中药药物后适应对急性心肌梗死PCI患者再灌注损伤心肌保护作用的Meta分析

Myocardial Protection of Herbal Medicine Pharmacological Postconditioning for Patients with Acute Myocardial Infarction:A Meta-analysis

目的:系统评价中药药物后适应(pharmacological postconditioning)对减轻急性心肌梗死患者经急诊PCI后的再灌注损伤的作用。方法:计算机检索关于中药药物后适应对减轻急性心肌梗死患者经急诊PCI后的再灌注损伤作用的随机对照试验(randomized controlled trial,RCT)。文献检索起止时间均从建库至2012年2月。由2名研究者按纳入与排除标准选择文献、提取资料、交叉核对,而后进行Meta分析。结果:共纳入9个RCT。2个RCT的Meta分析示:中药组CK-MB峰值与对照组相比有统计学差异[MD=63.91,95%CI(46.74,81.08),P<0.00001]。3个RCT的Meta分析显示:中药组再灌注心律失常发生率低于对照组[OR=0.5,95%CI(0.29,0.87),P=0.01]。对PCI术后2 h、24 h、7 d ST段回落率的Meta分析:PCI术后2 h[OR=1.22,95%CI(0.75-1.96),P=0.42],中药组与对照组无统计差异。PCI术后24 h[OR=2.32,95%CI(1.50-3.58),P=0.0002],PCI术后7 d[OR=3.54,95%CI(1.53-8.20),P=0.003],两组间差异有统计学意义。对PCI术后左心室射血分数的影响,中药组与对照组相比有统计学差异[MD=-4.26,95%CI(-7.38,-1.15),P=0.007]。在不良事件方面,3个研究的Meta分析,不良事件两组无统计学意义[OR=1.46,95%CI(0.54,3.91),P=0.46]。结论:对急性心肌梗死行急诊PCI术患者,术前给予中药治疗,有利于降低CK-MB峰值及再灌注心律失常发生率,并能提高ST段回落率及左心室射血分数。受纳入研究质量与数量限制,上述结果尚待更多高质量研究来证实。

Objective：To systematically evaluate the effect of herbal medicine on reducing ischemia reperfusion injury in pa- tients with acute myocardial infarction after emergency PCI. Methods ： A web - based search was performed for relevant studies, CNKI,CBM,VIP, the Coehrane library, Pubmed and EMbase were searched using pharmacological postconditioning, myocardial infarction,ischemia reperfusion injury,PCI,angiography as the keywords from the inception to February,2012. Randomized con- trolled trials（RCTs） to evaluate the herbal medicine effect on ischemia-reperfusion injury were collected and Meta-analysis was conducted, Domain-based evaluation analysis was conducted further. Results： Nine studies were identified. Pooled analysis of 2 studies demonstrated a significant reduction of peak creatine kinase with TCM relative to standard carel MD = 63.91,95% CI（46. 74,81.08 ）, P 〈 0. 00001 1- The analysis of 3 of the studies showed the rate of reperfusion arrhythmias of the TCM group was lower than that of the control group I OR = 0.5,95% CI（O. 29,0.87 ） ,P = 0.01 1-The Meta-analysis of the rate of ST-segmeni thll back after 2 hours,24 hours and 7 days of PCI showed ：2 hours after PCI E OR = 1.22,95 % CI （0.75 - 1.96 ） , P = 0.42 ] ;24 hours af- ter PCI[OR =2.32,95%CI （1.50 -3.58） ,P =0.002] ;7 days after PCI EOR =3.54,95%CI（1.53 -8.20） ,P =0.031. A a- nalysis of 2 of the studies showed an improvement of left ventricular ejection fraction with TCME MD = -4.26,95% CI（ -7.38, - 1.15 ）, P = O. 0071. About adverse events, two groups were not significant I （ OR = l. 46,95 % CI （ O. 54,3.91 ） 1- Conclusion ： Herbal medicine intervention before PCI for acute myocardial infarction patients may help reduce CK - MB peak and reperfusion arrhythmias im＇.idence, may improve the ST segment fall-back rate and left ventricular ejection fraction. For the limits of included researches quality and quantity, the effects of outcomes remain to be determined.