r-PA与rt-PA静脉溶栓治疗急性ST段抬高型心肌梗死效果与安全性的meta分析  

Efficacy and Safety of Intravenous Thrombolytic Therapy with Recombinant Human Tissue-type Plasminogen Kinase Derivatives( r-PA) and Recombinant Human Tissue Type Plasminogen Activator( rt-PA ) for the Treatment of Acute ST Segment Elevation Myocardial Inf

作　　者：李艳君[1] 唐艳红[1] 

机构地区：[1]武汉大学人民医院心血管内科,武汉430060

出　　处：《临床误诊误治》2015年第10期80-86,共7页Clinical Misdiagnosis & Mistherapy

摘　　要：目的评价注射用重组人组织型纤溶酶原激酶衍生物（r-PA）和注射用重组人组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）的效果与安全性。方法计算机检索Pub Med、EMbase、ISI Web of Knowledge、中国知网、维普和万方数据库建库至2015年4月收录的关于r-PA和rt-PA静脉溶栓治疗急性STEMI的随机对照试验（RCT）研究,对符合纳入标准的文献提取数据并行meta分析。结果共纳入14篇RCT研究,共1375例患者,其中高质量研究3篇,低质量研究11篇。试验组（r-PA组）给予10 m U静脉注射,30 min后重复上述剂量;对照组（rt-PA组）给予15 mg静脉注射,继而30 min内静脉滴注50 mg,后60 min内再滴注35 mg,总剂量达100 mg。meta分析结果显示：r-PA组溶栓后冠状动脉再通率明显高于rt-PA组[RR=1.17,95%CI 1.10~1.25,P〈0.01],溶栓后出血发生率无显著差异[RR=1.06,95%CI 0.80~1.41,P=0.69],溶栓后再灌注心律失常发生率无显著差异[RR=0.82,95%CI 0.65~1.03,P=0.08],溶栓后再梗死发生率无显著差异[RR=0.48,95%CI 0.15~1.58,P=0.23],溶栓后病死率无显著差异[RR=0.67,95%CI 0.40~1.12,P=0.13]。结论 r-PA静脉溶栓治疗急性STEMI的效果明显优于rt-PA溶栓治疗,但在安全性方面二者并无显著差异。Objective To evaluate the efficacy and safety of recombinant human tissue-type plasminogen kinase derivatives and recombinant human tissue type plasminogen activator thrombolytic therapy in acute ST segment elevation myocardial infarction. Methods Such databases as Pub Med,EMbase,the ISI Web of Knowledge Databases,CNKI,VIP and Wan fang were searched from their establishment to April 2014 for collecting the randomized controlled trials（ RCT） about r-PA versus rt-PA for the treatment of acute ST segment elevation myocardial infarction. Meta-analysis was performed using the RevMan5. 2 software. Results 14 studies involving 1375 patients were included. The results of meta-analysis showed that： compared with the rt-PA group,in r-PA group,recanalization rate after thrombolysis was higher [RR = 1. 17,95% CI 1. 10-1. 25,P 0. 01],blood loss rate had no significant difference [RR = 1. 06,95% CI 0. 80-1. 41,P = 0. 69],arrhythmia incidence had no significant difference [RR = 0. 82,95% CI 0. 65-1. 03,P = 0. 08 ],re-infarction rate had no significant difference [RR = 0. 48,95% CI 0. 15-1. 58,P = 0. 23 ],the mortality rate had no significant difference [RR = 0. 67,95% CI 0. 40-1. 12,P = 0. 13]. Conclusion The efficacy of r-PA intravenous thrombolytic therapy for acute ST segment elevation myocardial infarction is significantly better than rt-PA thrombolytic therapy and there is no significant difference in terms of safety at onset.

关 键 词：心肌梗死 血栓溶解疗法 注射用重组人组织型纤溶酶原激酶衍生物 注射用重组人组织型纤溶酶原激活剂 META分析 

分 类 号：R542.22[医药卫生—心血管疾病]