半剂量替罗非班用于中国急性心肌梗死患者PCI术后疗效与安全性的Meta-分析

Meta-analysis for efficacy and safety of half-dose tirofiban for patients with acute coronary syndrome after PCI in Chinese

目的系统评价半剂量替罗非班用于中国急性心肌梗死患者经皮冠状动脉内支架置入术(PCI)术后的疗效和安全性,为临床提供循证医学证据。方法检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普中文期刊全文数据库(VIP)、万方数据库、Cochrane图书馆、PubMed和EMBase数据库,均从建库至2019年5月,收集中国急性心肌梗塞患者PCI术后使用半剂量(观察组)对比标准剂量(对照组)替罗非班的临床随机对照研究(RCT),提取资料和质量评价后,采用RevMan 5.3软件进行Meta-分析。结果共纳入16个RCTs,包括1702例患者。Meta-分析结果显示:观察组患者PCI术后左心室射血分数(MD=-1.20,95%CI=-2.52~0.13)、心肌梗死溶栓后血流分级3级构成比(OR=0.74,95%CI=0.54~1.03)、心电图ST段抬高回落率(OR=0.78,95%CI=0.53~1.15)、主要心血管不良事件发生率(OR=1.16,95%CI=0.86~1.56)与对照组比较均无显著性差异,但出血及并发症发生率(OR=0.36,95%CI=0.27~0.49)显著小于对照组(P<0.01)。结论中国急性心肌梗死患者PCI术后予以半剂量替罗非班的临床疗效与标准剂量相当,但安全性优于标准剂量。

Objective To systematically evaluate the efficacy and safety of half-dose tirofiban for patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI)in China.And provide evidence-based medical evidence for clinical practice.Methods A randomized controlled trial(RCT)of half-dose(observation group)vs standard dose(control group)of tirofiban for patients with acute coronary syndrome after PCI in Chinese were conducted in CNKI,Wanfang,WIP,CBM,Cochrane Library,PubMed and EMBase from the database to May 2019.Date were extracted and evaluated by two reviewers independently with designed extraction form.The RevMan 5.3 software was used to carry out statistic analysis.Result A total of 16 RCTs and1702 patients were included.Meta-analysis results showed:there were no significant differences in the LVEF%(MD=-1.20,95%CI=-2.52~0.13),rate of TIMI blood flow grading grade 3(OR=0.74,95%CI=0.54~1.03),ST segment elevation fallback(OR=0.78,95%CI=0.53~1.15)and MACE(OR=1.16,95%CI=0.86~1.56)between the observation group and the control group.However,the rate of bleeding and complications(OR=0.36,95%CI=0.27~0.49)of was the observation group significantly lower than that of the control group(P<0.01).Conclusion The clinical efficacy of half-dose tirofiban after PCI in patients with ACS in China is comparable to the standard dose,but its safety is better than the standard dose.