阿替普酶和替奈普酶溶栓治疗对急性次大块肺栓塞的疗效及安全性的Meta分析  

The effectiveness and safety of tenecteplase and alteplase thrombolysis treatment in patients with acute submassive pulmonary embolism:a meta analysis

作　　者：安娜 胡中保 肖晶 

机构地区：[1]湖北省鄂州市鄂钢医院内一科,436000

出　　处：《重庆医学》2015年第20期2799-2804,共6页Chongqing medicine

摘　　要：目的评价溶栓治疗急性次大块肺栓塞（PE）的疗效和安全性。方法计算机检索阿替普酶和替奈普酶用于次大块PE患者的随机对照试验，时间截止2014年3月。由2位研究者独立评价纳入研究的质量、提取数据，统计分析采用RevMan5．z．7软件进行。结果共纳入8篇研究，总计676例次大块PE患者，其中溶栓组331例，对照组345例。分析显示：溶栓治疗并不能降低患者的早期病死率（RR=0．66；95％CI：0．31～1．40；P=0．28），可能不会降低溶栓后PE的再发生（RR=0．55；95％CI：0．21～1．40；P=0．21），也未增加主要出血事件发生率（RR=1．23；95％CI：0．57～2．68；P=0．60），但会增加次要出血事件发生风险（RR=3．88；95％CI：1．40～10．72；P=0．009）。结论溶栓治疗可能并不能改善次大块PE患者预后，而且会增加出血的风险，溶栓治疗对次大块PE患者预后影响仍需进一步证实。Objective To evaluate the efficacy and safety of thrombolysis treatment for acute massive pulmonary embolism （PE）. Methods Systematic literature retrieval was carried out to obtain randomized controlled trials of alteplase and tenecteplase for patients with submassive PE before March 2014. Methodological quality assessment and data collection were performed by two individual reviewers. A meta analysis was performed by RevMan 5.2.7 software. Results Totally 8 trials with 676 cases of patients with submassive PE were included, among which 331 cases were in thrombolysis group and 345 cases were in control group. Meta a- nalysis showed., thrombolytic therapy did not reduce early mortality （RR = 0.66 ;95CI% ： 0.31 -- 1.40 ; P = 0.28）, might not reduce PE recurrence after thrombolysis （RR= 0. 55;95CI% ：0.21-1.40;P= 0.21）, or did not increase the incidence of major bleeding e- vents （RR= 1.23 ; 95CI%; 0. 57 -- 2.68 ; P = 0.60）, but it could increase the risk of minor bleeding events （RR = 3.88 ; 95CI% ： 1.40--10.72;P= 0. 009）. Conclusion Thrombolytic therapy may not improve the prognosis of patients with submassive PE,it will increase the risk of bleeding. Limited by the quality of the studies,publication bias,and other aspects, thrombolytic therapy for pa- tients with submassive PE remains to be confirmed.

关 键 词：META分析 溶栓治疗 阿替普酶 替奈普酶 次大块肺栓塞 

分 类 号：R563.5[医药卫生—呼吸系统]