CAJ | 학술논문

目的：比较替罗非班经冠状动脉内注射与经静脉内注射在急性冠状动脉综合征（ACS）经皮冠状动脉介入治疗（PCI）中的疗效。方法计算机检索PubMed、EMBASE、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中国科技期刊数据库（VIP）、Cochrane图书馆，全面收集在ACS患者的治疗中，替罗非班冠状动脉内及静脉内给药初始剂量的随机对照研究。对纳入的研究进行资料提取后采用Cochrane协作网提供的RevMan5.2统计软件进行Meta分析。结果共收集25篇符合纳入标准的随机对照研究，共计2516例患者。Meta分析结果显示，与替罗非班静脉内给药（IV组）相比，冠状动脉内给予（IC组）替罗非班更能显著增加PCI术后TIMIⅢ级血流比率（RR 1.15，95％CI 1.07～1.23，P=0.0001）；PCI术后1周心脏超声评价两组左心室射血分数（LVEF）差异具有统计学意义，IC组LVEF较IV组平均增加2.69％（WMD 2.69，95％CI 0.14～5.25， P=0.04）；冠状动脉内给予替罗非班更能有效降低PCI术后30 d随访主要不良心血管事件（MACE）的发生率（RR 0.51，95％CI 0.38～0.69，P＜0.0001）。然而，PCI术后两组出血并发症发生率比较差异无统计学意义（RR 0.95，95％CI 0.76～1.19，P=0.64）。结论冠状动脉内给予替罗非班相比静脉内给予替罗非班更能有效增加冠状动脉血流和微血管灌注，能显著减少PCI术后随访30 d不良心血管事件的发生率，改善预后，且不增加出血风险。
목적：비교체라비반경관상동맥내주사여경정맥내주사재급성관상동맥종합정（ACS）경피관상동맥개입치료（PCI）중적료효。방법계산궤검색PubMed、EMBASE、중국생물의학문헌수거고（CBM）、중국기간전문수거고（CNKI）、중국과기기간수거고（VIP）、Cochrane도서관，전면수집재ACS환자적치료중，체라비반관상동맥내급정맥내급약초시제량적수궤대조연구。대납입적연구진행자료제취후채용Cochrane협작망제공적RevMan5.2통계연건진행Meta분석。결과공수집25편부합납입표준적수궤대조연구，공계2516례환자。Meta분석결과현시，여체라비반정맥내급약（IV조）상비，관상동맥내급여（IC조）체라비반경능현저증가PCI술후TIMIⅢ급혈류비솔（RR 1.15，95％CI 1.07～1.23，P=0.0001）；PCI술후1주심장초성평개량조좌심실사혈분수（LVEF）차이구유통계학의의，IC조LVEF교IV조평균증가2.69％（WMD 2.69，95％CI 0.14～5.25， P=0.04）；관상동맥내급여체라비반경능유효강저PCI술후30 d수방주요불양심혈관사건（MACE）적발생솔（RR 0.51，95％CI 0.38～0.69，P＜0.0001）。연이，PCI술후량조출혈병발증발생솔비교차이무통계학의의（RR 0.95，95％CI 0.76～1.19，P=0.64）。결론관상동맥내급여체라비반상비정맥내급여체라비반경능유효증가관상동맥혈류화미혈관관주，능현저감소PCI술후수방30 d불양심혈관사건적발생솔，개선예후，차불증가출혈풍험。
Objective To compare the effect of intracoronary versus intravenous administration of tiroifban for acute coronary syndrome (ACS) patients during percutaneous coronary intervention (PCI). Methods A search was retrieved from Pubmed, EMbase, Chinese Biomedical Literature Database (CBM), Chinese Journal Full-text Database (CNKI), Chinese Science and Technology Periodical Database (VIP), Cochrane Library to systematically collect the randomized controlled trials of intracoronary versus intravenous administration of tirofiban for the patients with ACS undergoing PCI. The data was extracted from the included studies and analyzed by Cochrane Collaboration's RevMan5.2 software. Results Twenty-five studies involving 2516 patients met the inclusion criteria. The results of meta-analysis showed that thrombolysis in myocardial infarction (TIMI) grade 3 lfow (RR 1.15, 95%CI 1.07-1.23, P=0.0001) were signiifcantly more often achieved in the patients by intracoronary administration of tiroifban (IC group) than those by intravenous strategy (IV group). Left ventricular ejection fraction (LVEF) values in a week after PCI which were evaluated by Cardiac Ultrasound were statistically significant between the two groups (WMD 2.69, 95%CI 0.14-5.25, P=0.04). LVEF values in IC group were increased by an average of 2.69% compared with group IV. Intracoronary administration resulted in a reduced incidence of major adverse cardiovascular events (MACE) at 30-day follow-up (RR 0.51, 95%CI 0.38-0.69, P < 0.0001). However, the incidence of bleeding complications was not statistically signiifcant between the two groups (RR 0.95, 95% CI 0.76-1.19, P=0.64). Conclusions Compared with intravenous strategy, intracoronary administration of tiroifban can be more effective in increasing coronary blood lfow and microvascular perfusion, more signiifcantly in reducing the incidence of MACE at 30-day follow-up and improving the prognosis after PCI without increasing the risk of bleeding.