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目的:系统评价阿替普酶初始溶栓序贯抗凝治疗老年急性次大面积肺栓塞(ASPE)的疗效与安全性。方法:检索中国知网、维普数据、中国生物医学文献数据库、万方数据、Medline、Embase、PubMed、The Cochrane Library、Clinical Trials，收集阿替普酶溶栓序贯抗凝对比单纯抗凝治疗ASPE的随机对照试验。检索时间为建库至2020年2月，2名评价者进行筛选文献、提取资料、质量评价后采用Review Manager 5.3软件进行meta分析。结果:最终纳入研究21个，总样本量1 602例。meta分析结果显示，与单纯抗凝相比，溶栓序贯抗凝有更好的治疗效果(n OR＝5.87，95%n CI：3.82～9.01，n P<0.000 01)，患者肺栓塞复发率(n OR＝0.36，95%n CI：0.16～0.80，n P＝0.01)和死亡率(n OR＝0.46，95%n CI：0.24～0.86，n P＝0.02)更低，但会增加出血概率(n OR＝1.65，95%n CI：1.21～2.24，n P＝0.001)，颅内出血发生率2种疗法差异无统计学意义(n OR＝0.77，95%n CI：0.21～2.77，n P＝0.69)。亚组分析还显示欧美人群接受阿替普酶序贯抗凝治疗后复发率更低(n OR＝0.34，95%n CI：0.14～0.83，n P＝0.02)，亚裔患者差异却无统计学意义，亚欧患者在死亡率、致命性出血率方面差异均无统计学意义。n 结论:阿替普酶初始溶栓序贯抗凝治疗可降低老年ASPE患者死亡率和复发率，尽管溶栓治疗会增加出血风险，但中远期的疗效仍优于抗凝。“,”Objective:To systematically evaluate the efficacy and safety of initial thrombolysis with alteplase and sequential anticoagulation in the treatment of acute submassive pulmonary embolism (ASPE) in the elderly.Methods:All randomized controlled trials on alteplase thrombolytic sequential anticoagulation versus anticoagulation for ASPE were collected from China National Knowledge Infrastructure, Chongqing VIP database, Chinese Biology Medicine database, Wanfang database, Medline, Embase, PubMed, The Cochrane Library, and Clinical Trials.Two reviewers screened the literatures from the database construction to February 2020, extracted data, and assessed the methodological quality of included studies.And then meta-analysis was conducted using Review Manager 5.3 software.Results:Twenty-one studies were included, with a total sample size of 1 602 patients.Compared with the anticoagulation, alteplase thrombolytic sequential anticoagulation showed a better efficacy (n OR=5.87, 95%n CI: 3.82-9.01, n P<0.000 01), lower recurrence rate of pulmonary embolism (n OR=0.36, 95%n CI: 0.16-0.80, n P=0.01) and mortality (n OR=0.46, 95%n CI: 0.24-0.86, n P=0.02), increased bleeding risk(n OR=1.65, 95%n CI: 1.21-2.24, n P=0.001). There was no statistical difference in the intracranial hemorrhage between two treatments (n OR=0.77, 95%n CI: 0.21-2.77, n P=0.69). The subgroup analysis showed that the recurrence rate after sequential anticoagulant therapy with alteplase was lower in the European and American population (n OR=0.34, 95%n CI: 0.14-0.83, n P=0.02), but there was no statistical difference in the Asian patients.There was no statistical difference in the mortality rate and fatal bleeding rate in the Asian and European patients.n Conclusions:The initial thrombolysis with alteplase and sequence anticoagulation can reduce the mortality and recurrence rate of elderly ASPE patients.Although thrombolytic therapy can increase the risk of bleeding, the medium and long-term efficacy is still superior to anticoagulation.