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浙江大学学报（医学版）
浙江大学学报（医学版）  2017, Vol. 46 Issue (3): 305-314    DOI: 10.3785/j.issn.1008-9292.2017.06.14
meat分析     
不同药物洗脱支架对冠状动脉小血管病变患者预后影响的meta分析
张晓群, 王启闻, 汪欣, 徐肖磊, 朱建华
浙江大学医学院附属第一医院心脏介入中心, 浙江 杭州 310003
Comparison of limus-eluting stent with paclitaxel-eluting stent for patients with coronary small vessel disease:a systematic review and meta-analysis
ZHANG Xiaoqun, WANG Qiwen, WANG Xin, XU Xiaolei, ZHU Jianhua
Cardiac Intervention Center, the First Affiliate Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
 全文: PDF(3622 KB)  
摘要：

目的：比较莫司类药物洗脱支架（LES）与紫杉醇洗脱支架（PES）在冠状动脉小血管病变患者中的疗效。方法：通过PubMed、Web of Science、ClinicalTrials、中国生物医学文献数据库、中国知网、万方数据和维普数据库对与本次研究主题相关的文献进行检索，对纳入的文献进行方法学质量评价。采用RevMan 5.2及Stata 14.0软件进行相关的统计学分析。结果：八项研究共4738例患者纳入此研究。与PES比较，植入LES能减少主要心血管不良事件（RR=0.64，95%CI：0.53~0.77，Z=4.59，P<0.01）、心肌梗死（RR=0.61，95%CI：0.45~0.82，Z=3.24，P<0.01）、支架内血栓（RR=0.22，95%CI：0.13~0.37，Z=5.71，P<0.01）以及靶病变血运重建（RR=0.56，95%CI：0.44~0.71，Z=4.72，P<0.01）的发生率。与PES比较，LES不能减少心因性死亡（RR=1.08，95%CI：0.62~1.88，Z=0.26，P>0.05）和靶血管血运重建事件的发生率（RR=0.80，95%CI：0.45~1.44，Z=0.74，P>0.05）。结论：对于冠状动脉小血管病变行经皮冠脉介入支架植入术的患者，LES较PES有更好的长期疗效，可作为该类患者的首选支架。
关键词： 冠状动脉疾病/治疗;  冠状动脉疾病/病理学;  西罗莫司/治疗应用;  西罗莫司/类似物和衍生物;  紫杉酚/治疗应用;  药物洗脱支架;  预后;  meta分析    
Abstract:

Objective:To compare the efficacy of limus-eluting stent (LES) with paclitaxel-eluting stent (PES) for patients with coronary small vessel disease. Methods:The studies of LES and PES used for patients with coronary small vessel disease were searched in PubMed, Web of Science, ClinicalTrials, SinoMed, CNKI, Wanfang data and CQVIP. The relative risk (RR) estimates with 95% confidence intervals and other statistical variables were calculated with Stata 14.0, and the meta analysis was performed with RevMan 5.2. Results:Eight studies involving 4738 patients were included in the meta-analysis. Compared with PES, LES implantation was associated with significant reduction in major adverse cardiovascular events (RR=0.64, 95% CI:0.53-0.77, Z=4.59, P<0.01), myocardial infarction (RR=0.61, 95% CI:0.45-0.82; Z=3.24, P<0.01), stent thrombosis (RR=0.22, 95% CI:0.13-0.37, Z=5.71, P<0.01), and target lesion revascularization (RR=0.56, 95% CI:0.44-0.71, Z=4.72, P<0.01), while no difference was observed in cardiac death (RR=1.08, 95% CI:0.62-1.88, Z=0.26, P>0.05) and target vessel revascularization(RR=0.80, 95% CI:0.45-1.44, Z=0.74, P>0.05). Conclusion:LES has better efficacy than PES for patients with coronary small vessel disease, which may be the preferred stents for these patients.
Key words: Coronary artery disease/therapy    Coronary artery disease/pathology    Sirolimus/therapeutic use    Sirolimus/analogs &    derivatives    Paclitaxel/therapeutic use    Drug-eluting stents    Prognosis    Meta-analysis
收稿日期: 2017-06-05 出版日期: 2017-06-25
CLC:  R541.4  
基金资助:

浙江省医药卫生科技计划（2017KY357）
通讯作者: 朱建华(1955-),男,硕士,教授,博士生导师,主要从事动脉粥样硬化发病机制和临床介入治疗、干细胞血管生物学研究;E-mail:zjh_john2017@zju.edu.cn     E-mail: zjh_john2017@zju.edu.cn
作者简介: 张晓群(1969-),女,学士,主管护师,主要从事心脏介入临床护理和管理工作及研究;E-mail:1187055@zju.edu.cn
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引用本文:

张晓群 等. 不同药物洗脱支架对冠状动脉小血管病变患者预后影响的meta分析[J]. 浙江大学学报（医学版）, 2017, 46(3): 305-314.

ZHANG Xiaoqun, WANG Qiwen, WANG Xin, XU Xiaolei, ZHU Jianhua. Comparison of limus-eluting stent with paclitaxel-eluting stent for patients with coronary small vessel disease:a systematic review and meta-analysis. Journal of ZheJiang University(Medical Science), 2017, 46(3): 305-314.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2017.06.14    或    http://www.zjujournals.com/xueshu/med/CN/Y2017/V46/I3/305

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