中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (4): 667-672.doi: 10.4103/1673-5374.155443

• 综述:脑损伤修复保护与再生 • 上一篇    

西洛他唑防治症状性颅内动脉狭窄：有利于降低缺血性脑卒中的发生风险

  

  • 收稿日期:2015-02-13 出版日期:2015-04-22 发布日期:2015-04-22

Effects of cilostazol on the progression and regression of symptomatic intracranial artery stenosis: it reduces the risk of ischemic stroke

Wen-hui Zhang, Fang-fang Cai, Zhong-min Wen   

  1. Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
  • Received:2015-02-13 Online:2015-04-22 Published:2015-04-22
  • Contact: Zhong-min Wen, Ph.D., wenzhongminsz@126.com.

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摘要：

目的：系统评价西洛他唑防治症状性颅内动脉狭窄的作用与安全性。
资料来源：检索Medline (1966/2014-06), Embase (1980/2014-06), Cochrane Library (Issue 6, 2014), 中国知网全文数据库(CNKI,1995/2014-06)，Current Controlled Trials (http://controlled-trials.com), Clinical Trials.gov (http://clinicaltrials.gov), Chinese Clinical Trial Registry (http://www.chictr.org)数据库，收集关于西洛他唑防治症状性颅内动脉狭窄的随机对照研究文献。检索词：cilostazol, phosphodiesterase 3 inhibitor, atherosclerosis and ischemic stroke，对发表文献的语言和出版物无限制。
资料选择：按Cochrane协作网质量评价标准的A级或B级标准筛选随机对照试验，以西洛他唑和阿司匹林为对照评价西洛他唑对颅内动脉狭窄患者的临床疗效。使用Cochrane系统评价手册5.0.1对入选文献质量进行评价，采用Cochrane协作网提供的Revman 5.2软件进行数据统计分析。
结局评价指标：通过磁共振血流成像和经颅多普勒超声评估西洛他唑防治症状性颅内动脉狭窄的进展和逆转的临床有效性及安全性。
结果：最终有2项随机对照研究包含203例患者纳入分析。结果显示西洛他唑能明改善颅内动脉狭窄的进展(OR=0.21，95%CI: 0.09-0.47，P = 0.0002)，而已发生颅内动脉狭窄逆转无明显作用(OR=1.42，95% CI: 0.80-2.51，P = 0.24)。随访期间患者有发生头痛、胃肠功能紊乱、眩晕等不良反应，但其出血事件的发生率低于阿司匹林治疗的患者。
结论：西洛他唑能有效防止症状性颅内动脉狭窄的进展，从而有利于降低缺血性脑卒中的发生风险。

关键词: 神经再生, 系统综述, 西洛他唑, 动脉粥样硬化, 阿司匹林, 脑卒中, 缺血性, 磁共振血管造影, 经颅多普勒超声, 颅内动脉狭窄, 随机对照研究

Abstract:

OBJECTIVE: To assess the efficacy and safety of cilostazol on the progression and regression of symptomatic intracranial artery stenosis.
DATA RETRIVAL: We searched the main databases for eligible trials including Medline (from 1966 to June 2014), Embase (from 1980 to June 2014), Cochrane Library (Issue 6, 2014), Chinese National Knowledge Infrastructure (from 1995 to June 2014), Current Controlled Trials (http://controlled-trials.com), Clinical Trials.gov (http://clinicaltrials.gov), and Chinese Clinical Trial Registry (http://www.chictr.org). All studies regarding prevention and treatment of symptomatic intracranial arterial stenosis by cilostazol were collected. The Mesh or text keywords were the English words: “cilostazol, phosphodiesterase 3 inhibitor, atherosclerosis, and ischemic stroke.” No restrictions were put on publications or publication language.
SELECTION CRITERIA: Grade A or B randomized controlled trials were selected according to the quality of evaluation criteria from the Cochrane Collaboration, in which cilostazol and aspirin were used to evaluate the effects of cilostazol in the treatment of patients with symptomatic intracranial artery stenosis. The quality of study methodology was evaluated based on criteria described in Cochrane Reviewer’s Handbook 5.0.1. RevMan 5.2 software was used for data analysis.
MAIN OUTCOME MEASURES: Clinical efficacy and safety of cilostazol in stopping progression and promoting regression of symptomatic intracranial artery stenosis were measured by magnetic resonance angiography and transcranial Doppler.
RESULTS: Two randomized controlled trials with a total of 203 patients were included in this study. The results showed that while cilostazol was associated with a significantly reduced progression of intracranial artery stenosis (OR = 0.21, 95%CI: 0.09–0.47, P < 0.01), it had no beneficial effect on symptom regression (OR = 1.42, 95%CI: 0.80–2.51, P = 0.24). During the follow-up period, although some adverse effects developed, including headache, gastrointestinal disturbance, and dizziness, incidences of bleeding were lower than in aspirin-treated patients.
CONCLUSION: Cilostazol may prevent the progression of symptomatic intracranial artery stenosis, which could reduce the incidence of ischemic stroke.

Key words: nerve regeneration, systemic review, cilostazol, atherosclerosis, aspirin, stroke, ischemic, magnetic resonance angiography, transcranial Doppler, intracranial artery stenosis, follow-up studies, neural regeneration