肝素与低分子肝素治疗ST段抬高性心肌梗死有效性和安全性的Meta分析  

Meta-analysis of Effectiveness and Safety of Heparin and Low Molecular Heparin for ST-segment Elevation Myocardial Infarction

作　　者：李小华[1] 孙毅毅[2] 

机构地区：[1]四川遂宁市第一人民医院,遂宁市629000 [2]成都医学院,成都市610083

出　　处：《中国药房》2011年第24期2272-2275,共4页China Pharmacy

摘　　要：目的:采用循证医学的方法对肝素治疗ST段抬高性心肌梗死(STEMI)的有效性和安全性进行系统评价。方法:系统检索Cochrane图书馆、Medline、EMBase、CNKI、CBMdisc数据库,手工检索《中华心血管病杂志》等8种杂志,纳入有关肝素治疗STEMI的随机对照试验(RCT),并采用RevMan5.0软件进行数据分析。结果:最终纳入8个RCT,28179例患者。低分子肝素组与普通肝素组比较,病死率[RR=0.92,95%CI(0.84,1.01),P=0.09]无统计学意义,但病死率/非致死性再梗死率[RR=0.81,95%CI(0.76,0.88),P<0.00001]、再梗死率[RR=0.66,95%CI(0.59,0.74),P<0.00001]低于普通肝素组,血运重建率[RR=0.84,95%CI(0.73,0.97),P=0.02]、出血率[RR=1.42,95%CI(1.21,1.68),P<0.0001]高于普通肝素组,差异有统计学意义。结论:肝素治疗STEMI的有效性和安全性评价中,低分子肝素显示了其优越性,但是出血率明显高于普通肝素组,因此可选用低分子肝素对STEMI患者进行抗凝治疗,但应注意出血引发的严重并发症的发生。OBJECTIVE： To evaluate the effectiveness and safety of heparin and low molecular heparin for ST-segment elevation myocardial infarction （STEMI） with evidence-based medicine. METHODS： Clinical controlled trials were retrieved from Cochrane Library, Medline, EMBase, CNKI, CBMdisc. We also searched 8 kinds of Chinese journals by hand, such as Chinese Journal of Cardiology. Randomized controlled trials （RCT） on heparin in the treatment of STEMI were included and analyzed by RevMan 5.0. RESULTS： 8 RCTs involoving 28 179 were included, there was no statistical significance in mortality between low molecular heparin and normal heparin [RR=0.92, 95%CI（0.84,1.01）,P=0.09]. The mortality/nonfatal recurrent MI [RR=0.81, 95%CI（0.76,0.88）,P0.000 01], recurrent MI [RR=0.66, 95%CI（0.59,0.74）,P0.000 01] of low molecular weight heparin group were lower than normal heparin group. The recirculation [RR=0.84, 95%CI（0.73,0.97）,P=0.02] and bleeding rate [RR=1.42, 95%CI（1.21,1.68）,P0.000 1] of low molecular weight heparin group were higher than normal heparin group. There was statistical significances. CONCLUSION： In effectiveness and safety evaluation of heparin for STEMI, low-molecular weight heparin is prior to normal heparin while the bleeding rate of low-molecular weight heparin group is higher than normal heparin group. Low-molecular weight heparin is suitable for STEMI patients but we should pay attention to the occurrence of severe bleeding.

关 键 词：肝素 低分子肝素 急性心肌梗死 META分析 

分 类 号：R541[医药卫生—心血管疾病]