血栓抽吸联合替罗非班治疗急性ST段抬高型心肌梗死疗效及安全性的Meta分析

摘要

目的 系统评价血栓抽吸联合替罗非班治疗急性ST段抬高型心肌梗死的有效性和安全性.方法 计算机检索建库始至2014年11月中国期刊全文数据库(CKNI)、万方数据库、维普数据库及Cochrane Library、PubMed等数据库,同时辅助其他检索,纳人血栓抽吸联合替罗非班治疗急性ST段抬高型心肌梗死的随机对照实验(RCTs).两名评价者独立评价纳入研究的质量并提取资料,并用RevMan 5.2软件进行统计分析.结果 共纳入16项随机对照临床试验,包括3 089例患者,其中观察组1 557例,对照组1 532例.Meta分析结果显示,与常规治疗组比较,试验组血流达TIMI3级情况明显优于对照组(OR=3.18,95%CI:2.40、4.22,P<0.01);试验组左心室射血分数(LVEF)提高率明显优于对照组(MD=8.61,95%CI:7.85,9.37,P<0.01);试验组ST段回落≥50%时间明显短于对照组(OR=2.29,95% CI:1.58,3.31,P<0.01);试验组CK-MB达峰时间较对照组明显提前(MD=-1.28,95%CI:-2.06,-0.49,P<0.01);试验组发生心血管事件明显少于对照组(RR=2.01 CI:1.67,2.43,P<0.01).结论 血栓抽吸联合替罗非班治疗急性ST段抬高型心肌梗死可改善患者左心室射血分数,增加冠状动脉血流灌注量.%Objective To review systematically the curative effect and safety of thrombus aspiration com-bined with tirofiban in the treatment of acute ST segment elevation myocardial infarction (ASTEMI). Methods The databases of CNKI, Wanfang, VIP and Cochrane Library and PubMed were retrieved from the building to Nov. 2014 for collecting the literature about treatment of ASTEMI with thrombus aspiration combined with tirofiban. At the same time, other retrieving methods were applied for collecting randomized controlled trials (RCTs) about thrombus aspira-tion combined with tirofiban in the treatment of ASTEMI. The quality of all RCTs were reviewed and data was extract-ed by two researchers independently. A meta-analysis was conducted by using Review5.2 software. Results There were totally 16 RCTs included, involving 3 089 patients, with 1 557 in experimental group and 1 532 in control group. Meta analysis showed that compared with routine therapeutic plan, the blood TIMI3 level in experimental group was significantly better than that in the control group (OR=3.18, 95% CI: 2.40~4.22, P<0.01). The increased rate of left ventricular ejection fraction (LEVF) in experimental group was significantly better than that in the control group (MD=8.61, 95% CI: 7.85~9.37, P<0.01). The ST segment resolution more than 50% time in the experimental group was shorter than that in the control group (OR=2.29, 95%CI:1.58~3.31, P<0.01). The time of CK-MB reaching the peak in the experimental group was significantly earlier than that in the control group (MD=-1.28, 95%CI:-2.06~-0.49, P<0.01). The cardiovascular events in the experimental group were significantly more than those in the control group (RR=2.01 CI:1.67~2.43, P<0.01). Conclusion Thrombus aspiration combined with tirofiban therapy in the treatment of AS-TEMI can improve the patients' left ventricular ejection fraction, and increase coronary blood flow perfusion.