中国循证医学杂志

中国循证医学杂志

极化液对急性心肌梗死患者心功能影响的系统评价

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目的 系统评价极化液对急性心肌梗死(AMI)患者心功能的影响。
方法 计算机检索 PubMed、EMbase、Cochrane 图书馆(2007 年第 4 期)、中国生物医学文献光盘数据库等,纳入极化液治疗 AMI 的临床随机对照试验(RCT),评价极化液治疗后患者心功能(左室射血分数、ST 段变化、左室重塑)的变化。由两名评价员独立选择试验和提取资料,并按照Cochrane 系统评价员手册的 4 条质量评价标准评价纳入文献的方法学质量,而后应用 RevMan 4.2.10 软件进行 Meta 分析。
结果 共纳入 5 个 RCT,研究地点均在国外,研究质量均较高,各试验间具有基线可比性。Meta分析结果显示:极化液治疗组较生理盐水对照组对左室射血分数的改善无差异 [WMD=1.87,95%CI(-0.32, 4.06),P=0.09],但极化液明显有助于 ST段的下降[OR=1.92, 95%CI(1.25, 2.96),P=0.003]和阻遏心肌重构的发生 [OR=0.08,95%CI(0.01,0.68),P=0.02]。
结论 现有的证据表明,尽管极化液在一定程度上有利于 AMI 患者 ST 段的下降及远期预后,但尚不能得出极化液能改善 AMI 患者心功能的结论。今后有必要实施重点关注极化液使用时间的更为严格的大型RCT,以充分论证极化液对AMI的治疗作用。

Objective To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction (AMI).
Methods Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis.
Results Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02).
Conclusion Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.

关键词: 极化液; 心肌梗死; 心功能; 随机对照试验; 系统评价

Key words: Glucose-insulin-potassium; Myocardial infarction; Heart function; Randomized controlled trial; Systematic Review

引用本文: 杨朝辉,杨克虎,马彬,尹少甫. 极化液对急性心肌梗死患者心功能影响的系统评价. 中国循证医学杂志, 2008, 08(2): 97-101. doi: 10.7507/1672-2531.20080025 复制

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1. 高润霖. 急性心肌梗死诊断和治疗指南.中华心血管病杂志, 2001, 29(12): 711.
2. Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛宁, 译. 中国循证医学杂志, 2004, 4(6): 426.
3. Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4. Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5. Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6. Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7. Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8. Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9. Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10. Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11. Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12. Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13. Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14. Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15. Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16. Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17. Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19. Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.