ObjectivesTo systematically review the risk of arterial ischemic and metabolic adverse events in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect clinical trials, observational studies and case reports of adverse events in CML patients treated with TKIs from inception to February 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 22 studies involving 4 223 patients were included. The incidence rates of ischemic heart disease in any grade were 2 per 100 patient-years (95%CI 2 to 3) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 3) for imatinib. The incidence of ischemic heart disease in grade 3 or 4 was 1 per 100 patient-years (95%CI 0 to 2) for nilotinib. The incidence of peripheral arterial occlusive disease in any grade was 2 per 100 patient-years (95%CI 0 to 14) for nilotinib, and 0 per 100 patient-years (95%CI 0 to 2) for imatinib. The incidence of hypertension in any grade was 1 per 100 patient-years (95%CI 0 to 3) for nilotinib, and 44 per 100 patient-years (95%CI 27 to 71) for ponatinib. The incidence of hypertension in grade 3 or 4 was 2 per 100 patient-years (95%CI 0 to 15) for nilotinib, and 22 per 100 patient-years (95%CI 8 to 58) for ponatinib. The incidence of hyperlipidemia in any grade was 17 per 100 patient-years (95%CI 5 to 59) for nilotinib. The incidence of hyperglycemia in any grade was 11 per 100 patient-years (95%CI 9 to 15) for nilotinib, 2 per 100 patient-years (95%CI 1 to 4) for imatinib, 1 per 100 patient-years (95%CI 0 to 5) for dasatinib, and 19 per 100 patient-years (95%CI 19 to 20) for bosutinib. The incidence of hyperglycemia in grade 3 or 4 was 4 per 100 patient-years (95%CI 3 to 5) for nilotinib, and 1 per 100 patient-years (95%CI 1 to 2) for bosutinib.ConclusionsPatients treated with nilotinib have a greater possibility of ischemic heart and peripheral arterial occlusive disease compared with patients treated with imatinib. Patients treated with ponatinib have a high incidence rate of hypertension, and patients treated with nilotinib have a high incidence rate of hyperlipidemia. Patients treated with bosutinib and nilotinib have higher risk of hyperglycemia compared with patients treated with imatinib or dasatinib.
目的 總結冠心病行不停跳冠狀動脈旁路移植術（OPCAB）中，右冠狀動脈突發急性缺血事件的處理經驗。 方法 2010 年 5 月至 2015 年 5 月我院共行 OPCAB 1 568 例，術中出現右冠狀動脈急性缺血事件 22 例，其中男 16 例、女 6 例，年齡（66.5±9.7）歲。 結果 11 例患者于緊急右冠狀動脈旁路移植術后、開放橋血管后 ST 段可以逐漸恢復正常，右心功能恢復，心律失常明顯減少或消失。2 例患者右冠狀動脈旁路移植后仍有右心功能不全表現，但經積極藥物處理以及主動脈內球囊反搏（IABP）應用后逐步脫離危險期。1 例患者術后循環仍不穩定，最終于術后 2 d 死亡。總死亡率 4.5%。發生圍術期心肌梗死 6 例，全組患者 IABP 應用 3 例。 結論 OPCAB 術中右冠狀動脈突發缺血事件更多表現為心律失常，發生率雖低，但在無雜交手術室的情況下能夠及時判斷并正確處理右冠狀動脈突發急性缺血事件至關重要，對患者術后及預后都有較積極的影響。