rt-PA与UK静脉溶栓治疗急性心肌梗死对照研究的系统评价

Meta-analysis: Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator vs Urokinase in Treatment of Acute Myocardial Infarction

目的进一步认识重组组织型纤溶酶原激活剂(rtPA)与尿激酶(UK)静脉溶栓治疗急性心肌梗死(AMI)疗效和安全性的差异。方法应用Meta分析方法对11项rtPA与UK静脉溶栓治疗AMI的对照研究进行同质性检验和合并效应量的检验。结果rtPA组与UK组两组间冠状动脉再通率、出血并发症、心律失常及病死率的所有对照研究均具有同质性(均P>0.05)。rtPA组的冠状动脉再通率为79.0%,显著高于UK组的55.6%(P<0.005),而出血并发症、心律失常的发生率及病死率均与UK组相似(P>0.75或P>0.25)。结论rtPA静脉溶栓治疗AMI的疗效显著优于UK,小剂量rtPA(50mg)费用不高,适合在国内推广应用。

Objective To further recognize the differences of efficacy and safety of intravenons thrombolysis with recombinant tissue plasminogen activator （rt-PA） vs urokinase（UK） in treatment of acute myocardial infarction （AMI）. Methods The efficacy and safety of intravenous thrombolysis with rt-PA vs UK in treatment of paticuts with AMI were analyzed by meta-analysis in homogeneity test and combined test in 11 studies. Homogeneity test showed that the cited studies were homogenecus with P 〉0.05 in the re-open rate of infarct related artery （IRA）, the complication of hemorrhage rate , the arhythnfia rate and the death rate between two groups. The re-open rate of IRA in rt-PA group was significantly higher than that in UK group （79.0% vs 55.6%, P 〈 0.005）. There were no significant differences between two groups in the complication d hemomhagerate,the arrhythmiarate and the death rate （ P 〉0.75 or P 〉0.25）. Conclusion The therapeutic effects of intravcuous thrombolysis with rt-PA for AMI is significantly superior to UK. Low dose （50 mg） rt-PA is cheap and can be widely used.