不同溶栓药物治疗肺血栓栓塞症随机对照试验的meta分析  

Comparison of different thrombolytics in treatment of pulmonary thromboembolism: a meta-analysis

作　　者：秦志强[1] 王辰[2] 

机构地区：[1]广西壮族自治区人民医院呼吸内科,南宁530021 [2]首都医科大学附属北京朝阳医院北京呼吸疾病研究所,100020

出　　处：《国外医学（呼吸系统分册）》2005年第1期1-4,共4页Section of Respiratory System Foreign Medical Sciences

基　　金：国家"十五"科技攻关计划课题"肺栓塞规范化诊治方法的研究"资助项目 (2 0 0 1BA70 3B13 )

摘　　要：目的　根据现有临床研究评价重组组织型纤溶酶原激活剂 (rt PA)与链激酶 (SK) /尿激酶(UK)治疗肺血栓栓塞症 (PTE)的有效性和安全性。方法　从MEDLINE和中国生物医学数据库光盘检索以人急性大面积和次大面积PTE为研究对象、比较rt PA与SK/UK治疗PTE效果的随机对照试验(RCT) ,并对RCT结果进行meta分析。结果　共 5项RCT 314例PTE入选 ,其中rt PA组 14 8例 ,SK和UK组 16 6例。与SK/UK治疗比较 ,rt PA降低PTE病死率和复发率的合并比数比 (OR合并)分别是 1.6 1(95 %CI为 0 .5 1～ 5 .11)和 0 .6 9(95 %CI为 0 .2 2～ 2 .13) ;溶栓治疗开始后 2小时平均肺动脉压的合并标准化均数差值是 - 4 .34mmHg (95 %CI- 6 .2 2～ - 2 .4 5 ) ;rt PA降低并发重要出血率OR合并为 1.0 0 (95 %CI为 0 .5 7～ 1.74 )。结论　rt PA治疗PTE的疗效和安全性与SK/UK相近 ,但rt PA能更快降低平均肺动脉压。Objective To pool the data of randomized controlled trials(RCT)that compared recombinant tissue-type plasminogen activator (rt-PA) with urokinase (UK) or streptokinase (SK) in human pulmonary thromboembolism (PTE) and evaluate the efficacy and safety of different thrombolytics.Methods After search of the RCTs that studied of the efficacy or safety,or both,of rt-PA and UK or SK in massive or submassive PTE from MEDLINE and CBM discs, A meta-analysis was employed to evaluate the results of the RCTs.Results Five RCTs comprising 314 cases were included.Comparing with the UK and SK,the total odds ratio (OR) of mortality and recurrence in rt-PA were 1.61 (95% CI 0.51 ～ 5.11 ) and 0.69 (95% CI 0.22 ～ 2.13 ) respectively.The combined standardized mean difference of mean pulmonary arterial pressure 2h post-therapy was -4.34 mmHg (95% CI -6.22 ～ -2.45 ).The total OR of major bleeding in rt-PA was 1.00 (95% CI 0.57 ～ 1.74 ).Conclusions Different thrombolytics share the similar efficacy and safety except rt-PA reduces the pulmonary arterial pressure more quickly.

关 键 词：溶栓药物 治疗 肺血栓栓塞症 随机对照试验 META分析 

分 类 号：R563.5[医药卫生—呼吸系统]