目的 评估依达拉奉联合丙戊酸钠治疗卒中后癫痫的有效性及安全性。方法 计算机检索 the Cochrane Library、PubMed、Embase、Web of Science、CNKI、万方数据库、VIP数据库，检索时限均为自建库起至2023年5月。收集依达拉奉联合丙戊酸钠对比丙戊酸钠单药治疗癫痫的随机对照试验，使用RoB 2工具评估所纳人文献的偏倚风险，使用RevMan 5。4软件进行Meta分析。结果 纳入13篇文献，总计1 092例患者。Meta分析结果显示，联合治疗组的有效率显著高于丙戊酸钠组[RR=0。18，95％CI(0。13，0。22)，P＜0。01]。且不良反应发生率更低[RR=0。73，95％CI(0。48，1。13)，P=0。16]。联合治疗组患者发作频次[MD=-0。30，95％CI(-0。43，-0。11)，P＜0。01]、发作持续时间[MD=-0。81，95％CI(-0。89，-0。72)，P＜0。01]均显著低于丙戊酸钠组;炎症因子肿瘤坏死因子-α[MD=-8。00，95％CI(-9。15，-6。84)，P＜0。01]。白细胞介素-2[MD=-10。19，95％CI(-14。61，-5。78)，P＜0。01]、白细胞介素-8[MD=-5。6，95％CI(-6。48，-4。73)，P＜0。01]均显著低于丙戊酸钠组;联合治疗组癫痫患者神经元特异性烯醇化酶(NSE)水平治疗后1个月[MD=-4。73，95％CI(-4。99，-4。46)，P＜0。01]、3 个月[MD=-2。10，95％CI(-3。26，-0。95)，P＜0。01]、6 个月[MD=-1。31，95％CI(-2。35，-0。27)，P＜0。01]显著优于丙戊酸钠组。12个月后NSE水平[MD=0。06，95％CI(-0。07，0。19)，P=0。34]无明显差别。结论 依达拉奉联合丙戊酸钠治疗卒中后癫痫，可提高患者癫痫控制率，缩短发作频率及发作持续时间，可降低患者体内炎症因子水平，促进NSE水平降低，提高其生活质量，具有一定的安全性。
The Meta-analysis of efficacy and safety of edaravone combined with sodium valproate in treatment of post-stroke epilepsy
Objective To systematically evaluate the efficacy and safety of the combination therapy of sodium valproate and edaravone in the treatment of post-stroke epilepsy(PSE).Methods The Cochrane Library,PubMed,Embase,Web of Science,CNKI,Wanfang database,and VIP databases were searched from the time of inception to May 2023.Randomized controlled trials of edaravone plus valproate versus valproate monotherapy for epilepsy were collected,the risk of bias of the included studies was assessed using the RoB 2 tool,and Meta-analyses were performed using RevMan 5.4 software.Results 13 studies with a total of 1 092 patients were included.The results showed that the response rate was significantly higher in the combination group than in the sodium valproate group[RR=0.18,95％CI(0.13 to 0.22),P＜0.01].The incidence of adverse reactions was lower[RR=0.73,95％CI(0.48 to 1.13),P=0.16].The seizure frequency[MD=-0.30,95％CI(-0.43,-0.11),P＜0.01]and duration of seizures[MD=-0.81,95％CI(-0.89,-0.72),P＜0.01]in the combined treatment group were significantly lower than those in the sodium valproate group.The inflammatory factors tumor necrosis factor-α[MD=-8.00,95％CI(-9.15,-6.84),P＜0.01],interleukin-2[MD=-10.19,95％CI(-14.61,-5.78),P＜0.01],interleukin-8[MD=-5.6,95％CI(-6.48,-4.73),P＜0.01]were significantly lower than those in the sodium valproate group.The neuron-specific enolase(NSE)level in patients with epilepsy in the combination treatment group was significantly better than that of the sodium valproate group at 1 month[MD=-4.73,95％CI(-4.99,-4.46),P＜0.01],3 months[MD=-2.10,95％CI(-3.26,-0.95),P＜0.01],and 6 months after treatment[MD=-1.31,95％CI(-2.35,-0.27),P＜0.01].There was no significant difference in NSE levels[MD=0.06,95％CI(-0.07,0.19),P=0.34]after 12 months.Conclusion Edaravone combined with sodium valproate in the treatment of post-stroke epilepsy can improve the epilepsy control rate of patients,shorten the frequency and duration of seizures,reduce the level of inflammatory factors in patients,promote the reduction of NSE levels,and improve their quality of life,which has a certain safety.
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