阿加曲班联合阿替普酶治疗急性脑梗死的临床疗效和安全性的系统评价  

System Evaluation of Clinical Efficacy and Safety of Argatroban Combined with Alteplase in the Treatment of Acute Cerebral Infarction

作　　者：石岩硕 曹格溪 邱学佳 赵建群[1] 曹丽 庞国勋[1] 董占军[1] SHI Yanshuo;CAO Gexi;QIU Xuejia;ZHAO Jianqun;CAO Li;PANG Guoxun;DONG Zhanjun(Dept.of Pharmacy,Heibei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院药学部,石家庄050051

出　　处：《中国医院用药评价与分析》2023年第8期990-994,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2021年度河北省医学科学研究课题计划(No.20211721)。

摘　　要：目的:系统评价阿加曲班联合阿替普酶治疗急性脑梗死的临床疗效和安全性,为临床用药选择提供循证学支持。方法:计算机检索PubMed、中国生物医学文献数据库、中国知网、万方数据库和维普数据库等(检索时间为建库至2021年10月),收集阿加曲班联合阿替普酶(观察组)对比单纯使用阿替普酶(对照组)治疗急性脑梗死的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取和质量评价后,采用RevMan 5.3统计软件进行Meta分析。结果:共纳入18项RCT,涉及1701例患者。Meta分析结果显示,观察组患者的总有效率(RR=1.18,95%CI=1.13~1.24,P<0.00001)、痊愈率(RR=1.48,95%CI=1.23~1.79,P<0.0001)和显效率(RR=1.23,95%CI=1.07~1.41,P=0.004)均显著高于对照组,无效率(RR=0.20,95%CI=0.06~0.68,P=0.01)、美国国立卫生研究院脑卒中量表评分(MD=-1.68,95%CI=-1.99~-1.38,P<0.00001)显著低于对照组,差异均有统计学意义;两组患者不良反应发生率的差异无统计学意义(RR=0.88,95%CI=0.64~1.22,P=0.46)。结论:与单纯使用阿替普酶比较,阿加曲班联合阿替普酶治疗急性脑梗死的临床疗效更好,且安全性相当。OBJCETIVE:To systematically review the clinical efficacy and safety of argatroban combined with alteplase in the treatment of acute cerebral infarction,so as to provide evidence-based support for clinical drug selection.METHODS:PubMed,CBM,CNKI,Wanfang Data and VIP databases were retrieved to collect the randomized controlled trials(RCT)of agattriban combined with alteplase(observation group)versus alteplase alone(control group)in the treatment of acute cerebral infarction(retrieval time from database establishment to Oct.2021).After data extraction and quality evaluation,Meta-analysis was carried out by RevMan 5.3 statistical software.RESULTS:A total of 18 RCT were enrolled,including 1701 patients.Meta-analysis showed that the total effective rate(RR=1.18,95%CI=1.13-1.24,P<0.00001),recovery rate(RR=1.48,95%CI=1.23-1.79,P<0.0001)and significant effective rate(RR=1.23,95%CI=1.07-1.41,P=0.004)in the observation group were significantly higher than those in the control group,the ineffective rate(RR=0.20,95%CI=0.06-0.68,P=0.01)and the National Institutes of Health Stroke Scale score(MD=-1.68,95%CI=-1.99--1.38,P<0.00001)were significantly lower than those in the control group,with statistically significant differences.There was no significant difference in the incidence of adverse reactions between two groups(RR=0.88,95%CI=0.64-1.22,P=0.46).CONCLUSIONS:Compared with alteplase alone,agatroban combined with alteplase has better clinical efficacy and comparable safety in the treatment of acute cerebral infarction.

关 键 词：阿加曲班 阿替普酶 急性脑梗死 META分析 

分 类 号：R973[医药卫生—药品]