目的 评价注射用灯盏花素联合化学药治疗急性缺血性脑卒中的疗效和安全性，为临床治疗提供循证参考。方法 计算机检索中国期刊全文数据库、中国生物医学文献数据库、万方数据知识服务平台、维普生物医学数据库、PubMed、Cochrane Library、Springer Link、Web of Science等中英文数据库，收集注射用灯盏花素联合化学药在急性缺血性脑卒中治疗中的随机对照（RCTs），检索时限为建库至2023年6月。筛选文献、提取资料、评价文献质量后，采用Stata 17.0软件进行网状Meta分析。结果 共纳入29项RCTs，共计2 930例患者；涉及8种干预措施，分别为注射用灯盏花素＋依达拉奉、注射用灯盏花素＋奥扎格雷、注射用灯盏花素＋常规治疗、注射用灯盏花素、依达拉奉、奥扎格雷、常规治疗、复方丹参。网状Meta分析结果显示，在临床疗效方面，注射用灯盏花素与3种不同化学药分别联合的干预措施较单独使用常规治疗、复方丹参、灯盏花素治疗急性缺血性脑卒中的总有效率更高；注射用灯盏花素＋依达拉奉、注射用灯盏花素＋奥扎格雷2种干预措施较单独使用依达拉奉治疗急性缺血性脑卒中的总有效率更高；注射用灯盏花素＋奥扎格雷较单独使用奥扎格雷治疗急性缺血性脑卒中的总有效率更高；但注射用灯盏花素与3种不同化学药分别联合的干预措施之间两两比较差异无统计学意义（P＞0.05）。累积概率曲线下面积（SUCRA）排名前3的为注射用灯盏花素＋奥扎格雷、注射用灯盏花素＋依达拉奉和注射用灯盏花素＋常规治疗。在不良反应方面，相对于单独使用化学药治疗，注射用灯盏花素与3种不同化学药分别联合治疗急性缺血性脑卒中的不良反应发生率差异均无统计学意义（P＞0.05），且注射用灯盏花素与3种不同化学药分别联合的干预措施之间两两比较差异亦无统计学意义（P＞0.05）。SUCRA排名前3的为复方丹参、注射用灯盏花素＋常规治疗和注射用灯盏花素＋奥扎格雷。结论 相对于单独使用化学药治疗，注射用灯盏花素联合化学药可显著提高治疗急性缺血性脑卒中的总有效率，且不会增加不良反应发生的风险，安全性较高。但由于纳入文献量少，文献质量偏低，未来还需更多大样本、高质量、随机双盲试验以验证本研究结果。

Objective To evaluate the efficacy and safety of Breviscapine Injection combined with western medicine in the treatment of acute cerebral infarction, and to provide evidence-based reference for clinical treatment. Methods Chinese and English databases such as CNKI, Chinese Biomedical Literature Database, Wanfang Data Knowledge Service Platform, VIP, PubMed, Cochrane Library, Springer Link, Web of Science were searched by computer. RCTs of Breviscapine Injection combined with western medicine in the treatment of acute cerebral infarction were collected, and the search time was established to June 2023. After literature screening, data extraction and literature quality evaluation, Stata 17.0 software was used to perform mesh Meta-analysis. Results A total of 29 RCTs were included, with a total of 2 930 patients. Eight interventions were involved, namely, breviscapine & edaravone for injection, breviscapine & ozagrel for injection, breviscapine & conventional treatment, edaravone, ozagrel for injection, Breviscapine Injection, compound danshen and conventional treatment. The results of mesh Meta-analysis showed that in terms of clinical efficacy, the total effective rate of Breviscapine Injection combined with three different western medicines was higher than that of conventional treatment alone, compound danshen and breviscapine in the treatment of acute cerebral infarction. The total effective rate of breviscapine & edaravone for injection and breviscapine & ozagrel for injection was higher than that of edaravone alone in the treatment of acute cerebral infarction. The total effective rate of breviscapine plus ozagrel for injection was higher than that of ozagrel alone in the treatment of acute cerebral infarction. However, there was no significant difference between the intervention measures of Breviscapine Injection and three different western medicines (P > 0.05). The top 3 areas under the Cumulative Probability Curve (SUCRA) were Breviscapine Injection & ozagrel, Breviscapine Injection & edaravone and Breviscapine Injection & conventional treatment. In terms of adverse reactions, compared with western medicine alone, there was no statistically significant difference in the incidence of adverse reactions between injection breviscapine and three different western medicines in the treatment of acute cerebral infarction (P > 0.05), and there was no statistically significant difference between pin-wise comparison of intervention measures between injection breviscapine and three different western medicines in the treatment of acute cerebral infarction (P > 0.05). The top 3 areas under the Surface Under the Cumulative Ranking Curve (SUCRA) were compound danshen, Breviscapine Injection & conventional treatment and Breviscapine Injection & ozagrel. Conclusion Compared with western medicine alone, Breviscapine Injection combined with western medicine can significantly improve the total effective rate in the treatment of acute cerebral infarction, and does not increase the risk of adverse reactions, and has high safety.

R971

中央高校基本科研业务专项（2020-JYB-ZDGG-072）