冠脉内注射阿昔单抗用于急性冠脉综合征经皮介入治疗的Meta分析  

Intracoronary Administration of Abciximab for Acute Coronary Syndrome Patients undergoing Percutaneous Coronary Intervention:a Meta-analysis

作　　者：尹晴[1,2] 屠伟峰[2] 马亚平 张乃丽[1] 许四洋[4] 

机构地区：[1]南方医科大学,广州510015 [2]广州军区广州总医院,广州510010 [3]深圳翰宇药业股份有限公司,广东深圳518057 [4]南方医科大学图书馆,广州510015

出　　处：《中国药房》2013年第16期1468-1473,共6页China Pharmacy

基　　金：国家高技术研究发展计划重大新药创制专项资助项目(No.2011ZX092021-006)

摘　　要：目的:系统评价阿昔单抗冠脉内应用与静脉内应用在急性冠脉综合征(ACS)经皮介入治疗(PCI)中的疗效和安全性。方法:计算机检索Pubmed、EMbase、OVID、中国生物医学文献数据库、中国期刊全文数据库和中文科技期刊数据库,纳入冠脉内与静脉内应用阿昔单抗在ACS的PCI治疗中的所有随机对照试验(RCTs)。按照Cochrane系统评价方法进行评价和资料提取后,采用Rev Man 5.1统计软件进行Meta分析。结果:共纳入7项RCT,包括3343例患者。Meta分析结果显示,与阿昔单抗初始剂量常规静脉给药相比,阿昔单抗初始剂量冠脉内给药能降低给药后主要不良心脏事件发生率[RR=0.57,95%C(I0.38,0.88),P=0.01]、再次心肌梗死发生率[RR=0.63,95%CI(0.41,0.96),P=0.03]、靶血管血运重建发生率[RR=0.51,95%CI(0.33,0.80),P<0.01];但对于死亡率两组相当,差异无统计学意义[RR=0.77,95%CI(0.55,1.07),P=0.12]。与阿昔单抗初始剂量静脉给药相比,阿昔单抗初始剂量冠脉给药的轻微出血事件[RR=0.92,95%CI(0.73,1.17),P=0.51]及严重出血事件[RR=1.26,95%CI(0.78,2.02),P=0.35]发生率并无明显差异。结论:与常规静脉内给药相比,阿昔单抗初始剂量冠脉内给药能更好地改善接受PCI治疗的ACS患者的临床预后,且不增加出血事件发生率。OBJECTIVE： To systematically evaluate the efficacy and safety of intracoronary administration vs. intravenous administration of abciximab in percutaneous coronary intervention （PCI） for acute coronary syndrome （ACS）. METHODS： Retrieved from Pubmed, EMbase, OVID, CBM, CNKI and VIP, randomized controlled trials（RCTs）of intracoronary administration vs. intravenous administration of abciximab in PCI for ACS were retrieved. According to the criteria of the Cochrane Handbook, and then the extracted data were analyzed by using Rev Man 5.1 software. RESULTS： 7 RCTs involving 3 343 patients. The results of Meta-analysis showed that： compared with intravenous administration, intracoronary administration of abciximab could decrease the major adverse cardiovascular event （MACE） [RR=0.57,95%CI（0.38,0.88）,P=0.01], the incidence of re-infarction （MI） [RR= 0.63,95% CI （0.41,0.96）, P：0.03] and revascularization （TVR） [RR：0.51,95% CI （0.33,0.80）, P〈0.01]. But for the mortality, there were no significant differences between two groups, there was no statistical significance [RR=0.77,95% CI （0.55,1.07）,P= 0.12]. Compared with intravenous administration, intracoronary administration of abciximab resulted in minor bleeding complications [R%=0.92, 95% CI （0.73, 1.17）, P=0.51] and severe bleeding [RR= 1.26, 95% CI （0.78, 2.02）, P=0.35]. CONCLUSION： Compared with conventional intravenous administration, intracoronary administration of abciximab could improve clinical prognosis of ACS patients receiving PCI treatment, and doesn＇t increase the incidence of bleeding events.

关 键 词：阿昔单抗 急性冠脉综合征 经皮介入治疗 冠脉 静脉 META分析 

分 类 号：R452[医药卫生—治疗学]