降压治疗对脑卒中二级预防的荟萃分析

发布时间：2018-08-04 09:54

【摘要】：研究背景脑卒中是造成全世界人民死亡的一个主要来源。有着高患病率,高病死率、高致残率以及高复发率,严重危害着人类的健康。在中国,每年有150万~200万的新发脑卒中患者[1],而约四分之一的患者为再发性的脑卒中。据流行病学的调查,高血压是脑卒中最重要的独立危险因素。随着我国人民老龄化,高血压患者在逐年不断增加,脑卒中的发生率也在逐年上升。2010年我国的高血压防治指南指出,有效控制血压可以减少脑卒中事件。目前有充足的证据表明控制血压是脑卒中一级预防最有效的方法,然而国内外专门针对脑卒中二级预防降压治疗药物的临床试验并不多,而不同药物作用是否一致也有待进一步明确。本论文综合降压治疗对脑卒中二级预防的证据进行荟萃分析,并探讨降压治疗的有效性和安全性。研究目的荟萃分析降压治疗对脑卒中二级预防的疗效。研究方法运用计算机检索Cochrane图书馆、Pubmed及EMbase外文医学数据库和中国知网,维普中文科技期刊中文数据库中临床对照试验资料库。时间选取2013年12月份以前的有关不同类型降压药物在脑卒中二级预防疗效与安全性的随机对照试验,评价文献质量,搜索公开发表的有关降压药治疗脑卒中患者预防再发的随机对照试验的文献,从中提取卒中事件数,心血管事件,心肌梗死事件等数据资料。使用从Cochrane协作网下载的Revman5.2软件辅助STATA 11.0软件统计并分析降压药物对卒中复发事件以及心血管事件再发的疗效性。研究结果本次meta分析一共纳入9项临床随机对照试验,10个亚组,共37474名入选受试者,每一项试验的Jadad评分均5分。统计效应量显示降压治疗能减少脑卒中再发的OR值为0.74(95%CI,0.60,0.90,P0.00001),减少心血管事件发生的OR值为0.79(95%CI,0.67,0.93,P0.0001),降压药物治疗对心肌梗死发生率无影响OR值为0.85(95%CI,0.75,0.97,P=0.09)。每个临床中均有部分人因药物副反应而中途退出试验。结论降压治疗能降低脑卒中再发,同时降低心血管事件发生率。
[Abstract]:Background Stroke is a major cause of death worldwide. With high prevalence, high mortality, high disability rate and high recurrence rate, serious harm to human health. In China, there are 1.5 million ~ 2 million new stroke patients every year, and about 1/4 of the patients are recurrent stroke. According to epidemiological surveys, hypertension is the most important independent risk factor for stroke. With the aging of the people in China, hypertension patients are increasing year by year, and the incidence of stroke is also rising year by year. The 2010 guidelines for the Prevention and treatment of Hypertension in China point out that effective blood pressure control can reduce the incidence of stroke. At present, there is sufficient evidence that blood pressure control is the most effective method for the primary prevention of stroke. However, there are few clinical trials at home and abroad devoted to the treatment of secondary prophylaxis and depressurization of stroke. Whether the action of different drugs is consistent or not needs to be further clarified. In this paper, the evidence of secondary prevention of stroke was analyzed by comprehensive hypotension therapy, and the efficacy and safety of hypotension therapy were discussed. Objective to analyze the efficacy of hypotensive therapy in the secondary prevention of stroke. Methods computer search was used to search the clinical controlled trial databases of Cochrane library in foreign language medicine database, EMbase database, Chinese knowledge network and Chinese database of Chinese scientific journals. A randomized controlled trial on the efficacy and safety of different types of antihypertensive drugs in the secondary prevention of stroke was conducted before December 2013 to evaluate the quality of the literature. To search for published literature on randomized controlled trials on stroke prevention in patients with stroke treated with antihypertensive drugs, and to extract data on stroke events, cardiovascular events, myocardial infarction events, and so on. STATA 11.0 software was used to analyze the curative effect of antihypertensive drugs on recurrent stroke events and cardiovascular events. Results the meta analysis included 9 randomized controlled trials, 10 subgroups and 37474 subjects. The Jadad scores of each trial were 5. The statistical effects showed that the OR value of antihypertensive therapy was 0.74 (95CI0.600.90 / P0.00001), the OR value of reducing cardiovascular events was 0.79 (95CI0.670.93 / P0.0001), and the OR value of antihypertensive drug treatment was 0.85 (95CI0.750.97 / P0.09). In each case, some people quit the trial because of side effects. Conclusion hypotensive therapy can reduce the recurrence of stroke and the incidence of cardiovascular events.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R544.1

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