3种改善血液循环药物联合基础治疗用于急性脑梗死的网状Meta分析及药物经济学评价

Reticular Meta-analysis and pharmacoeconomic evaluation of three drugs to improve blood circulation combined with basic therapy for acute cerebral infarction

目的通过评价3种改善血液循环类药物(阿加曲班注射液、丁苯酞注射液和尤瑞克林注射液)分别联合基础治疗(抗血小板+调脂、抗血小板+调脂+阿替普酶)用于治疗急性脑梗死的有效性、安全性及经济性,为相关决策提供参考。方法检索中国知网数据库、重庆维普中文科技期刊数据库、万方数据库、Pub Med、Web of Science等数据库并搜集相关的临床试验,采用Stata 14.1软件,进行基于NIHSS有效率、不良反应发生率的网状Meta分析,以评价有效性和安全性;采用最小成本分析法和成本-效果分析法进行经济性评价。结果共纳入32篇文献,涉及3 071例患者。有效性和安全性网状Meta分析结果均显示,各干预措施的差异无统计学意义。但从严重不良反应发生情况来看,阿加曲班组的严重不良反应发生率相对最低,安全性相对最好,其次依次为丁苯酞组和尤瑞克林组。经济性评价结果显示,阿加曲班组的经济性相对最佳。结论与丁苯酞组和尤瑞克林组相比,阿加曲班联合基础治疗的有效性和安全性良好、严重不良反应最少,且经济性最佳。

Objective The efficacy, safety and economy of three blood circulation drugs(Argatroban injection, butylphthalide injection and Urinary Kallidinogenase injection) combined with basic treatment(antiplatelet agent+lipid-lowering medication/antiplatelet agent lipid-lowering medication+rt-PA) for acute cerebral infarction were evaluated to provide reference for relevant decision-making. Methods By searching CNKI, VIP, Wangfang databases, and Pub Med, Web of Science databases, and collecting relevant clinical trials, Stata 14.1 software was used to evaluate the efficacy and safety of network Meta analysis based on NIHSS effectiveness rate and adverse reaction incidence. Minimum cost analysis method and cost-effect analysis method are used to evaluate economy. Results A total of 32 articles were included, involving 3 071 patients. The results of efficacy and safety mesh meta-analysis showed that there were no statistically significant differences between the interventions. However, in terms of the occurrence of severe adverse reactions, the argatroban group had a lower incidence of severe adverse reactions and a relatively better safety, followed by the butylphthalide group and the Urinary Kallidinogenase group. The economic evaluation results show that the economic performance of argatroban group is the best. Conclusion Compared with butylphthalide and urinary kallidinogenase group, argatroban combined with basic therapy has good efficacy and safety, the least serious adverse reactions, and the best economy.