SS-31肽防治心肌缺血再灌注损伤的疗效——基于动物模型的系统综述

Efficacy of SS31 Peptide in Treating Myocardial Ischemia Reperfusion Injury:A Systematic Review of Animal models

目的系统综述SS-31肽防治模型动物心肌缺血再灌注损伤的疗效及安全性。方法计算机检索Pub Med(1966年—2015年5月)、Embase(1966年—2015年5月)、CBM(1978年—2015年5月)、CNKI(1979年—2015年5月)、VIP(1989年—2015年5月)及万方(1990年—2015年5月)等数据库,手工检索参考文献,纳入SS-31肽防治心肌缺血再灌注损伤的动物实验,由两名研究者独立评价纳入研究的质量,提取数据并交叉核对。结果 60/78篇文献经剔重与初筛剔除,18篇文献进入全文复筛,11篇会议摘要因未获得全文剔除,余7篇文献经全文阅读共纳入3篇,研究对象均为急性心肌梗死后缺血再灌注损伤模型动物。结局评价包括心肌损伤程度、无复流范围、心肌舒缩功能及电活动、不良反应及不良事件。3篇文献报道均提示再灌注起始前给予SS-31治疗可显著减小模型动物的心肌梗死面积,且疗效优势的体现与心肌缺血程度呈正相关;2篇文献报道了无复流现象的相关疗效,表明缺血期SS-31治疗可减轻心肌低灌注区的无复流范围;1篇文献报道了SS-31对模型动物心律失常发生率及严重程度的改善作用。3篇文献均报道了SS-31对研究期间模型动物心率改变的影响,均未提示阳性干预作用。1篇文献报道显示SS-31治疗对模型动物心输出量的改变无显著影响。因缺乏不良反应及不良事件的报道,对SS-31的安全性评价证据不足。结论 SS-31可有效防治心肌缺血再灌注损伤,且其疗效优势在一定程度内受治疗时间窗及心肌低灌注面积的影响。但因证据有限,目前尚无法得到较为可靠的结论。

Objective To assess the efficacy and safety of SS - 31 peptide for myocardial ischernia reperfusion injury based on animal models. Methods We searched PubMed （1966 to May,2015） ,Embase（1966 to May,2015） ,CBM（1978 to May,2015） ,CNK1（.1979 to May,2015）,VIP（1989 to May, 2015） and Wanfang databases（1990 to May, 2015）, and references were hand searched. All researches based on animal models of treating myocardial ischemia reperfusion injury with S4S - 31 peptide versus untreated groups were included. Data were extracted independently by two reviewers. Results Sixty of the 78 articles were excluded on duplicate and title/abstract. Eighteen articles underwent full- text review, eleven of which were meeting abstracts and excluded in that the fulltexts were not obtained. Seven articles left were screened by full- texts and 3 articles were included in total,the objects of the studies were all ischemia reperfusion injury animals after acute myocardial infarction. Outcome measurements included myocardial injury degree, no- flow extent, myocardial systaltic function and electrical activity, adverse effects and events. Three articles reported significant reduction of myocardial infarction area in animal models with administration of SS - 31 before reperfusion, and the therapeutic advantage was more evident as the extent of myocardial area at risk was larger. Two articles reported reduction in the extent of no- flow when SS - 31 was applied during ischemia for each animal in experimental group. One reported the effect in SS- 31 group for ameliorating the incidence rate and severity of arrhythmia in animal models. Three articles reported non - significant differences between groups for the heart rates of model animals during ischemia and reperfusion,and one article reported the same result for cardiac output. Insufficient evidence was presented for adverse effects and events to undertake safety assessment. Conclusion SS- 31 shows effective prevention and treatment on myocardial ischemia reperfusion injury, and the therapeutic advantage was limited to some extent by therapeutic window and the area at risk. While the evidence was limited at present to reach a reliable conclusion.