米诺环素在急性卒中中的应用：随机对照试验的系统评价与荟萃分析及试验序贯分析。
完整摘要 · 中文译文
背景：米诺环素因其抗炎、抗凋亡及稳定血脑屏障的作用，已成为急性卒中潜在的辅助神经保护治疗。我们旨在评估米诺环素在急性卒中（包括缺血性和出血性亚型）中的疗效及部分安全性相关结局。 方法：本系统评价和荟萃分析遵循系统评价和荟萃分析优先报告条目指南。检索主要数据库截至2026年3月20日，纳入比较米诺环素与对照或标准治疗在急性卒中中应用的随机对照试验。风险比（RR）和均数差以95%置信区间（CI）合并。使用ROB 2评估偏倚风险，使用推荐分级的评估、制定与评价评估证据确定性，并使用试验序贯分析评估稳健性。 结果：共分析9项试验，纳入2186名参与者。米诺环素显著降低急性缺血性卒中3个月美国国立卫生研究院卒中量表评分（均数差-2.43，95% CI -4.42至-0.44；P = .0169），但在脑出血中未见此效应。3个月功能独立在缺血性卒中中显示有利信号（改良Rankin量表0至2分：风险比1.40，95% CI 1.05-1.86；P = .0219），而定义为改良Rankin量表0至1分的良好结局未显著改善。Barthel指数在缺血性卒中中也支持米诺环素，尽管总体结果无统计学显著性。死亡率、复发性血管事件、出血 agic型转化、血肿体积、血肿周围水肿和基质金属蛋白酶-9水平未见显著改变。试验序贯分析提示证据不足以得出确定性结论。 结论：米诺环素可能改善急性缺血性卒中的神经功能恢复；然而，由于存在显著异质性、低确定性证据以及试验序贯分析尚无定论，这些发现仍属探索性。需要更大规模的标准化试验。
完整摘要 · 英文原文
BACKGROUND: Minocycline has emerged as a potential adjunctive neuroprotective therapy in acute stroke owing to its anti-inflammatory, antiapoptotic, and blood-brain barrier-stabilizing effects. We aimed to evaluate the efficacy and selected safety-related outcomes of minocycline in acute stroke, including ischemic and hemorrhagic subtypes. METHODS: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major databases were searched through March 20, 2026 for randomized controlled trials comparing minocycline with control or standard care in acute stroke. Risk ratios (RRs) and mean differences were pooled with 95% confidence intervals (CIs). Risk of bias was assessed using ROB 2, certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation, and robustness using trial sequential analysis. RESULTS: Nine trials including 2186 participants were analyzed. Minocycline significantly reduced 3-month National Institutes of Health Stroke Scale scores in acute ischemic stroke (mean difference -2.43, 95% CI -4.42--0.44; P = .0169), but not in intracerebral hemorrhage. Functional independence at 3 months showed a favorable signal in ischemic stroke (modified rankin scale 0 to 2: risk ratio 1.40, 95% CI 1.05-1.86; P = .0219), while favorable outcome defined as modified rankin scale 0 to 1 was not significantly improved. Barthel Index also favored minocycline in ischemic stroke, although overall results were not statistically significant. Mortality, recurrent vascular events, hemorrhagic transformation, hematoma volume, perihematomal edema, and Matrix Metalloproteinase-9levels were not significantly altered. Trial sequential analysis indicated insufficient evidence for definitive conclusions. CONCLUSION: Minocycline may improve neurological recovery in acute ischemic stroke; however, these findings remain exploratory because of substantial heterogeneity, low-certainty evidence, and inconclusive trial sequential analysis. Larger standardized trials are required.