目的 系統(tǒng)評價中國人群分別予以標(biāo)準(zhǔn)劑量（0.9 mg/kg）和低劑量（0.6 mg/kg）阿替普酶治療急性缺血性腦卒中的臨床療效和安全性，為臨床提供循證醫(yī)學(xué)證據(jù)。方法 計算機檢索EMbase、PubMed、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫（CBM）、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、維普中文科技期刊數(shù)據(jù)庫（VIP）和萬方數(shù)據(jù)庫，收集急性缺血性腦卒中患者分別采用標(biāo)準(zhǔn)劑量和低劑量阿替普酶靜脈溶栓的隨機對照研究（RCT），檢索時限均為建庫—2018年3月，提取數(shù)據(jù)后采用RevMan 5.2軟件進行Meta-分析。結(jié)果 共納入16個RCTs，1 745例患者。Meta-分析結(jié)果顯示：標(biāo)準(zhǔn)劑量組在總有效率（RR=0.95，95%CI=0.92~0.99，P=0.01）、降低NIHSS評分（SMD=0.27，95%CI=0.14~0.40，P<0.001）、提高預(yù)后良好率（RR=0.85，95%CI=0.78~0.92，P=0.000 2）和降低腦出血率（RR=0.59，95%CI=0.38~0.92，P=0.02）方面均優(yōu)于低劑量組，差異均有統(tǒng)計學(xué)意義（P<0.05），但是病死率（RR=1.23，95%CI=0.84~1.80，P=0.28）差異無統(tǒng)計學(xué)意義。結(jié)論 現(xiàn)有證據(jù)表明，標(biāo)準(zhǔn)劑量阿替普酶靜脈溶栓具有更好的臨床療效，但可能增加溶栓后腦出血的風(fēng)險，臨床醫(yī)務(wù)人員應(yīng)予以重點關(guān)注。

Objective To evaluate the clinical efficacy and safety of alteplase with standard dose (0.9 mg/kg) and low dose (0.6 mg/kg) in the treatment of acute ischemic stroke in Chinese patients, and provide the dvidence-based medical evidence for the clinic. Methods Randomized controlled trial (RCT) of standard dose and low dose of alteplase in the treatment of acute ischemic stroke in Chinese patients were searched from PubMed, EMbase, CBM, CNKI,VIP and WanFang Database by computer, data were collected from inception to March 2018. After extracting data, Meta-analysis was conducted by RevMan 5.2 software. Results A total of 16 RCTs and 1 745 patients were included. Meta-analysis showed that standard dose group were better than low dose group in improvomg total efficiency (RR=0.95, 95%CI=0.92-0.99, P=0.01), reducing NIHSS score (SMD=0.27, 95%CI=0.14-0.40, P<0.001), improving the rate of good prognosis (RR=0.85, 95%CI=0.78-0.92, P=0.000 2), and reducing the incidence of cerebral hemorrhage (RR=0.59, 95%CI=0.38-0.92, P=0.02), the differences were all statistically significant (P<0.05), but there was no statistically significant difference in mortality rate (RR=1.23, 95%CI=0.84-1.80, P=0.28). Conclusion The results of this study shows that, alteplase with standard dose intravenous thrombolysis has better clinical efficacy, but may increase the risk of intracerebral hemorrhage after thrombolysis. Clinical medical personnel should pay attention to it.