直接经皮冠状动脉介入治疗联合冠状动脉内注射重组人尿激酶原或替罗非班对ST段抬高型心肌梗死患者疗效与安全性的Meta分析  

Efficacy and safety of intracoronary recombinant human pro-urokinase or Tirofiban injection during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction:a Meta analysis

作　　者：杜淑珍 剡冬冬 张钲[2,3,4] DU Shu-zhen;YAN Dong-dong;ZHANG Zheng(The First Clinical Medical College of Lanzhou University,Lanzhou 730000,China;Department of Cardiology,the First Hospital of Lanzhou University,Lanzhou 730000,China;Heart Center,the First Hospital of Lanzhou University,Lanzhou 730000,China;Gansu Provincial Clinical Research Center for Cardiovascular Diseases,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院心内科,甘肃兰州730000 [3]兰州大学第一医院心脏中心,甘肃兰州730000 [4]甘肃省心血管病临床医学研究中心,甘肃兰州730000

出　　处：《中国介入心脏病学杂志》2024年第9期516-527,共12页Chinese Journal of Interventional Cardiology

基　　金：兰州大学第一医院院内基金项目(ZX-62000002-2021-346)。

摘　　要：目的直接经皮冠状动脉介入治疗(PPCI)期间冠状动脉内注射重组人尿激酶原(rhPro-UK)或替罗非班有助于改善冠状动脉微循环灌注。本研究旨在探索ST段抬高型心肌梗死(STEMI)患者PPCI期间冠状动脉内注射rhPro-UK或替罗非班的有效性和安全性。方法计算机检索PubMed,Ovid-MEDLINE,Embase,Web of Science,Cochrane Library,clinical trials.gov,中国知网(CNKI),维普网(VIP),中国生物医学文献服务系统(SinoMed),万方数据知识服务平台(WANFANG)数据库,纳入STEMI患者PPCI期间冠状动脉内注射rhPro-UK或替罗非班的随机对照试验(RCT)及队列研究。检索时间为从建库至2023年11月27日。文献筛选、资料提取及偏倚风险评估均由2名研究者独立完成。采用RevMan 5.4软件对数据进行Meta分析。结果共纳入12项研究,包括1721例患者,冠状动脉内注射rhPro-UK 864例(试验组),注射替罗非班857例(对照组)。Meta分析显示,与对照组相比,试验组可改善PPCI术后冠状动脉微循环灌注,包括心肌梗死溶栓治疗试验(TIMI)血流分级Ⅲ级及TIMI心肌灌注分级(TMPG)Ⅲ级比例显著高于对照组(OR 1.83,95%CI 1.36~2.46,P<0.0001;OR 2.38,95%CI 1.22~4.66,P=0.010);校正TIMI帧计数(cTFC)显著低于对照组(MD–2.43,95%CI–2.94~–1.92,P<0.00001);ST段回落率(STR)≥70%高于对照组(OR 1.93,95%CI 1.01~3.68,P=0.050)。显著降低术后1个月主要不良心血管事件(MACE)发生率(OR 0.54,95%CI 0.35~0.82,P=0.004)。改善心功能,术后1个月左心室射血分数(LVEF)高于对照组(MD1.71,95%CI0.04~3.38,P=0.050)。缩小心肌梗死面积,术后肌酸激酶同工酶MB型(CK-MB)峰值低于对照组(MD–74.16,95%CI–83.59~–64.74,P<0.00001)。两组间出血事件发生率比较(OR1.18,95%CI0.64~2.16,P=0.600),差异无统计学意义。结论STEMI患者PPCI期间,冠状动脉内注射rhPro-UK较替罗非班可有效改善患者冠状动脉微循环灌注、心功能,缩小心肌梗死面积,降低术后1个月MACE发生率,同时两�Objective Intracoronary administration of Tirofiban or recombinant human pro-urokinase(rhPro-UK)during primary percutaneous coronary intervention(PPCI)has been shown to improve coronary artery microcirculation perfusion.This study aims to explore the efficacy and safety of intracoronary rhPro-UK or Tirofiban in patients with ST-segment elevation myocardial infarction(STEMI)undergoing PPCI.Methods The PubMed,Ovid-MEDLINE,Embase,Web of Science,Cochrane Library,clinical trials.gov,CNKI,WANFANG,VIP,SinoMed,databases were searched for randomized controlled trials(RCTs)or cohort researches of the Intracoronary injection of rhPro-UK or Tirofiban during PPCI in STEMI patients from inception to 27th November 2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis of data was performed by RevMan 5.4.Results There were 12 studies involving 1721 patients were included,with 864 in the rhPro-UK group(experimental group)and 857 in the Tirofiban group(control group).Meta-analysis showed that compared to the control group,intracoronary rhPro-UK significantly improved postoperative myocardial blood flow perfusion,including higher proportions of thrombolysis in myocardial infarction(TIMI)gradeⅢand TIMI myocardial perfusion grades(TMPG)gradeⅢ(OR 1.83,95%CI 1.36-2.46,P<0.0001;OR 2.38,95%CI 1.22-4.66,P=0.010);And significantly lower corrected TIMI frame count(cTFC)(MD–2.43,95%CI–2.94-–1.92,P<0.00001);ST-segment resolution(STR)≥70%was higher than that of control group(OR 1.93,95%CI 1.01-3.68,P=0.050).There was a significant reduction in major adverse cardiovascular events(MACE)one month postoperatively(OR 0.54,95%CI 0.35-0.82,P=0.004).Improving cardiac function one month after surgery,higher left ventricular ejection fraction(LVEF)(MD 1.71,95%CI 0.04-3.38,P=0.050).Reducing the size of the myocardial infarction,the postoperative peak value of CK-MB was lower than that of control group(MD–74.16,95%CI–83.59-–64.74,P<0.00001).The incidence of blee

关 键 词：ST段抬高型心肌梗死 重组人尿激酶原 替罗非班 直接经皮冠状动脉介入治疗 META分析 

分 类 号：R54[医药卫生—心血管疾病]