| Background:Stroke is one of the major cause of death and disability around the world currently, is the third major cause of death in the most industrialized countries.Effective pharmacological treatments are very limited and hardly can be applied to clinical use especially neuroprotective agents.An important neuroprotective strategy based on erythropoietin is becoming a research hot spot.Erythropoietin (EPO),a hematopoietic hormone belong to the growth hormone/prolactin cytokine family regulate red cell production. EPO has been shown to be neuroprotective in experimental stroke. Although recombinant human erythropoietin has been administered to millions of patients,and many trials studying the safety and efficacy of it for treatment of stroke have been performed, its effect in patients with stroke is still controversial.Objectives:The aims of this meta-analysis were assessing the efficacy of EPO in patients with stroke, including ischemic stroke and hemorrhagic stroke (intracerebral hemorrhage and subarachnoid hemorrhage).Methods:We searched PubMed, Embase, Cochrane Central Register of Controlled Trials databases, Web of Science, CNKI, WanFang Med Online and relevant websites from 1990 to December 2015.We included randomized controlled trials recruiting patients with the above two types of stroke.The primary outcomes were the mortality and functional outcome(using Barthel Index(BI) and modified Rankin Scale(mRS))at the end of trials. Secondary outcomes included impairment (using a stroke severity scale, such as the National Institute of Health Stroke Scale (NIHSS)), number of vasospasm and vasospasm-related infarction in subarachnoid hemorrhage (SAH) patients, serum neuron specific enolase(NSE) and Infarct volume after treatment.Results:We included 11 studies composing of 1514 participants. Extract relevant data and perform a meta—nalysis by ReviewManagers 5.3. According to the results of this Meta—nalysis, administration of EPO showed a significant increase the death by the end of the trial (OR1.79; 95%CI 1.14-2.80; p=0.01),but a non-significant improvement in poor functional outcome (OR0.97; 95%CI 0.71-1.33; p=0.87).However, EPO therapy markedly decreased NIHSS(MD-0.2.4,95%CI-2.83—1.98;P<0.00001).In addition, EPO can prominently decrease the vasospasm-related infarction incidence(OR 0.38; 95%CI 0.16-0.91; p=0.03)and the NSE concentration(MD-3.72,95%CI-5.67—1.77;P=0.0002)while show a unconspicuous effect in vasospasm (OR0.65; 95%CI 0.32-1.31; p=0.23) and the infarct volume(SMD-0.07,95%CI-0.23-0.09;P=0.38).Conclusion:Our meta-analysis indicates that EPO therapy for stroke exists safety warning while points out that EPO aids recovery of NIHSS in stroke. EPO could improve the clinical symptoms of patients with stroke but can not reduce the mortality. The neuroprotective effect of EPO remains to be developed.We hope get more neuroprotective effects by improving the molecular structure or other ways. |
PDF Full Text Request