1
|
Dong MX, Hu QC, Shen P, Pan JX, Wei YD, Liu YY, Ren YF, Liang ZH, Wang HY, Zhao LB, Xie P. Recombinant Tissue Plasminogen Activator Induces Neurological Side Effects Independent on Thrombolysis in Mechanical Animal Models of Focal Cerebral Infarction: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0158848. [PMID: 27387385 PMCID: PMC4936748 DOI: 10.1371/journal.pone.0158848] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/22/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Recombinant tissue plasminogen activator (rtPA) is the only effective drug approved by US FDA to treat ischemic stroke, and it contains pleiotropic effects besides thrombolysis. We performed a meta-analysis to clarify effect of tissue plasminogen activator (tPA) on cerebral infarction besides its thrombolysis property in mechanical animal stroke. METHODS Relevant studies were identified by two reviewers after searching online databases, including Pubmed, Embase, and ScienceDirect, from 1979 to 2016. We identified 6, 65, 17, 12, 16, 12 and 13 comparisons reporting effect of endogenous tPA on infarction volume and effects of rtPA on infarction volume, blood-brain barrier, brain edema, intracerebral hemorrhage, neurological function and mortality rate in all 47 included studies. Standardized mean differences for continuous measures and risk ratio for dichotomous measures were calculated to assess the effects of endogenous tPA and rtPA on cerebral infarction in animals. The quality of included studies was assessed using the Stroke Therapy Academic Industry Roundtable score. Subgroup analysis, meta-regression and sensitivity analysis were performed to explore sources of heterogeneity. Funnel plot, Trim and Fill method and Egger's test were obtained to detect publication bias. RESULTS We found that both endogenous tPA and rtPA had not enlarged infarction volume, or deteriorated neurological function. However, rtPA would disrupt blood-brain barrier, aggravate brain edema, induce intracerebral hemorrhage and increase mortality rate. CONCLUSIONS This meta-analysis reveals rtPA can lead to neurological side effects besides thrombolysis in mechanical animal stroke, which may account for clinical exacerbation for stroke patients that do not achieve vascular recanalization with rtPA.
Collapse
Affiliation(s)
- Mei-Xue Dong
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Qing-Chuan Hu
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Peng Shen
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun-Xi Pan
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - You-Dong Wei
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Yun Liu
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Fei Ren
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Hong Liang
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai-Yang Wang
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- * E-mail:
| |
Collapse
|
2
|
Liu B, Li Q, Wang J, Xiang H, Ge H, Wang H, Xie P. A Highly Similar Mathematical Model for Cerebral Blood Flow Velocity in Geriatric Patients with Suspected Cerebrovascular Disease. Sci Rep 2015; 5:15771. [PMID: 26497612 PMCID: PMC4620558 DOI: 10.1038/srep15771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/01/2015] [Indexed: 11/21/2022] Open
Abstract
Cerebral blood flow velocity(CBFV) is an important parameter for study of cerebral hemodynamics. However, a simple and highly similar mathematical model has not yet been established for analyzing CBFV. To alleviate this issue, through TCD examination in 100 geriatric patients with suspected cerebrovascular disease (46 males and 54 females), we established a representative eighth-order Fourier function Vx(t) that simulates the CBFV. The measured TCD waveforms were compared to those derived from Vx(t), an illustrative Kolmogorov-Smirnov test was employed to determine the validity. The results showed that the TCD waves could been reconstructed for patients with different CBFVs by implementing their variable heart rates and the formulated maximum/minimum of Vx(t). Comparisons between derived and measured TCD waveforms suggest that the two waveforms are very similar. The results confirm that CBFV can be well-modeled through an eighth-order Fourier function. This function Vx(t) can be used extensively for a prospective study of cerebral hemodynamics in geriatric patients with suspected cerebrovascular disease.
Collapse
Affiliation(s)
- Bo Liu
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China.,Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China.,Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing 400016, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing 400016, China
| | - Jisheng Wang
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Hu Xiang
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Hong Ge
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Hui Wang
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China
| | - Peng Xie
- Department of Neurology, The Third Hospital of Mianyang, Mianyang, Sichuan 621000, China.,Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China.,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing 400016, China
| |
Collapse
|