冠状动脉内注射阿昔单抗用于经皮冠状动脉介入治疗的系统评价  

Intracoronary abciximab administration for patients undergoing percutaneous coronary intervention:a meta-analysis of randomized trials

作　　者：尹晴[1,2] 张志刚[2] 马亚平 李斌飞[2] 

机构地区：[1]中山大学附属第一医院麻醉科,广州510080 [2]广东省中山市人民医院麻醉科,528403 [3]深圳翰宇药业股份有限公司,广东深圳518057

出　　处：《重庆医学》2013年第33期3995-3998,4001,共5页Chongqing medicine

基　　金：国家高技术研究发展计划"863计划"(2011ZX092011-006)

摘　　要：目的：系统评价阿昔单抗冠状动脉内应用与静脉内应用在经皮冠状动脉介入（PCI）治疗中的疗效和安全性。方法计算机检索PubMed、EMBASE、OVID、CBM、CNKI、VIP ，检索时间均从建库至2013年9月30日，并手工检索最近1年国内已发表的有关论文，纳入冠状动脉内应用阿昔单抗与静脉内应用阿昔单抗比较在PCI治疗中应用的所有随机对照试验（RCTs），并同时追索纳入研究的参考文献。按照Cochrane系统评价方法，由两名评价者独立对纳入研究的质量进行评价和资料提取后，采用RevMan5．1软件进行Meta分析。结果共纳入8个RCT ，10篇文献，包括4150例进行PCI治疗的患者。Meta分析结果显示：（1）阿昔单抗负荷剂量常规静脉给药组与阿昔单抗负荷剂量冠状动脉给药组相比，主要不良心脏事件（MACE）发生率和病死率在两组之间差异无统计学意义（OR＝0．78，95％ CI 0．54～1．14，P＝0．20）、（OR＝0．56，95％ CI 0．24～1．30，P＝0．18）。（2）与阿昔单抗负荷剂量静脉给药相比，阿昔单抗负荷剂量冠状动脉给药的严重出血事件发生率差异无统计学意义（OR＝1．26，95％ CI 0.78～2．02，P＝0．35）。结论与常规静脉给药相比，阿昔单抗负荷剂量冠状动脉内给药临床疗效相当，且不增加出血事件发生率。Objective To systematically evaluate the efficacy and safety of intracoronary abciximab administration as compared to intravenous in percutaneous coronary intervention （PCI） .Methods A search was conducted in PubMed ,EMBASE ,OVID ,CBM , CNKI and VIP for the randomized controlled trials （RCTs）of intracoronary abciximab administration versus intravenous in PCI , from the date of their establishment to September 30 ,2013 ,and the domestic relevant papers published in recent 1 year were also searched manually ,the bibliographies of the included studies were searched too .According to the criteria of the cochrane Hand-book ,two reviewers evaluated the quality of the included RCTs and extracted data independently ,and then the extracted data were analyzed by using RevMan 5 .1 software .Results 8 RCTs involving 10 articles with 4 150 patients who treated with PCI were in-cluded .The results of meta-analysis showed that ：（1） Compared intravenous administration and intracoronary abciximab administra-tion ,there were no significant differences in the two groups for the major adverse cardiovascular event （MACE） and the mortality （OR=0 .78 ,95% CI 0 .54-1 .14 ,P=0 .20） ,（OR=0 .56 ,95% CI 0 .24-1 .30 ,P=0 .18） .（2）Compared with intravenous adminis-tration ,intracoronary abciximab administration were not associated with any excess of major bleeding complications ：（OR=1 .26 , 95% CI 0 .78-2 .02 ,P=0 .35） .Conclusion Compared with standard abciximab regimen of intravenous bolus ,intracoronary admin-istration had equivalent effects in clinical outcomes in patients undergoing PCI ,and did not increase the incidence of bleeding events .

关 键 词：阿昔单抗 血小板糖蛋白Ⅱb IIIA受体拮抗剂 经皮介入治疗 冠状血管 静脉 Meta分析 

分 类 号：R543[医药卫生—心血管疾病]