尼可地爾對急性心肌梗死再灌注療效的Meta分析_《中國循證醫學雜志》

作者：

陳清杰 ¹ ,  楊毅寧 ¹ , 馬依彤 ¹ , 李曉梅 ¹ , 謝翔 ¹ , 于子翔 ¹ , 郭海 ²

1. 新疆醫科大學第一附屬醫院心臟中心冠心病科（烏魯木齊 830054）；2. 新疆醫科大學第一附屬醫院麻醉科（烏魯木齊 830054）;

關鍵詞：

尼可地爾急性心肌梗死再灌注 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20120208

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目的　系統評價尼可地爾對急性心肌梗死再灌注的療效，為合理制定急性心肌梗死治療方案提供高質量證據。
方法　計算機檢索The Cochrane Library（2012年第3期）、PubMed、EMbase、HighWire、CBM和CNKI數據庫，收集尼可地爾治療急性心肌梗死再灌注的隨機對照試驗，檢索時限截至2012年3月。由2位評價者按納入和排除標準獨立篩選文獻、提取資料并評價納入文獻方法學質量后，采用RevMan5.1軟件進行Meta分析。
結果　最終共納入11個研究，合計1 027例患者。Meta分析結果顯示：尼可地爾可降低急性心肌梗死再灌注后無復流或慢血流率［RR=0.34，95%CI（0.19，0.61），P=0.000 3］，提高心臟左室射血分數［MD=5.49，95%CI（4.51，6.47），P lt;0.000 01］，減小左室舒張末期容積［MD=–14.38，95%CI（–17.31，–11.45），P lt;0.000 01］，降低心臟不良事件發生率［RR=0.34， 95%CI（0.25，0.46），P lt;0.000 01］、再入院率［RR=0.33，95%CI（0.17，0.63），P=0.000 8］及病死率［RR=0.40，95%CI（0.16，0.97），P=0.04］。
結論　現有證據表明，尼可地爾作為輔助治療急性心肌梗死再灌注的藥物，可增加患者冠狀動脈微循環，改善患者預后，降低心臟不良事件發生率、再入院率及病死率。受納入研究數量和質量限制，上述結論尚需開展大樣本、高質量的RCT進一步論證，建議臨床醫生應根據患者具體情況合理采用治療策略。

引用本文： 陳清杰,楊毅寧,馬依彤,李曉梅,謝翔,于子翔,郭海. 尼可地爾對急性心肌梗死再灌注療效的Meta分析. 中國循證醫學雜志, 2012, 12(11): 1130-1138. doi: 10.7507/1672-2531.20120208 復制

1.	Kevelaitis E, Oubenaissa A, Peynet J, et al. Precon-ditioning by mitochondrial ATP-sensitive potassium channel openers: An effective approach for improving the preservation of heart trans-plants. Circulation, 1999, 100(19): 345-350.
2.	Mizumura T, Nithipatikom K, Gross GJ, et al. an ATP-sensitive potassium channel opener, mimics the effects of ischemic pre-conditioning to reduce infarct size, adenosine release, and neutron- phil function in dogs. Circulation, 1995, 92 (5): 1236-1245.
3.	Yao Z, Gross GJ. Activation of ATP-sensitive potassium channels lowers threshold for ischemic preconditioning in dogs. Am J Physiol, 1994, 267(5): 1888-1894.
4.	Matsuda N, Morgan KG, Sellke FW. Preconditioning improves car-dioplegia-related coronary microvascular smooth muscle hypercon-tractility: Role of KATP channels. J Thorac Cardiovasc Surg, 1999, 118(3): 438-445.
5.	Ren Z, Yang Q, Floten HS, et al. ATP-sen-sitive potassium channel opener may mimic the effects of hypoxic preconditioning on the coronary artery. Ann Thorac Surg, 2001, 71(2): 642-647.
6.	Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol, 1999, 33(3): 654-660.
7.	Kita M, Asakura M, Kim J, et al. Human atrial natriure ticpeptide and nicorandil as adjuncts to reperfusion treatment for acute myocardial infarction (J-WIND): Two randomised trials. Lancet, 2007, 370(9597): 1483-1493.
8.	Tadasu A, Katsuhiro S, Yoshihito I, et al. Continuous administration of nicorandil decreases QT dispersion during the chronic phase of acute myocardial infarction. Int Heart J, 2006, 47(3): 351-361.
9.	Fujiwara T, Matsunaga T, Kameda K, et al. Nicorandil suppresses the increases in plasma level of matrix metalloproteinase activity and attenuates left ventricular remodeling in patients with acute myocardial infarction. Heart Vessels, 2007, 22 (5): 303-309.
10.	Nameki M, Ishibashi I, Miyazaki Y, et al. Comparison between nicorandil and magnesium as an adjunct cardioprotective agent to percutaneous coronary intervention in acute anterior myocardial infarction. Circ J, 2004, 68(3): 192-197.
11.	Ono H, Osanai T, Ishizaka H, et al. Nicorandil improves cardiac function and clinical outcome in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: Role of inhibitory effect on reactive oxygen species formation. Am Heart J, 2004, 148(4): 15.
12.	Ishii H, Ichimiya S, Kanashiro M, et al. Impact of a single intravenous administration of nicorandil before reperfusion in patients with ST-segment-elevation myocardial infarction. Circulation, 2005, 112(9): 1284-1288.
13.	Ota S, Nishikawa H, Takeuchi M, et al. Impact of nicorandil to prevent reperfusion injury in patients with acute myocardial infarction: Sigmart Multicenter Angioplasty Revascularization Trial (SMART). Circ J, 2006, 70(9): 1099-1104.
14.	Lee HC, An SG, Choi JH, et al. Effect of intra-coronary nicorandil administration prior to reperfusion in acute ST segment elevation myocardial infarction. Circ J, 2008, 72(9): 1425-1429.
15.	王秀娟. 尼可地爾對急性心肌梗死患者短期預后的影響. 中國臨床醫學. 2009, 16(3): 344-345.
16.	Kobayashi Y, Goto Y, Daikoku S, et al. Cardioprotective effect of intravenous nicorandil in patients with successful reperfusion for acute myocardial infarction. Jpn Circ J, 1998, 62(3): 183-189.
17.	Ito H, TaniyamaY, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol, 1999, 33(3): 654-660.
18.	陳亞想, 陳山, 王金福, 等. 尼可地爾心臟缺血預處理聯合溶栓治療在急性心肌梗死中的近期療效觀察. 中國醫師進修雜志·綜合版. 2011, 34(13): 58-59.
19.	Dargie HJ, Ford I, Fox KM. Effect of nicorandil on coronary events in patients with stable angina: The Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet, 2002, 359(9314): 1269-1275.
20.	Horinaka S, Yabe A, Yagi H, et al. Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese coronary artery disease (JCAD) study. Circ J, 2010, 74(3): 503-509.
21.	Kasama S, Toyama T, Sumino H, et al. Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with ?rst acute myocardial infarction. J Nucl Med, 2007, 48(10): 1676-1682.
22.	Krumenacker M, Roland E. Clinical pro?le of nicorandil: an overview of its hemodynamic properties and therapeutic ef?cacy. J Cardiovasc Pharmacol, 1992, 20(3): 93-102.
23.	Ikeda N, Yasu T, Kubo N, et al. Nicorandil versus isosorbide dinitrate as adjunctive treatment to direct balloon angioplasty in acute myocardial infarction. Heart, 2004, 90(2): 181-185.
24.	Asakura M, Kitakaze M. Cardioprotection in the clinical setting-lessons from J-WIND studies. Cardiovasc Drugs Ther, 2010, 24(3): 289-295.

1. Kevelaitis E, Oubenaissa A, Peynet J, et al. Precon-ditioning by mitochondrial ATP-sensitive potassium channel openers: An effective approach for improving the preservation of heart trans-plants. Circulation, 1999, 100(19): 345-350.
2. Mizumura T, Nithipatikom K, Gross GJ, et al. an ATP-sensitive potassium channel opener, mimics the effects of ischemic pre-conditioning to reduce infarct size, adenosine release, and neutron- phil function in dogs. Circulation, 1995, 92 (5): 1236-1245.
3. Yao Z, Gross GJ. Activation of ATP-sensitive potassium channels lowers threshold for ischemic preconditioning in dogs. Am J Physiol, 1994, 267(5): 1888-1894.
4. Matsuda N, Morgan KG, Sellke FW. Preconditioning improves car-dioplegia-related coronary microvascular smooth muscle hypercon-tractility: Role of KATP channels. J Thorac Cardiovasc Surg, 1999, 118(3): 438-445.
5. Ren Z, Yang Q, Floten HS, et al. ATP-sen-sitive potassium channel opener may mimic the effects of hypoxic preconditioning on the coronary artery. Ann Thorac Surg, 2001, 71(2): 642-647.
6. Ito H, Taniyama Y, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol, 1999, 33(3): 654-660.
7. Kita M, Asakura M, Kim J, et al. Human atrial natriure ticpeptide and nicorandil as adjuncts to reperfusion treatment for acute myocardial infarction (J-WIND): Two randomised trials. Lancet, 2007, 370(9597): 1483-1493.
8. Tadasu A, Katsuhiro S, Yoshihito I, et al. Continuous administration of nicorandil decreases QT dispersion during the chronic phase of acute myocardial infarction. Int Heart J, 2006, 47(3): 351-361.
9. Fujiwara T, Matsunaga T, Kameda K, et al. Nicorandil suppresses the increases in plasma level of matrix metalloproteinase activity and attenuates left ventricular remodeling in patients with acute myocardial infarction. Heart Vessels, 2007, 22 (5): 303-309.
10. Nameki M, Ishibashi I, Miyazaki Y, et al. Comparison between nicorandil and magnesium as an adjunct cardioprotective agent to percutaneous coronary intervention in acute anterior myocardial infarction. Circ J, 2004, 68(3): 192-197.
11. Ono H, Osanai T, Ishizaka H, et al. Nicorandil improves cardiac function and clinical outcome in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: Role of inhibitory effect on reactive oxygen species formation. Am Heart J, 2004, 148(4): 15.
12. Ishii H, Ichimiya S, Kanashiro M, et al. Impact of a single intravenous administration of nicorandil before reperfusion in patients with ST-segment-elevation myocardial infarction. Circulation, 2005, 112(9): 1284-1288.
13. Ota S, Nishikawa H, Takeuchi M, et al. Impact of nicorandil to prevent reperfusion injury in patients with acute myocardial infarction: Sigmart Multicenter Angioplasty Revascularization Trial (SMART). Circ J, 2006, 70(9): 1099-1104.
14. Lee HC, An SG, Choi JH, et al. Effect of intra-coronary nicorandil administration prior to reperfusion in acute ST segment elevation myocardial infarction. Circ J, 2008, 72(9): 1425-1429.
15. 王秀娟. 尼可地爾對急性心肌梗死患者短期預后的影響. 中國臨床醫學. 2009, 16(3): 344-345.
16. Kobayashi Y, Goto Y, Daikoku S, et al. Cardioprotective effect of intravenous nicorandil in patients with successful reperfusion for acute myocardial infarction. Jpn Circ J, 1998, 62(3): 183-189.
17. Ito H, TaniyamaY, Iwakura K, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol, 1999, 33(3): 654-660.
18. 陳亞想, 陳山, 王金福, 等. 尼可地爾心臟缺血預處理聯合溶栓治療在急性心肌梗死中的近期療效觀察. 中國醫師進修雜志·綜合版. 2011, 34(13): 58-59.
19. Dargie HJ, Ford I, Fox KM. Effect of nicorandil on coronary events in patients with stable angina: The Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet, 2002, 359(9314): 1269-1275.
20. Horinaka S, Yabe A, Yagi H, et al. Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese coronary artery disease (JCAD) study. Circ J, 2010, 74(3): 503-509.
21. Kasama S, Toyama T, Sumino H, et al. Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with ?rst acute myocardial infarction. J Nucl Med, 2007, 48(10): 1676-1682.
22. Krumenacker M, Roland E. Clinical pro?le of nicorandil: an overview of its hemodynamic properties and therapeutic ef?cacy. J Cardiovasc Pharmacol, 1992, 20(3): 93-102.
23. Ikeda N, Yasu T, Kubo N, et al. Nicorandil versus isosorbide dinitrate as adjunctive treatment to direct balloon angioplasty in acute myocardial infarction. Heart, 2004, 90(2): 181-185.
24. Asakura M, Kitakaze M. Cardioprotection in the clinical setting-lessons from J-WIND studies. Cardiovasc Drugs Ther, 2010, 24(3): 289-295.

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