促红细胞生成素对急性心肌梗死经皮冠状动脉成形术后疗效的Meta分析及系统评价

Administration of erythropoietin in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and Meta-analysis

目的 应用Meta分析方法评价促红细胞生成素对急性心肌梗死患者经皮冠状动脉成形术后的疗效及安全性。 方法 检索中文数据库（中国知网、中国生物医学文献、万方、维普）和英文数据库（PubMed、Embase、Cochrane Library、Web of Science）,时间截止至2017年1月31日。纳入有关急性心肌梗死患者经皮冠状动脉成形术后促红细胞生成素与非促红细胞生成素疗效比较的随机对照试验,采用 RevMan5.3软件进行统计学分析。 结果 最终纳入14个研究（2044例患者）。Meta 分析结果表明,低风险偏倚文献显示促红细胞生成素治疗与非促红细胞生成素治疗相比,AMI患者经皮冠状动脉成形术后左心室射血分数、左心室收缩期末容积变化量、左心室舒张期末容积变化量和梗死面积差异无统计学意义。高风险偏倚文献显示促红细胞生成素可以提高左心室射血分数,降低左心室收缩期末容积变化量,减少梗死面积,但对左心室舒张期末容积变化量无改善。高剂量促红细胞生成素对血管事件发生率无影响；低剂量促红细胞生成素可减少血管事件发生率。 结论 急性心肌梗死患者经皮冠状动脉成形术后应用促红细胞生成素治疗,对左心室功能（左心室射血分数、左心室收缩期末容积变化量、左心室舒张期末容积变化量）及梗死面积的改善无明显影响,低剂量使用可能会改善血管事件发生率。

Aim This meta-analysis was to systematically assess the efficacy and safety of erythropoietin （EPO） for patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention （PCI）. Methods Eight online databases were investigated （CNKI, CBM, Wanfang, VIP, PubMed, Embase, Cochrane Library, Web of Science）, then randomized clinical trials （RCT） comparing the efficacy of EPO versus non-EPO in patients with AMI after PCI published before January 2017 were included. Data analysis was carried out using RevMan software（V.5.3）. Results 14 RCT （enrolling 2044 patients） were included in the review. Literatures with low risk bias showed, in the case of improving left ventricular ejection fraction （LVEF）, left ventricular end-systolic volume （LVESV）, left ventricular end-diastolic volume （LVEDV） and infarct size, EPO and non-EPO treatment had no distinction. Literatures with high risk bias showed, EPO could significantly improve LVEF, reduce the LVESV and infarct size, no significant difference of EPO was found on LVEDV. High doses of EPO had no effect on vascular events; low doses can reduce the incidence of vascular events. Conclusion The use of EPO in patients with AMI may not improve left ventricular function （LVEF, LVEDV, LVESV） and infarct size after PCI, and low-dose may improve the incidence of vascular events.