杜淑珍,剡冬冬,张钲

• 1:兰州大学第一临床医学院
• 2:兰州大学第一医院心内科
• 3:兰州大学第一医院心脏中心
• 4:甘肃省心血管病临床医学研究中心

摘要(Abstract)：

目的 直接经皮冠状动脉介入治疗（PPCI）期间冠状动脉内注射重组人尿激酶原（rhPro-UK）或替罗非班有助于改善冠状动脉微循环灌注。本研究旨在探索ST段抬高型心肌梗死（STEMI）患者PPCI期间冠状动脉内注射rhPro-UK或替罗非班的有效性和安全性。方法 计算机检索PubMed,Ovid-MEDLINE,Embase,Web of Science,Cochrane Library,clinical trials.gov，中国知网（CNKI），维普网（VIP），中国生物医学文献服务系统（SinoMed），万方数据知识服务平台（WANFANG）数据库，纳入STEMI患者PPCI期间冠状动脉内注射rhPro-UK或替罗非班的随机对照试验（RCT）及队列研究。检索时间为从建库至2023年11月27日。文献筛选、资料提取及偏倚风险评估均由2名研究者独立完成。采用RevMan 5.4软件对数据进行Meta分析。结果 共纳入12项研究，包括1 721例患者，冠状动脉内注射rhPro-UK 864例（试验组），注射替罗非班857例（对照组）。Meta分析显示，与对照组相比，试验组可改善PPCI术后冠状动脉微循环灌注，包括心肌梗死溶栓治疗试验（TIMI）血流分级Ⅲ级及TIMI心肌灌注分级（TMPG）Ⅲ级比例显著高于对照组（OR 1.83,95%CI 1.36～2.46,P<0.0001;OR 2.38,95%CI 1.22～4.66,P=0.010）；校正TIMI帧计数（cTFC）显著低于对照组（MD–2.43,95%CI–2.94～–1.92,P<0.00001）;ST段回落率（STR）≥70%高于对照组（OR 1.93,95%CI 1.01～3.68,P=0.050）。显著降低术后1个月主要不良心血管事件（MACE）发生率（OR 0.54,95%CI 0.35～0.82,P=0.004）。改善心功能，术后1个月左心室射血分数（LVEF）高于对照组（MD1.71,95%CI0.04～3.38,P=0.050）。缩小心肌梗死面积，术后肌酸激酶同工酶MB型（CK-MB）峰值低于对照组（MD–74.16,95%CI–83.59～–64.74,P<0.00001）。两组间出血事件发生率比较（OR1.18,95%CI0.64～2.16,P=0.600），差异无统计学意义。结论 STEMI患者PPCI期间，冠状动脉内注射rhPro-UK较替罗非班可有效改善患者冠状动脉微循环灌注、心功能，缩小心肌梗死面积，降低术后1个月MACE发生率，同时两组间出血事件差异无统计学意义。

关键词(KeyWords)： ST段抬高型心肌梗死;重组人尿激酶原;替罗非班;直接经皮冠状动脉介入治疗;Meta分析

Abstract:

Keywords:

基金项目(Foundation): 兰州大学第一医院院内基金项目（ZX-62000002-2021-346）

作者(Author): 杜淑珍,剡冬冬,张钲

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