瑞替普酶对比阿替普酶治疗中国急性心肌梗死患者疗效的Meta分析
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摘要
目的:系统评价瑞替普酶对比阿替普酶治疗中国急性心肌梗死患者的疗效,为临床提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、Medline、中国期刊全文数据库、中文科技期刊数据库、万方数据等,并手工检索相关文献,检索时限为1995年1月-2018年9月,收集瑞替普酶(试验组)对比阿替普酶(对照组)治疗中国急性心肌梗死患者疗效(溶栓再通率)的随机对照试验(RCT),对符合纳入标准的研究进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3软件对溶栓再通率进行Meta分析。结果:共纳入23项RCT,合计1 742例患者。Meta分析结果显示,试验组患者溶栓再通率显著高于对照组,差异有统计学意义[OR=0.61,95%CI(0.50,0.73),P<0.001],根据溶栓再通成功时间进行亚组Meta分析,结果显示,试验组患者溶栓后1 h[OR=0.38,95%CI(0.25,0.58),P<0.001]、1.5 h[OR=0.44,95%CI(0.25,0.79),P=0.006]、2 h[OR=0.62,95%CI(0.42,0.92),P=0.02]的溶栓再通率均显著高于对照组,差异均有统计学意义。结论:中国急性心肌梗死患者使用瑞替普酶的溶栓再通率优于阿替普酶。
OBJECTIVE:To evaluate therapeutic efficacy of reteplase versus alteplase in the treatment of acute myocardial infarction in China,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from Cochrane library,PubMed,Embase,Medline,CJFD,CSJD,Wanfang database by computor,etc.,also by manual search,RCTs about therapeutic efficacy(recanalization rate of thrombolysis)of reteplase(trial group)versus alteplase(control group)in the treatment of acute myocardial infarction in China were collected from Jan. 1995 to Sept. 2018. After data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0,Meta-analysis was performed for recanalization rate of thrombolysis by using Rev Man 5.3 software. RESULTS:A total of 23 RCTs were included,involving 1 742 patients. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group was significantly higher than control group,with statistical significance [OR=0.61,95%CI(0.50,0.73),P<0.001]. Sub-group Meta-analysis was performed according to the successful time of thrombolysis. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group 1 h [OR=0.38,95%CI(0.25,0.58),P<0.001],1.5 h[OR=0.44,95%CI(0.25,0.79),P=0.006] and 2 h [OR=0.62,95%CI(0.42,0.92),P=0.02] after thrombolysis were significantly higher than control group,with statistical significance. CONCLUSIONS:The recanalization rate of thrombolysis by reteplase in Chinese patients with acute myocardial infarction in better than by alteplase.
OBJECTIVE:To evaluate therapeutic efficacy of reteplase versus alteplase in the treatment of acute myocardial infarction in China,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from Cochrane library,PubMed,Embase,Medline,CJFD,CSJD,Wanfang database by computor,etc.,also by manual search,RCTs about therapeutic efficacy(recanalization rate of thrombolysis)of reteplase(trial group)versus alteplase(control group)in the treatment of acute myocardial infarction in China were collected from Jan. 1995 to Sept. 2018. After data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0,Meta-analysis was performed for recanalization rate of thrombolysis by using Rev Man 5.3 software. RESULTS:A total of 23 RCTs were included,involving 1 742 patients. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group was significantly higher than control group,with statistical significance [OR=0.61,95%CI(0.50,0.73),P<0.001]. Sub-group Meta-analysis was performed according to the successful time of thrombolysis. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group 1 h [OR=0.38,95%CI(0.25,0.58),P<0.001],1.5 h[OR=0.44,95%CI(0.25,0.79),P=0.006] and 2 h [OR=0.62,95%CI(0.42,0.92),P=0.02] after thrombolysis were significantly higher than control group,with statistical significance. CONCLUSIONS:The recanalization rate of thrombolysis by reteplase in Chinese patients with acute myocardial infarction in better than by alteplase.
引文
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[12]赖晓明,欧阳天龙,骆向文,等.阿替普酶治疗急性心肌梗死的疗效观察[J].河北医药,2013,35(5):706-708.
[13]李丽琴,陈晓敏,林珮仪,等.阿替普酶与瑞替普酶治疗急性心肌梗死的疗效比较[J].实用医学杂志,2008,24(15):2675-2677.
[14]廖振海,周文忠,陈东来,等.阿替普酶与瑞替普酶治疗急性ST段抬高型心肌梗死患者的疗效对比[J].岭南心血管病杂志,2018,24(1):27-29.
[15]卢延涛.不同溶栓药物治疗急性ST段抬高型心肌梗死的效果分析[J].河南科技大学学报(医学版),2016,34(2):116-117.
[16]吕云,高彦.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的临床对比分析[J].现代中西医结合杂志,2014,23(11):1197-1199.
[17]平凌云.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的疗效比较[J].中西医结合心脑血管病杂志,2013,11(3):359-360.
[18]宋彩虹.急性心肌梗死应用瑞替普酶和阿替普酶溶栓效果的对比研究[J].中国实用医药,2015,35(5):156-157.
[19]汪涛,李恩,孙利强,等.瑞替普酶治疗急性心肌梗死效果观察[J].郑州大学学报(医学版),2009,44(4):864-866.
[20]杨欣.急性ST段抬高性心肌梗死应用瑞替普酶溶栓治疗的疗效观察[J].世界临床医学,2015,9(7):131.
[21]张双月,王雪青,刘长涛,等.小剂量瑞替普酶和阿替普酶溶栓治疗75岁以上老年急性心肌梗死疗效比较[J].中国新药杂志,2010,19(9):766-768.
[22]张兰芳,陈春红,贾新未,等.不同溶栓药物治疗急性ST段抬高性心肌梗死的临床疗效对比研究[J].临床合理用药杂志,2013,6(20):5-6.
[23]张建军.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中对比研究[J].中国实用医药,2014,34(22):146-147.
[24]张瑾.阿替普酶与瑞替普酶在治疗急性ST段抬高型心肌梗死溶栓治疗中的临床对比研究[J].中国实用医药,2015,35(12):144-146.
[25]祝立梅.瑞替普酶对ST段抬高型心肌梗死溶栓的疗效观察[J].中国医学工程,2013,21(9):83.
[26]LI J,LI X,ROSS JS,et al.Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011:China PEACE-retrospective AMI study[J].Eur Heart J Acute Cardiovasc Care,2017,6(3):232-243.
[27]刘浙波,夏豪,童随阳,等.阿替普酶与尿激酶静脉溶栓治疗急性心肌梗死疗效与安全性的Meta分析[J].疑难病杂志,2015,14(2):191-195.
[28]王国防,王幼萌,陈建,等.伴心房颤动的急性缺血性卒中静脉溶栓研究进展[J].中国现代神经疾病杂志,2018,18(7):546-550.
[29]邓本强,沈红健.急性缺血性脑卒中静脉溶栓治疗:新证据、新热点[J].第二军医大学学报,2018,39(9):959-964.
[30]李认书,丁文侠,郭欣,等.急性缺血性脑卒中的溶栓药物概况[J].中国新药与临床杂志,2013,32(8):599-602.
[31]孙慧,研究显示:第三代溶栓药瑞通立药物经济学价值明显[EB/OL].[2018-10-07].http://www.xinhuanet.com//health/2017-04/07/c_1120769615.htm.
[2]FONSECA F,IZAR MC,MAUGERI I,et al.Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy:design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction(BATTLE-AMI)study:study protocol for a randomized controlled trial[J].Trials,2017,18(1):601.
[3]白瑞文.注射用瑞替普酶治疗急性心肌梗死有效性及安全性临床分析[J].中国实用医刊,2015,42(17):57-58.
[4]蔡继锐,刘东亮,杨春香,等.国产瑞替普酶和进口阿替普酶对ST段抬高型心肌梗死的溶栓疗效比较[J].中国心血管病研究,2011,9(3):181-183.
[5]陈晓辉,江慧琳,林珮仪,等.急诊室内使用瑞替普酶治疗急性心肌梗死的疗效评价[J].中华急诊医学杂志,2007,16(8):855-858.
[6]陈瑞炳,胡炜.急性心肌梗死使用瑞替普酶和阿替普酶溶栓治疗的对比观察[J].浙江临床医学,2015,17(1):45-46.
[7]陈廷春.针对瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的临床对比分析[J].当代医学,2016,22(18):149-150.
[8]丁华钢.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的效果[J].临床医学研究与实践,2018,3(12):31-32.
[9]伏继伟.瑞替普酶与阿替普酶对急性心肌梗死患者溶栓效果的对比研究[J].中国实用医药,2013,8(28):186-187.
[10]郝志敏,黄贤胜,侯瑞田,等.急性心肌梗死应用瑞替普酶和阿替普酶溶栓治疗对比研究[J].中西医结合心脑血管病杂志,2009,7(2):144-145.
[11]黄子波,罗宇欢,李观庆.瑞替普酶和阿替普酶溶栓治疗急性心肌梗死的对比研究[J].当代医学,2014,20(19):138.
[12]赖晓明,欧阳天龙,骆向文,等.阿替普酶治疗急性心肌梗死的疗效观察[J].河北医药,2013,35(5):706-708.
[13]李丽琴,陈晓敏,林珮仪,等.阿替普酶与瑞替普酶治疗急性心肌梗死的疗效比较[J].实用医学杂志,2008,24(15):2675-2677.
[14]廖振海,周文忠,陈东来,等.阿替普酶与瑞替普酶治疗急性ST段抬高型心肌梗死患者的疗效对比[J].岭南心血管病杂志,2018,24(1):27-29.
[15]卢延涛.不同溶栓药物治疗急性ST段抬高型心肌梗死的效果分析[J].河南科技大学学报(医学版),2016,34(2):116-117.
[16]吕云,高彦.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的临床对比分析[J].现代中西医结合杂志,2014,23(11):1197-1199.
[17]平凌云.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中的疗效比较[J].中西医结合心脑血管病杂志,2013,11(3):359-360.
[18]宋彩虹.急性心肌梗死应用瑞替普酶和阿替普酶溶栓效果的对比研究[J].中国实用医药,2015,35(5):156-157.
[19]汪涛,李恩,孙利强,等.瑞替普酶治疗急性心肌梗死效果观察[J].郑州大学学报(医学版),2009,44(4):864-866.
[20]杨欣.急性ST段抬高性心肌梗死应用瑞替普酶溶栓治疗的疗效观察[J].世界临床医学,2015,9(7):131.
[21]张双月,王雪青,刘长涛,等.小剂量瑞替普酶和阿替普酶溶栓治疗75岁以上老年急性心肌梗死疗效比较[J].中国新药杂志,2010,19(9):766-768.
[22]张兰芳,陈春红,贾新未,等.不同溶栓药物治疗急性ST段抬高性心肌梗死的临床疗效对比研究[J].临床合理用药杂志,2013,6(20):5-6.
[23]张建军.瑞替普酶与阿替普酶在急性ST段抬高型心肌梗死溶栓治疗中对比研究[J].中国实用医药,2014,34(22):146-147.
[24]张瑾.阿替普酶与瑞替普酶在治疗急性ST段抬高型心肌梗死溶栓治疗中的临床对比研究[J].中国实用医药,2015,35(12):144-146.
[25]祝立梅.瑞替普酶对ST段抬高型心肌梗死溶栓的疗效观察[J].中国医学工程,2013,21(9):83.
[26]LI J,LI X,ROSS JS,et al.Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011:China PEACE-retrospective AMI study[J].Eur Heart J Acute Cardiovasc Care,2017,6(3):232-243.
[27]刘浙波,夏豪,童随阳,等.阿替普酶与尿激酶静脉溶栓治疗急性心肌梗死疗效与安全性的Meta分析[J].疑难病杂志,2015,14(2):191-195.
[28]王国防,王幼萌,陈建,等.伴心房颤动的急性缺血性卒中静脉溶栓研究进展[J].中国现代神经疾病杂志,2018,18(7):546-550.
[29]邓本强,沈红健.急性缺血性脑卒中静脉溶栓治疗:新证据、新热点[J].第二军医大学学报,2018,39(9):959-964.
[30]李认书,丁文侠,郭欣,等.急性缺血性脑卒中的溶栓药物概况[J].中国新药与临床杂志,2013,32(8):599-602.
[31]孙慧,研究显示:第三代溶栓药瑞通立药物经济学价值明显[EB/OL].[2018-10-07].http://www.xinhuanet.com//health/2017-04/07/c_1120769615.htm.
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