溶栓药物治疗中国急性ST段抬高型心肌梗死患者有效性和安全性的网状Meta分析  

Effectiveness and safety of thrombolytics for patients with ST-segment elevation myocardial infarction in China:a network meta-analysis

作　　者：牛小伟[1] 张晶晶[2] 白明[3,4] 彭瑜[3,4] 张钲[3,4] NIU Xiaowei ZHANG Jingjing BAI Ming PENG Yu ZHANG Zheng(The First Clinical Medical College, Lanzhou University, Lanzhou, 730000, P.R.China Baiyin Second People＇s Hospital, Baiyin, 730900, P.R.China The Heart Center, The First Hospital, Lanzhou University, Lanzhou, 730000, P.R. China Gansu Key Laboratory of Cardiovascular Disease, Lanzhou, 730000, P.R.China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]白银市第二人民医院,甘肃白银730900 [3]兰州大学第一医院心脏中心,兰州730000 [4]甘肃省心血管疾病重点实验室,兰州730000

出　　处：《中国循证医学杂志》2017年第7期798-809,共12页Chinese Journal of Evidence-based Medicine

摘　　要：目的采用网状Meta分析方法评价溶栓药物治疗中国ST段抬高型心肌梗死(STEMI)患者的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CBM、WanFang Data和CNKI数据库,搜集溶栓药物治疗中国STEMI患者的随机对照试验(RCT),检索时限均为建库至2016年10月。由两位评价者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用WinBUGS 1.4.3及R 3.3.1软件进行网状Meta分析。结果共纳入32个RCT,包括3 164例患者,涉及7种溶栓药物。网状Meta分析结果显示:尿激酶治疗患者的溶栓再通率低于替奈普酶(rhTNK-tPA)、瑞替普酶、阿替普酶、尿激酶原(P值均<0.05),而病死率或不良心血管事件风险高于rhTNK-tPA、瑞替普酶、阿替普酶、尿激酶原(P值均<0.05),非颅内出血事件发生率也高于阿替普酶、尿激酶原(P值均<0.05)。各溶栓药物的颅内出血率差异无统计学意义(P值均>0.05)。采用累积排序概率图下面积值对干预措施疗效进行排序提示rh TNK-t PA疗效较好,尿激酶最差。结论现有证据表明国产rhTNK-tPA可能是具有良好应用前景的溶栓药物。受纳入研究数量和质量的限制,本研究结论尚需开展更多高质量研究予以证实。Objective To systematically review the effectiveness and safety of thrombolytics for treating ST- segment elevation myocardial infarction （STEMI） in China by network meta-analysis. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang Data, and CNKI databases were searched for randomized controlled trials （RCTs） of thrombolytics for Chinese patients with STEMI from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed by WinBUGS 1.4.3 software and R 3.3.1 software. Results A total of 32 RCTs involving 3 164 patients with 7 types of thrombolytics were included. The results of network meta-analysis showed： the urokinase had lower reperfusion rate than tenecteplase （rhTNK-tPA）, reteplase, alteplase, and pro-urokinase （all P values 〈0.05）, however, had higher mortality or major adverse cardiovascular events rates than rhTNK-tPA, reteplase, alteplase, and pro-urokinase （all P values 〈0.05）, and higher incidence of non-intracranial hemorrhage than those of alteplase and pro-urokinase （both P values 〈0.05）. The incidence of intracranial hemorrhage had no statistical differences among different thrombolytics （all P values 〉0.05）. The results of area under the cumulative ranking curve which ranked effectiveness of all thrombolytics showed that rhTNK-tPA had the best effectiveness and urokinase had the relative worst effectiveness among different thrombolytics. Conclusions The current evidence shows that domestic rhTNK-tPA may be effective in thrombolytic treatment. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

关 键 词：血栓溶解剂 纤溶酶原激活剂 心肌梗死 网状Meta分析 随机对照试验 

分 类 号：R542.22[医药卫生—心血管疾病]