经皮冠状动脉介入治疗中应用替罗非班的疗效及安全性的Meta分析

目的 评价经皮冠脉介入治疗中应用替罗非班的疗效及安全性.方法 检索Cochrane library、PubMed、EMBASE、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和万方数据库（截至2011年10月）.由2名评价者独立评价纳入研究的质量、提取资料并交叉核对,对同质研究采用RevMan 5.0 软件进行Meta分析.结果 共纳入7项随机对照试验,包括909例患者.Meta分析显示：与安慰剂对照组比较,替罗非班可以降低无再流/慢血流的发生率（OR=0.24,95%CI：0.13～0.45,P＜0.01）,增加左心室射血分数（MD=6.24,95%CI：4.33～8.16,P＜0.01）,降低心力衰竭的发生率（OR=0.23,95%CI：0.10～0.53,P＜0.01）及病死率（OR=0.13,95%CI：0.02～0.75,P=0.02）;但两组TIMI计帧数（MD=-5.63,95%CI：-11.65～0.33）、靶血管重建、再次心肌梗死及出血发生率无统计学差异（P均＞0.05）.结论 替罗非班可对PCI术后冠脉无再流的发生具有较好的预防作用,但由于本文纳入的研究质量较低,样本量较小,有必要进行大样本随机对照临床试验进一步的验证其疗效和安全性.

A Meta-analysis on curative effect and safety of tirofiban applied in percutaneous coronary intervention

Objective To review the curative effect and safety of tirofiban applied in percutaneous coronary intervention (PCI). Methods The databases of Cochrane Library,PubMed,EMBASE,CNKI,CBM,CSJD and WangFang Database were retrieved (up to Oct. 2011). The quality of included researches was reviewed and materials were extracted and checked crossly by 2 independent reviewers,and then all cognate researches were given Meta-analysis by using RevMan 5.0 software. Results There were totally 7 randomized and controlled trials (RCT) enclosed involving 909 patients. The results of Meta-analysis showed that,compared with placebo,tirofiban reduced the incidence of non-reflow/slow flow (OR=0.24,95%CI:0.13~0.45,P<0.01),increased left ventricular ejection fraction (LVEF,MD=6.24,95%CI:4.33~8.16,P<0.01),decreased the incidence (OR=0.23,95%CI:0.10~0.53,P<0.01) and mortality (OR=0.13,95%CI:0.02~0.75,P=0.02) of heart failure. There was no statistical difference in TIMI frame count (MD=-5.63,95%CI:-11.65~0.33),target vessel reestablishing and incidence of secondary myocardial infarction and hemorrhage (all P>0.05) between two groups. Conclusion Tirofiban has a better preventive effect to coronary non-reflow after PCI. As the quality of enclosed RCT is not good enough and sample is not large enough,the large-sample randomized,and controlled trials are required to prove further the curative effect and safety of tirofiban.