阿替普酶与尿激酶静脉溶栓治疗急性心肌梗死疗效与安全性的Meta分析

Efficacy and safety of intravenous thrombolytic therapy with alteplase and urokinase for the treatment of acute myocardial infarction:A Meta-analysis

目的系统评价阿替普酶与尿激酶静脉溶栓治疗急性心肌梗死的疗效与安全性。方法检索中国生物医学文献数据库（1978年-2014年9月）、中国期刊全文数据库（1994年-2014年9月）、维普数据库（1999年-2014年9月）、万方数据库（1990年-2014年9月）、PubMed（1990年-2014年9月）、Cochrane Library（2014年第9期）。纳入阿替普酶（试验组）与尿激酶（对照组）静脉溶栓治疗急性心肌梗死的随机对照试验（RCTs）,采用Jadad改良法制定的量表评价纳入研究的质量,采用RevMan5.2进行Meta分析。结果共检索到文献581篇,按照纳入和排除标准,最终纳入17篇进行Meta分析。Meta分析结果：试验组溶栓后再通率高于对照组（RR=1.33,95%CI1.18-1.48,P〈0.01）,出血发生率低于对照组[RR=0.42,95%CI 0.30-0.58,P〈0.01）,心律失常发生率低于对照组（RR=0.76,95%CI 0.58-0.98,P=0.04）,再梗死发生率低于对照组（RR=0.49,95%CI 0.32-0.75,P=0.0009）,病死率低于对照组（RR=0.46,95%CI 0.29-0.71,P=0.000 5）。结论阿替普酶静脉溶栓治疗急性心肌梗死的疗效优于尿激酶,且安全性高于尿激酶。

Objective To systemic review the efficacy and safety of alteplase and urokinase thrombolytic therapy in a-cute myocardial infarction. Methods Searched on CBMdisc （ 1978 -2014 September ） , China journal full text database （1994-2014 September）, VIP database （1999-2014 September）, Wanfang database （1990-2014 September）, PubMed （1990-2014 September）, Cochrane Library （2014 ninth period）. Included alteplase （experimental group） and urokinase （ control group） randomized controlled trial of intravenous thrombolytic therapy in the treatment of acute myocardial infarction （RCTs）, scale for assessment formulated by modified Jadad method the quality of the included studies, using RevMan5. 2 Meta analysis. Results A total of 581 literatures were retrieved. According to inclusion and exclusion criteria, finally 17 arti-cles were included for Meta-analysis. The Meta-analysis results： experimental group after thrombolysis ＆#39; recanalization rate higher than that of the control group （RR=1. 33, 95%CI 1. 18-1. 48, P 〈0. 01）, bleeding rate lower than that of the con-trol group, （RR = 0. 42, 95%CI 0. 30-0. 58, P 〈0. 01）, arrhythmia incidence was lower than that of the control group （RR = 0. 76, 95%CI 0. 58-0. 98, P =0. 04）, re-infarction rate lower than that of the control group （RR = 0. 49, 95%CI 0. 32-0. 75, P =0. 000 9）, the mortality rate is lower than the control group （RR = 0. 46, 95%CI 0. 29-0. 71, P =0. 000 5）. Conclusion Alteplase intravenous thrombolytic therapy for acute myocardial infarction curative effect is better than that of urokinase.