ST段抬高型心肌梗死急诊介入冠状动脉内应用尿激酶原有效与安全性的Meta分析  

Efficacy and safety of intracoronary prourokinase administration during emergency percutaneous coronary intervention in ST-segment elevation myocardial infarction:a Meta analysis

作　　者：冯娟 闫奎坡[2] 朱翠玲[2] 朱明军[2] 孙彦琴[2] 徐亚洲[2] 刘刚[2] 郭雨晴 FENG Juan;YAN Kuipo;ZHU Cuiling;ZHU Mingjun;SUN Yanqin;XU Yazhou;LIU Gang;GUO Yuqing(Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学,450000 [2]河南中医药大学第一附属医院心脏中心

出　　处：《心肺血管病杂志》2021年第4期368-375,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金青年基金支持项目(81303073);河南中医学院一附院院内博士项目(2012KJ32);河南中医学院省属科研业务专项(2014KYYWF-YQ12);河南省科技攻关重点项目(112102310317);河南省高校科技创新团队支持计划(13IRTSTHN012);河南省中医药防治心血管疾病创新型科技团队(C20130050);国家人社部留学人员支助项目(2010412);河南省首批青苗人才培养项目(201816);河南省科技攻关项目(192102310161,182102310291);河南省中医药科学研究专项课题(2017ZY2017);河南省中医药科学研究专项课题(2016ZY3003,2016ZY2051,2017ZY2017);河南省中医药科学研究专项(20-21ZY1015;20-21ZY2004);国家重点研发计划(2019YFC1710000,2019YFC1710001,2019YFC1710003)。

摘　　要：目的:系统评价冠状动脉内靶向应用重组人尿激酶原(rhPro-UK)对ST段抬高型心肌梗死急诊PCI患者心肌灌注、不良心血管事件的影响及安全性。方法:检索中英文数据库发表的相关随机对照试验,评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:纳入18篇文章,1893例受试者;Meta分析显示,尿激酶原组不良心血管事件发生率低于对照组(RR=0.47,95%CI:0.39-0.57,P<0.00001);尿激酶原组出血风险与对照组相比,差异无统计学意义(RR=1.18,95%CI:0.90-1.53,P=0.23);尿激酶原组心肌梗死溶栓试验血流3级获得率(RR=1.12,95%CI:1.06-1.20,P=0.0003)、心肌灌注3级获得率(RR=1.19,95%CI:1.06-1.34,P=0.003)和血栓积分0-1分获得率(RR=1.45,95%CI:1.15-1.83,P=0.002)高于对照组;尿激酶原组无复流或慢血流发生率低于对照组(RR=0.49,95%CI:0.32-0.73,P=0.0005);尿激酶原组LVEF高于对照组(MD=1.85,95%CI:1.382.32,P<0.00001);尿激酶原组LVEDD低于对照组(MD=-1.57,95%CI:-1.89--1.24,P<0.00001)。结论:冠状动脉内靶向应用尿激酶原能提高STEMI急诊PCI患者靶血管和心肌灌注水平,降低梗死后心肌重构,改善心功能和预后,减少术后不良心血管事件,且不增加出血风险。Objective:To review the efficacy and safety of intracoronary prourokinase administration on myocardial perfusion,major adverse cardiovascular events.Methods:The computer retrieved databases for related trials from the establishment of the database to August 2020.Reviewers assessed risk of bias of included studies,then,meta-analysis was performed by using RevMan 5.3 software.Results:18 articles and 1893 subjects were included.Meta analysis showed experimental group was better than control group in reducing the incidence of MACE(RR=0.47,95%CI:0.39-0.57,P<0.00001)and without increasing the risk of bleeding(RR=1.18,95%CI:0.90-1.53,P=0.23).Experimental group was better than control group in improving the rate of TFG3(RR=1.12,95%CI:1.06-1.20,P=0.0003)and TMPG3(RR=1.19,95%CI:1.06-1.34,P=0.003).Experimental group was better than control group in reducing no/slow reflow(RR=0.49,95%CI:0.32-0.73,P=0.0005).Experimental group was better than control group in increasing LVEF(MD=1.85,95%CI:1.382.32,P<0.00001),and reducing LVEDD(MD=-1.57,95%CI:-1.89--1.24,P<0.00001).Conclusions:Intracoronary prourokinase administration can increase target vascular and myocardial perfusion levels,reduce myocardial remodeling after infarction,improve heart function and prognosis,reduce MACE without increasing the risk of bleeding.

关 键 词：冠状动脉内溶栓 重组人尿激酶原 经皮冠状动脉介入治疗 急性ST段抬高型心肌梗死 META分析 

分 类 号：R54[医药卫生—心血管疾病]