冠状动脉介入治疗中阿昔单抗两种给药途径治疗效果比较的meta分析

Meta-analysis of randomized controlled trials of intracoronary vs. intravenous administration of abciximab during percutaneous coronary intervention for ST-elevation myocardial infarction

目的:比较冠状动脉介入治疗(PCI)中冠状动脉内和静脉内使用阿昔单抗的治疗效果。方法:计算机检索PubMed、EMbase、Cochrane图书馆、中国生物医学文献光盘数据等数据库,系统性搜索已发表的相关临床研究,并对纳入的研究进行质量评价,对相关结果进行meta分析。共纳入6个随机对照临床研究,共1 138例患者,其中试验组580例(冠状动脉内运用阿昔单抗组),对照组558例(静脉内运用阿昔单抗组)。纳入患者均为急性ST段抬高型心肌梗死。结果:冠状动脉内运用阿昔单抗组仅在心肌梗死溶栓后Ⅲ级血流所占比例优于静脉内运用阿昔单抗组[RR=1.06,95%CI(1.01,1.12),P=0.02]。而在病死率[RR=0.48,95%CI(0.23,1.02),P=0.06]、靶血管血运重建[RR=0.55,95%CI(0.30,0.99),P=0.05],以及出血事件发生率[RR=0.88,95%CI(0.63,1.23),P=0.44],两组没有统计学意义上的差异。结论:与静脉内使用阿昔单抗组相比,冠状动脉内使用阿昔单抗改善了急性ST段抬高型心肌梗死患者的心肌灌注,但并未降低其病死率、靶血管血运重建及出血事件发生率。

AIM： To compare the effect of intracoronary （IC） vs. intravenous （IV） administration of abciximab during percutaneous coronary intervention （PCI） for ST-elevation myocardial infarction （STE- MI）. METHODS： Published research was retrieved mainly from electronic databases （PubMed, EMBASE and the Cochrane Central Register of Controlled Trials）. All randomized controlled trials comparing IC and IV administration of abciximab were included. RESULTS： A total of six randomized trials were included in the current meta-analysis, involving 1 138 patients. IC administration was more effective than IV administration of abciximab only in patients with thrombolysis in MI grade III flow [ RR = 1.06, 95% CI（1.01, 1.12）, P =0. 02]. No statistically significant difference was found between the IC and IV groups according to the mortality rate [ RR =0.48, 95% CI（0. 23, 1.02）, P =0. 06], target vessel revascularization [ RR = 0. 55, 95% CI （0. 30, 0. 99）, P = 0. 05 ] and bleeding events [ RR = 0. 88, 95 % CI （0. 63, 1.23 ）, P = 0. 44 ]. CONCLUSION ： Compared with IV administration of abciximab, IC administration of abciximab improves myocardial reperfusion but does not reduce mortality rate, target vessel revascularization, or bleeding events in STEMI patients undergoing primary PCI.