微循环学杂志
微循環學雜誌
미순배학잡지
Chinese Journal of Microcirculation
2015年
4期
50-56
,共7页
蒋小波%杨帆%陈刚%韩乾国
蔣小波%楊帆%陳剛%韓乾國
장소파%양범%진강%한건국
Xa 因子抑制剂%急性冠脉综合征%疗效%安全性
Xa 因子抑製劑%急性冠脈綜閤徵%療效%安全性
Xa 인자억제제%급성관맥종합정%료효%안전성
Xa inhibitors%Acute coronary syndrome%Efficacy%Safety
目的：：评价 Xa 因子(FXa)抑制剂对急性冠脉综合征(ACS)的疗效及安全性。方法：计算机检索 Co-chrane Central Register of Controlled Trials、MEDLINE、EMbase、万方数据、中国知网数据库、中国生物医学文献数据库及维普数据库从建库至今有关 FXa 抑制剂对 ACS 患者疗效及安全性的临床随机对照试验(RCT)。由3名研究者进行文献提取和质量评价,对符合纳入标准的研究采用 Review 5.1软件进行偏倚定性和 Meta 分析。结果：共纳入6篇 RCT,均采用随机、双盲、安慰剂对照组,且数据完整,非选择性结果报道为低偏倚风险。Meta 分析结果显示,低、中、高剂量 FXa 抑制剂均不能降低 ACS 患者全因死亡风险[RR=0.92,95%CI(0.80,1.07)；RR=0.95,95%CI(0.48,1.87)；RR=0.97,95%CI(0.38,2.52)]；仅低剂量 FXa 抑制剂可以降低 ACS 患者再发心肌梗死风险[RR=0.87,95%CI(0.77,0.98)]；FXa 抑制剂不能明显降低 ACS 患者缺血性卒中风险[RR=0.98,95%CI (0.74,1.31)]；低、中、高剂量 FXa 抑制剂均可增加 ACS 患者主要出血事件风险[RR=2.31,95%CI(1.66,3.21)；RR=6.69,95%CI(2.73,16.43)；RR=6.23,95%CI(2.75,14.14)]。结论：低剂量 FXa 抑制剂治疗 ACS 患者可以降低再发心肌梗死风险；FXa 联合抗血小板药物治疗 ACS 对降低患者全因死亡、缺血性卒中和主要出血事件风险与既往抗血小板治疗比较并无明显优势。
目的：：評價 Xa 因子(FXa)抑製劑對急性冠脈綜閤徵(ACS)的療效及安全性。方法：計算機檢索 Co-chrane Central Register of Controlled Trials、MEDLINE、EMbase、萬方數據、中國知網數據庫、中國生物醫學文獻數據庫及維普數據庫從建庫至今有關 FXa 抑製劑對 ACS 患者療效及安全性的臨床隨機對照試驗(RCT)。由3名研究者進行文獻提取和質量評價,對符閤納入標準的研究採用 Review 5.1軟件進行偏倚定性和 Meta 分析。結果：共納入6篇 RCT,均採用隨機、雙盲、安慰劑對照組,且數據完整,非選擇性結果報道為低偏倚風險。Meta 分析結果顯示,低、中、高劑量 FXa 抑製劑均不能降低 ACS 患者全因死亡風險[RR=0.92,95%CI(0.80,1.07)；RR=0.95,95%CI(0.48,1.87)；RR=0.97,95%CI(0.38,2.52)]；僅低劑量 FXa 抑製劑可以降低 ACS 患者再髮心肌梗死風險[RR=0.87,95%CI(0.77,0.98)]；FXa 抑製劑不能明顯降低 ACS 患者缺血性卒中風險[RR=0.98,95%CI (0.74,1.31)]；低、中、高劑量 FXa 抑製劑均可增加 ACS 患者主要齣血事件風險[RR=2.31,95%CI(1.66,3.21)；RR=6.69,95%CI(2.73,16.43)；RR=6.23,95%CI(2.75,14.14)]。結論：低劑量 FXa 抑製劑治療 ACS 患者可以降低再髮心肌梗死風險；FXa 聯閤抗血小闆藥物治療 ACS 對降低患者全因死亡、缺血性卒中和主要齣血事件風險與既往抗血小闆治療比較併無明顯優勢。
목적：：평개 Xa 인자(FXa)억제제대급성관맥종합정(ACS)적료효급안전성。방법：계산궤검색 Co-chrane Central Register of Controlled Trials、MEDLINE、EMbase、만방수거、중국지망수거고、중국생물의학문헌수거고급유보수거고종건고지금유관 FXa 억제제대 ACS 환자료효급안전성적림상수궤대조시험(RCT)。유3명연구자진행문헌제취화질량평개,대부합납입표준적연구채용 Review 5.1연건진행편의정성화 Meta 분석。결과：공납입6편 RCT,균채용수궤、쌍맹、안위제대조조,차수거완정,비선택성결과보도위저편의풍험。Meta 분석결과현시,저、중、고제량 FXa 억제제균불능강저 ACS 환자전인사망풍험[RR=0.92,95%CI(0.80,1.07)；RR=0.95,95%CI(0.48,1.87)；RR=0.97,95%CI(0.38,2.52)]；부저제량 FXa 억제제가이강저 ACS 환자재발심기경사풍험[RR=0.87,95%CI(0.77,0.98)]；FXa 억제제불능명현강저 ACS 환자결혈성졸중풍험[RR=0.98,95%CI (0.74,1.31)]；저、중、고제량 FXa 억제제균가증가 ACS 환자주요출혈사건풍험[RR=2.31,95%CI(1.66,3.21)；RR=6.69,95%CI(2.73,16.43)；RR=6.23,95%CI(2.75,14.14)]。결론：저제량 FXa 억제제치료 ACS 환자가이강저재발심기경사풍험；FXa 연합항혈소판약물치료 ACS 대강저환자전인사망、결혈성졸중화주요출혈사건풍험여기왕항혈소판치료비교병무명현우세。
Objective:To evaluate the efficacy and the safety of factor Xa inhibitor in patients with acute cort-nary syndrome(ACS).Method:Cochrane Central Register of Controlled Trials,Medline,Embase,CNKI,Wanfang and VIP Data were searched for the RCTs of factor Xa inhibitor in patients with ACS from the date of 1 997 to 201 5. The included studies were evaluated and extracted by two researchers independently.The statistical analyses were performed by Review5.1.Results:A total of 6 articles,taking random and double-blind way,having placebo control group and complete statistic,were identified.The non-selected analysis found then were low bias risk.Meta analy-sis showed that the Xa inhibitor from low-dose to high-dose can't decrease the all-cause mortally risk in ACS patients [RR=0.92,95%CI(0.80,1.07)],[RR=0.95,95%CI(0.48,1.87)],[RR=0.97,95%CI(0.38,2.52)].Meta analysis showed that low-dose Xa inhibitor decrease the risk of myocardial infarction (MI)with ACS[RR=0.87, 95%CI(0.77,0.98)]and Xa inhibitor can't significantly decrease the risk of ischemic stroke in ACS patients[RR=0.98,95%CI (0.74,1.31)].Xa inhibitor from low-dose to high-dose increase the risk of major bleeding in ACS pa-tients [RR=2.31,95% CI(1.66,3.21 )],[RR = 6.69,95% CI (2.73,1 6.43 )],[RR = 6.23,95% CI (2.75, 14.14)].Conclusion:Low-dose Xa inhibitor could prevent incidence of MI in ACS patients.Compared to the tradi-tional antiplatelet therapy,the combined therapy of Xa inhibitor and anti-platelet agent can not have an advantage in decreasing the risk of all-cause mortally,ischemic stroke and major bleeding.
