冠脉介入治疗中冠脉内与静脉内应用GPⅡb/Ⅲa抑制剂疗效与安全性比较的Meta分析被引量：1

A comparison of intracoronary with intravenous glycoprotein IIb /IIIa inhibitors during percutaneous coronary intervention: a Meta-analysis

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摘要目的：系统评价急性冠脉综合征经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）中冠脉内应用GP IIb／III a抑制剂的疗效及安全性。方法：计算机检索Pubmed，Springer，Ovid，Embase，CochranceLibrary，Clinicahrails．gov和中国知网、万方数据库，检索从建库开始至2013年5月的所有相关临床随机对照研究。同时检索纳入文献的参考文献，并逐个进行质量评价和资料提取。统计学分析采用Rev-Man5．0软件。结果：共纳入15个RCT，共计4268例患者。Meta分析结果显示，与静脉内应用GPIIb／III a抑制剂相比，冠脉内应用GPIIb／IIIa抑制剂可以降低PCI术后主要不良心脏事件发生风险[OR=0．62，95％CI（0．49～0．77）]、再次心肌梗死发生风险[OR=0．63，95％CI（0．42，0．96）]、靶血管血运重建发生风险[OR=0．53，95％CI（0．35，0．82）]；增加PCI术后达心肌梗死溶栓治疗（TIMI）3级血流的比率[OR=1．56，95％CI（1．14，2．14）]和TMP心肌灌注（TMP）达2～3级的比率[OR=2．14，95％CI（1．61，2．86）]；增加术后2周心脏左室射血分数（LVEF）[OR=5．23，95％CI（1．76，8．70）]。但两组死亡风险之间的差异并没有统计学意义[OR=0．74，95％CI（0．53，1．03）]。安全性方面，冠脉内应用GPIIb／IIIa抑制剂并不增加严重出血[OR=1．15，95％CI（0．74，1．77）]及轻微出血[OR=0．94，95％CI（0．75，1．19）]的发生率。结论：现有的资料表明，冠脉内应用GPⅡb／III a抑制剂可以降低PCI术后主要不良心脏事件的发生风险，改善PCI术后心肌血流灌注，且不增加出血的风险。 Objective： To evaluate the efficacy and safety of intracoronary glycoprotein IIb/IIIa inhibitors （GPIs） during percutaneous coronary intervention （PCI） in patients with acute coronary syndrome. Methods： Data were collected from PubMed, Springer, Ovid, Embase, Cochrance Library, Clinicaltrails. gov, CNKI and Wanfang database （ -May 2013）. Bibliographies of the retrieved articles were checked and analyzed. Results： A total of 15 trials invoiving 4 268 patients were included. The meta-analysis showed that intracoronary administration of GPIs reduced risk of PCI postoperative major adverse cardiac events [ OR = 0.62, 95 % CI （0.49 -0.77） ], reinfarction [ OR =0.63, 95% CI（0.42,0.96） ], target vessel revascularization [ OR =0.53, 95% CI（0.35,0. 82） ] and significantly increased TIMI grade 3 flow [ OR = 1.56, 95% CI（1.14,2.14） ] , TMP grade 2 -3 flow [ OR = 2.14, 95% CI（1. 61,2. 86） ] and LVEF in PCI postoperative two weeks [ OR =5.23, 95% CI（1.76,8.70） ]. No significant difference was observed in mortality risk and bleeding complication between the two groups. Conclusion ： Intracoronary administration of GPIs in patients with acute coronary syndrome undergoing PCI can reduce risk of PCI major postoperative adverse cardiac events and significantly increase target coronary flow and myocardial reperfusion without increasing the risk of bleeding complication.

作者徐兵陈梅顾永丽孙洁

机构地区连云港市第一人民医院药剂科中国药科大学临床药学教研室

出处《中国新药杂志》 CAS CSCD 北大核心 2014年第4期449-456,共8页 Chinese Journal of New Drugs

关键词急性冠脉综合征经皮冠状动脉介入治疗 GPⅡb Ⅲa抑制剂 META分析 acute coronary syndrome percutaneous coronary intervention glycoprotein IIb/IIIa inhibitors Meta-analysis

分类号 R973 [医药卫生—药品]

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1GOHLKE H, ALBUS C, GYSAN DB, et al. Cardiovascular pre- vention in clinical practice (ESC and German guidelines 2007 ) [J]. Herz,2009,34(1) :4 -14.
2ANDERSON JL,ADAMS CD,ANTMAN EM,et at. 2Ott ACCF/ AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/ non-ST-elevation myocardial infarction : a report of the american college of cardiology foundation/American heart association task force on practice guidelines [ J 1. Circulation, 2011,123 ( 18 ) : e426 - e579.
3JNEID H, ANDERSON JL, WRIGHT RS,et al. 2012 ACCF/ AHA focused update of the guideline for the management of pa- tients with unstable angina/non-ST-elevation myocardial infarc- tion ( updating the 2007 guideline and replacing the 2011 focused update) : a report of the American college of cardiology founda- tion/American heart association task force on practice Guidelines [J]. JAm Coll Cardiol,2012,60(7):645-681.
4无.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690. 被引量：1962
5RAZAKJR OA, TAN HC, YIP WL, et al. Predictors of bleeding complications and thrombocytopenia with the use of abciximab during percutaneous coronary intervention [ J ]. J lnterv Cardiol, 2005,18(1) :33 -37.
6JADAD AR, MOORE RA, CARROLL D. Assessing the quality of reports of randomized clinical trials: is blinding necessary? [ J ]. Control Clin Trials, 1996,17 ( 1 ) : 1 - 12.
7DEIBELE AJ, JENNINGS KL, TCHENG JE,et al. Intracoronary eptifibatide bolus administration during percutaneous coronary re- vascularization for acute coronary syndromes with evaluation of platelet glycoprotein Ⅱb/Ⅲa receptor occupancy and platelet function :the intracoronary eptifibatide (ICE) trial [ J ]. Circula- tion,2010,121 (6) :784 -791.
8YANG XC,ZHANG DP,WANG LF,et al. Effects of intracoro- nary or intravenous tirofiban administration in patients with acute ST-elevation myocardial infarction undergoing primary percutane- ous coronary intervention[ J]. Zhonghua Xin Xue Guan Bing Za Zhi,2007,35 (6) :517 - 522.
9WU TG, ZHAO Q, HUANG WG,et al. Effect of intracoronary tirofiban in patients undergoing percutaneous coronary interven- tion for acute coronary syndrome [ J ]. Circ J, 2008,72 (10) : 1605 - 1609.
10CANDEMIR B, KILICKAP M, OZCAN OU,et al. Intracoronary versus intravenous high-dose bolus plus maintenance administra- tion of tirofiban in patients undergoing primary percutaneous coro- nary intervention for acute ST elevation myocardial infarction [ J ]. J Thromb Thrombolysis ,2012,34 ( 1 ) :65 - 72.