乏足够的临床证据证明其有效性和安全性,今后还需要大样本高质量的随机对照研究来验证。

关键词: 视网膜中央动脉阻塞, 动脉溶栓, 系统评价, Meta分析

Abstract: Objective To compare the effects of intra-arterial thrombolysis and traditional treatment in central retinal artery occlusion(CRAO). Methods We searched the Pubmed, Embase, Clinical.gov, CNKI, and Wan Fang databases for related studies that were published up to May 14, 2020. We included clinical controls that compared intra-arterial thrombolysis and conventional treatment in CRAO. The random effect model and R software were used for data analysis. Results We identified seven studies including 563 CRAO patients. Meta-analysis results of two randomized controlled trials(RCTs)showed that there was no significant difference in visual acuity improvement between CRAO patients treated with arterial thrombolysis therapy and those with conventional therapy(RR: 1.17, 95% confidence interval 0.80-1.72, P=0.409). Meta-analysis results of five cohort studies indicated that compared with conventional therapy, arterial thrombolysis therapy significantly improved visual acuity(RR: 1.86, 95% confidence interval 1.43-2.41, P<0.001). The difference between thrombolysis therapy and conventional therapy may be caused by the different treatment time windows in patients. Concerning the adverse reactions after treatment, two RCTs and five cohort studies showed that the adverse reactions in the thrombolysis group are significantly higher than those in the conventional treatment group. Conclusion Although intra-arterial thrombolysis therapy has therapeutic potential in CRAO patients, there is still insufficient clinical evidence to prove its effectiveness and safety. Further studies with a large sample and high quality RCTs are required.

Key words: Central retinal artery occlusion, Intra-arterial thrombolysis, Systematic review, Meta-analysis

中图分类号: 

  • R774.1
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