瑞替普酶对比阿替普酶治疗中国急性心肌梗死患者疗效的Meta分析

目的:系统评价瑞替普酶对比阿替普酶治疗中国急性心肌梗死患者的疗效,为临床提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、Medline、中国期刊全文数据库、中文科技期刊数据库、万方数据等,并手工检索相关文献,检索时限为1995年1月-2018年9月,收集瑞替普酶(试验组)对比阿替普酶(对照组)治疗中国急性心肌梗死患者疗效(溶栓再通率)的随机对照试验(RCT),对符合纳入标准的研究进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3软件对溶栓再通率进行Meta分析。结果:共纳入23项RCT,合计1 742例患者。Meta分析结果显示,试验组患者溶栓再通率显著高于对照组,差异有统计学意义OR=0.61,95%CI(0.50,0.73),P<0.001],根据溶栓再通成功时间进行亚组Meta分析,结果显示,试验组患者溶栓后1 hOR=0.38,95%CI(0.25,0.58),P<0.001]、1.5 hOR=0.44,95%CI(0.25,0.79),P=0.006]、2 hOR=0.62,95%CI(0.42,0.92),P=0.02]的溶栓再通率均显著高于对照组,差异均有统计学意义。结论:中国急性心肌梗死患者使用瑞替普酶的溶栓再通率优于阿替普酶。

Therapeutic Efficacy of Reteplase versus Alteplase in the Treatment of Acute Myocardial Infarction in China:A Meta-analysis

OBJECTIVE:To evaluate therapeutic efficacy of reteplase versus alteplase in the treatment of acute myocardial infarction in China,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from Cochrane library, PubMed,Embase,Medline,CJFD,CSJD,Wanfang database by computor,etc.,also by manual search,RCTs about therapeutic efficacy(recanalization rate of thrombolysis)of reteplase(trial group)versus alteplase(control group)in the treatment of acute myocardial infarction in China were collected from Jan. 1995 to Sept. 2018. After data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0,Meta-analysis was performed for recanalization rate of thrombolysis by using Rev Man 5.3 software. RESULTS:A total of 23 RCTs were included,involving 1 742 patients. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group was significantly higher than control group,with statistical significance OR=0.61, 95%CI(0.50,0.73),P<0.001]. Sub-group Meta-analysis was performed according to the successful time of thrombolysis. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group 1 h OR=0.38,95%CI(0.25,0.58),P<0.001],1.5 h OR=0.44,95%CI(0.25,0.79),P=0.006] and 2 h OR=0.62,95%CI(0.42,0.92),P=0.02] after thrombolysis were significantly higher than control group,with statistical significance. CONCLUSIONS:The recanalization rate of thrombolysis by reteplase in Chinese patients with acute myocardial infarction in better than by alteplase.