急性心肌梗死伴ST段抬高患者冠状动脉内注射重组人尿激酶原的安全性和有效性：一项随机对照试验的荟萃分析

Safety and efficacy of intracoronary recombinant human prourokinase administration in patients with acute myocardial infarction and ST‑segment elevation: A meta‑analysis of randomized controlled trials.

作者信息

Fan Gang, Wu Xiang-Ge, Jiao Wen-Ping, Zhang Hong-Kao, Guo Dian-Long

机构信息

Second Cardiology Department of Xianyang First People's Hospital, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712000, P.R. China.

出版信息

Exp Ther Med. 2022 Nov 30;25(1):40. doi: 10.3892/etm.2022.11739. eCollection 2023 Jan.

Slow blood flow or no reflow following percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) typically leads to an adverse prognosis. However, it is controversial whether to use prourokinase (Pro-UK) during PCI in patients with acute STEMI. The present meta-analysis compared the efficacy and safety of intracoronary Pro-UK administration in patients with acute STEMI. Published randomized controlled trials (RCTs) were analyzed to compare Pro-UK with non-Pro-UK treatment in patients with acute STEMI. PubMed, Cochrane Library and China National Knowledge Infrastructure were searched and meta-analysis was performed using Review Manager 5.3 software. A total of 13 RCTs were selected and 1,797 patients were considered in the meta-analysis, including 897 patients who received Pro-UK intervention and 900 patients who were in the control group. No significant heterogeneity was identified across these selected studies. Pro-UK therapy significantly decreased the incidence of major adverse cardiac events [risk ratio (RR), 0.68; 95% CI, 0.56-0.82, P<0.0001], left ventricular end-diastolic diameter [standardized mean difference (SMD), -0.26; 95% CI, -0.40 - -0.12; P=0.0003], corrected thrombolysis in myocardial infarction (TIMI) frame count [SMD, -0.45; 95% CI, -0.62 - -0.28; P<0.00001] and cardiac troponin I [SMD, -0.31; 95% CI, -0.46 - -0.17; P<0.0001]. In addition, Pro-UK administration increased TIMI grade 3 flow (RR, 1.16; 95% CI, 1.07-1.25; P=0.0003), TIMI myocardial perfusion grade 3 (RR: 1.39, 95% CI: 1.12-1.74, P=0.004), ST-segment resolution (RR, 1.23; 95% CI, 1.10-1.36; P=0.0002) and left ventricular ejection fraction (SMD, 0.38; 95% CI, 0.27-0.49; P<0.00001). No significant difference was identified in bleeding (RR, 1.12; 95% CI, 0.85-1.47; P=0.41). The present meta-analysis determined that intracoronary Pro-UK administration is efficacious and safe to decrease slow blood flow or no reflow phenomena following PCI and improve the prognosis of patients with acute STEMI.

急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后出现血流缓慢或无复流现象通常会导致不良预后。然而，急性STEMI患者在PCI期间是否使用尿激酶原（Pro-UK）存在争议。本荟萃分析比较了急性STEMI患者冠状动脉内注射Pro-UK的疗效和安全性。分析已发表的随机对照试验（RCT），以比较Pro-UK与非Pro-UK治疗对急性STEMI患者的效果。检索了PubMed、Cochrane图书馆和中国知网，并使用Review Manager 5.3软件进行荟萃分析。共纳入13项RCT，1797例患者纳入荟萃分析，其中897例接受Pro-UK干预，900例为对照组。这些入选研究未发现显著异质性。Pro-UK治疗显著降低了主要不良心脏事件的发生率[风险比（RR），0.68；95%可信区间（CI），0.56 - 0.82，P<0.0001]、左心室舒张末期内径[标准化均数差（SMD），-0.26；95%CI，-0.40 - -0.12；P = 0.0003]、校正的心肌梗死溶栓（TIMI）帧数[SMD，-0.45；95%CI，-0.62 - -0.28；P<0.00001]和心肌肌钙蛋白I[SMD，-0.31；95%CI，-0.46 - -0.17；P<0.0001]。此外，注射Pro-UK增加了TIMI 3级血流（RR，1.16；95%CI，1.07 - 1.25；P = 0.0003）、TIMI心肌灌注3级（RR：1.39，95%CI：1.12 - 1.74，P = 0.004）、ST段回落（RR，1.23；95%CI，1.10 - 1.36；P = 0.0002）和左心室射血分数（SMD，0.38；95%CI，0.27 - 0.49；P<0.00001）。出血方面未发现显著差异（RR，1.12；95%CI，0.85 - 1.47；P = 0.41）。本荟萃分析确定，冠状动脉内注射Pro-UK对于减少PCI后的血流缓慢或无复流现象以及改善急性STEMI患者的预后是有效且安全的。