阿替普酶与尿激酶初始溶栓治疗中老年急性肺栓塞患者治愈率与安全性的Meta分析  

Recovery Rate and Safety of Initial Thrombolytic Therapy with Alteplase and Urokinase in the Treatment of Middleaged Patients with Acute Pulmonary Embolism:a meta-analysis

作　　者：王秋桐[1] 吴爽[1] 刘颖[1] 王晓宇[1] 陈玲[1] 赵瑞 WANG Qiutong;WU Shuang;LIU Ying;WANG Xiaoyu;CHEN Ling;ZHAO Rui(Cangzhou Medical College•Hebei•China,Cangzhou 061001,China;Department of Pharmaceutical Affairs,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]沧州医学高等专科学校,河北省沧州市061001 [2]首都医科大学北京朝阳医院药事部,北京市100020

出　　处：《实用心脑肺血管病杂志》2020年第7期88-95,共8页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景急性肺栓塞(APE)是一种高误诊率、高病死率、预后差的呼吸系统疾病,且多发于中老年人群。鉴于APE病情多突发且急危,临床建议给予阿替普酶或尿激酶初始溶栓治疗,但目前涉及两种药物疗效的对比研究结果各异。目的系统评价阿替普酶与尿激酶初始溶栓治疗中老年APE患者的治愈率及安全性。方法计算机检索中文数据库(中国知网、维普网、中国生物医学文献数据库、万方数据知识服务平台)、英文数据库(Medline、EMBase、PubMed、The Cochrane Library、Clinical Trials),采用主题词与自由词相结合的检索方式,搜集相关文献。根据文献纳入与排除标准筛选相关文献,并完成数据提取和质量评价,采用Review Manager 5.3软件进行Meta分析。结果最终共纳入16篇高质量文献,共涉及患者1197例。Meta分析结果显示:阿替普酶组治愈率高于尿激酶组〔OR=3.72,95%CI(2.65,5.21),P<0.00001〕。阿替普酶组死亡率低于尿激酶组〔OR=0.44,95%CI(0.23,0.84),P=0.01〕。欧美患者中阿替普酶组与尿激酶组死亡率比较,差异无统计学意义〔OR=1.27,95%CI(0.33,4.89),P=0.73〕。亚裔患者中阿替普酶组死亡率低于尿激酶组〔OR=0.32,95%CI(0.15,0.69),P=0.004〕。阿替普酶组出血率低于尿激酶组〔OR=0.49,95%CI(0.36,0.67),P<0.001〕。阿替普酶组轻微性出血率低于尿激酶组〔OR=0.49,95%CI(0.34,0.70),P<0.0001〕。阿替普酶组致命性出血率低于尿激酶组〔OR=0.50,95%CI(0.26,0.94),P=0.03〕。欧美患者中阿替普酶组与尿激酶组致命性出血率比较,差异无统计学意义〔OR=0.77,95%CI(0.23,2.55),P=0.67〕。亚裔患者中阿替普酶组致命性出血率低于尿激酶组〔OR=0.42,95%CI(0.20,0.90),P=0.03〕。漏斗图评价结果显示,根据阿替普酶与尿激酶治疗APE的出血率纳入的文献存在发表偏倚的可能性小,根据阿替普酶与尿激酶治疗APE的死亡率纳入的文献存在一定程度的发表偏倚。结论与尿�Background Acute pulmonary embolism(APE)is a respiratory disease with high misdiagnosis rate,mortality and poor prognosis,which occurs frequently in the aged.Considering the condition of APE is sudden and urgent,initial thrombolysis with alteplase or urokinase is recommended for clinical treatment.However,the results of comparative studies involving the efficacy of the two drugs are different.Objective To systematically evaluate the efficacy and safety of initial thrombolytic therapy with alteplase and urokinase in the treatment of elderly patients with APE.Methods The combination of subject words and free words were used to collect relevant literatures derived from Chinese databases(CNKI,CQVIP,China Biology Medicine Disc,Wanfang Data)and English databases(Medline,EMBase,PubMed,The Cochrane Library,Clinical Trials)online.According to the inclusion and exclusion criteria,the relevant literatures were screened,data extraction and quality evaluation were completed,and the Meta-analysis was performed by Review Manager 5.3 software.Results Finally,16 high-quality literatures were included,involving 1197 patients.Meta-analysis results showed that the recovery rate of alteplase group was statistically significantly higher than that of urokinase group〔OR=3.72,95%CI(2.65,5.21),P<0.00001〕,while the mortality rate of alteplase group was statistically significantly lower than that of urokinase group〔OR=0.44,95%CI(0.23,0.84),P=0.01〕.There was no statistically significant difference in the mortality between altiplase group and urokinase group for the European and American patients〔OR=1.27,95%CI(0.33,4.89),P=0.73〕.The mortality of the Asian patients treated with alteplase was statistically significantly lower than that in urokinase group〔OR=0.32,95%CI(0.15,0.69),P=0.004〕.Hemorrhaging rate of alteplase group was statistically significantly lower than that of urokinase group〔OR=0.49,95%CI(0.36,0.67),P<0.001〕.Mild hemorrhage rate of alteplase group was statistically significantly lower than that of urokinase gr

关 键 词：肺栓塞 组织型纤溶酶原激活物 阿替普酶 尿激酶型纤溶酶原激活物 尿激酶 溶栓 治愈率 安全性 META分析 

分 类 号：R563.5[医药卫生—呼吸系统]