瑞替普酶与尿激酶静脉溶栓治疗急性心肌梗死有效性与安全性的Meta分析

目的 系统评价瑞替普酶与尿激酶静脉溶栓治疗急性心肌梗死的有效性及安全性.方法 检索中国生物医学文献数据库（1978-2014.09）、中国期刊全文数据库（1994-2014.09）、维普数据库（1999-2014.09）、万方数据库（1990-2014.09）、PubMed（1990-2014.09）、Cochrane Library（2014年第9期）.纳入瑞替普酶（试验组）与尿激酶（对照组）比较静脉溶栓治疗急性心肌梗死的随机对照试验（RCTs）,由2位研究员独立筛选并提取资料,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653篇,按照纳入和排除标准,最终纳入18篇进行Meta分析.结果 ①瑞替普酶溶栓后30 min内再通率高于尿激酶（RR=2.65,95％CI 2.02～3.47,P＜0.01）;②瑞替普酶溶栓后60 min内再通率高于尿激酶（RR=2.14,95％CI 1.68～2.73,P＜0.01）;③瑞替普酶溶栓后90 min内再通率高于尿激酶（RR=1.67,95％CI 1.39～2.01,P＜0.01）;④瑞替普酶溶栓后120 min内再通率高于尿激酶（RR=1.31,95％CI 1.21～1.43,P＜0.01）;⑤瑞替普酶出血并发症发生率与尿激酶比较差异无统计学意义（RR =0.68,95％CI 0.46～1.01,P=0.06）;⑥瑞替普酶死亡率低于尿激酶（RR =0.45,95％CI 0.29～0.70,P=0.0004）.结论 瑞替普酶静脉溶栓治疗急性心肌梗死的有效性和安全性高于尿激酶.

Efficacy and safety of intravenous thrombolytic therapy using Reteplase andUrokinase for the treatment of Acute myocardial infarction: A Meta-analysis

Objective To assess the efficacy and safety of intravenous thrombolytic therapy using Reteplase and Urokinase for the treatment of acute myocardial infarction.Methods The databases of CJFD,CBM,WanFang Database,PubMed and Cochrane Library were retrieved.The randomized controlled trials（RCTs） about the comparison treatment of acute myocardial infarction with Reteplase（treatment group） or Urokinase（control group） were included.The data were screened and extracted by two researches independently,and then the quality was reviewed by using Jadad scale and treated by using RevMan 5.2.software.Results A total of 653 articles were found,according to inclusive and exclusive criteria,18 of which were finally included and the results of Meta-analysis showed as follows：（1）The recanalization rate at 30 min in the treatment group was superior to that of the control group （RR=2.65,95%CI 2.02-3.47,P〈0.01）.（2）The recanalization rate at 60 min in the treatment group was superior to that of the control group （RR=2.14,95%CI 1.68-2.73,P〈0.01）.（3）The recanalization rate at 90 min in the treatment group was superior to that of the control group（RR=1.67,95%CI 1.39-2.01,P〈0.01）.（4）The recanalization rate at 120 min in the treatment group was superior to that of the control group （RR=1.31,95%CI 1.21-1.43,P〈0.01）.（5）The incidence of bleeding complications has no obvious difference in the treatment group and that in the control group （RR=0.68,95%CI 0.46-1.01,P=0.06）.（6）The death rate after thrombolysis in the treatment group was significantly lower than the control group （RR=0.45,95%CI 0.29-0.70,P=0.0004）.Conclusion Compared with Urokinase,Reteplase is an effective,reliable and safe thrombolytic agent in the treatment of acute myocardial infarction.However,more high quality,large-scale RCTs are still needed to confirm the effectiveness and safety of intravenous thrombolytic therapy using Reteplase and Urokinase for the treatment of acute myocardial infarction because of th