2018 年第 9 期 第 13 卷

比伐卢定对比肝素应用于ST段抬高型心肌梗死患者有效性和安全性的Meta分析

Efficacy and safety of bivalirudin versus heparin in patients with ST-segment elevation myocardial infarction: a meta analysis

作者：刘成君李瑞莲

英文作者：

单位：810001西宁，青海省药品采购中心供应监督科（刘成君）；810000西宁，青海大学医学院药理教研室（李瑞莲）

英文单位：

关键词：ST段抬高型心肌梗死；比伐卢定；肝素

英文关键词：

• 摘要：

• 【摘要】目的    系统评价比伐卢定对比肝素应用于ST段抬高型心肌梗死（STEMI）患者的有效性和安全性。方法    采用计算机检索结合手工检索的方法，搜索中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBMdisc）、万方数据库、维普中文科技期刊数据库和PubMed， Cochrane Library， Embase外文数据库关于比伐卢定对比肝素应用于STEMI行经皮冠状动脉介入治疗患者的相关临床研究文文献，检索时间为建库至2017年6月。采用RevMan 5.1软件进行Meta分析。结果    共纳入5篇文献6项随机对照试验研究数据，包括10 740例患者，其中比伐卢定组5 375例，肝素组5 365例。Meta分析结果显示，应用比伐卢定较肝素能够明显降低长期死亡率(风险比＝0.71，95%置信区间：0.54～0.93，P＝0.01，I2＝0%)、短期(风险比＝0.64，95%置信区间：0.42～0.97，P＝0.04，I2＝75%)和长期(风险比＝0.44，95%置信区间：0.23～0.84，P＝0.01，I2＝50%)出血事件发生率。但比伐卢定组短期再发心肌梗死率高于肝素组(风险比＝1.47，95%置信区间：1.10～1.96，P＝0.008，I2＝34%)。结论    比伐卢定较肝素能够明显降低短期和长期出血事件发生率以及长期死亡率，但升高了短期再发心肌梗死率。

• 【Abstract】Objective    To evaluate the efficacy and safety of bivalirudin and heparin in patients with ST-elevation myocardial infarction（STEMI）. Methods    Literatures of clinical randomized controlled trails of bivalirudin versus heparin treating STEMI patients during percutaneous coronary intervention published before June 2017 on China National Knowledge Infrastructure(CNKI), CBMdisc, Wanfang, VIP, PubMed, Cochrane Library and Embase were searched by computer and manual review. The RevMan 5.1 software was used for meta analysis. Results    Five literatures of 6 randomized controlled trials were included; 10 740 patients were included in total, with 5 375 patients in bivalirudin group and 5 365 patients in heparin group. Results     of meta analysis showed that the long-term death rate(risk ratio＝0.71, 95% confidence interval: 0.54-0.93， P＝0.01， I2＝0%), short-term hemorrhage rate(risk odds ratio＝0.64, 95% confidence interval: 0.42-0.97， P＝0.04， I2＝75%) and long-term hemorrhage rate(risk ratio＝0.44, 95% confidence interval: 0.23-0.84， P＝0.01， I2＝50%) in bivalirudin group were significantly lower than those in heparin group. However, the short-term recurrent myocardial infarction rate in bivalirudin group was significantly higher than that in heparin group(risk ratio＝1.47, 95% confidence interval: 1.10-1.96， P＝0.008， I2＝34%). Conclusion    Bivalirudin can reduce short- and long-term hemorrhage and long-term mortality but increase short-term recurrent myocardial infarction compared with heparin.